早期直肠癌内镜下粘膜下剥离后复发为肿瘤沉积。

IF 0.9 Q4 GASTROENTEROLOGY & HEPATOLOGY
Clinical Journal of Gastroenterology Pub Date : 2025-08-01 Epub Date: 2025-06-23 DOI:10.1007/s12328-025-02160-9
Takaaki Yoshikawa, Momoko Iketani, Atsushi Yamauchi, Sonoka Katsuyama, Sota Nakagami, Kenshiro Hirohashi, Shujiro Yazumi
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引用次数: 0

摘要

我们在结肠镜(CS)下发现了一个15mm, 0-IIa + IIc的直肠乙状结肠息肉,并对其进行了内镜下粘膜剥离(ESD)。组织病理标本显示为高分化腺癌,T1b (SM2, 2000 μm)、Ly0、v0、BD1、pHM0、pVM0。尽管采用了SM-deep侵袭的非治愈性切除,患者还是选择了对比增强计算机断层扫描和CS仔细随访。在ESD术后3年半首次在左侧直肠下部发现结节。由于其逐渐增大,我们判断为局部复发淋巴结转移,并在ESD后5年行了进一步手术。病理结果显示结节为肿瘤沉积(TD)的局部复发。切除输尿管输尿管一年后,发现有肺转移,手术切除。如果ESD完成了T1b结直肠癌的完全切除,而深部粘膜下浸润是唯一无法治愈的切除因素,则可以选择随访而不是额外的手术切除。然而,应考虑仔细随访,因为包括TD在内的复发可能在ESD后数年发生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Recurrence as a tumor deposit after endoscopic submucosal dissection of early rectal cancer.

We found a 15 mm, 0-IIa + IIc polyp in the rectosigmoid with colonoscopy (CS), and performed endoscopic submucosal dissection (ESD) for it. The histopathologic specimen revealed that it was well-differentiated adenocarcinoma, T1b (SM2, 2000 μm), Ly0, v0, BD1, pHM0, and pVM0. Despite the non-curative resection with SM-deep invasion, the patient chose careful follow-up with contrast-enhanced computed tomography and CS. A nodule was first detected on the left side just out of the lower rectum 3 and a half years after ESD. Since it enlarged gradually, we judged that it was local recurrence in form of lymph-node metastasis and performed additional surgery 5 years after ESD. Pathological findings disclosed that the nodule was local recurrence as a tumor deposit (TD). One year after TD resection, lung metastasis was additionally founded and was resected surgically. If ESD accomplishes complete resection for T1b colorectal cancer and deep submucosal invasion is the only factor of non-curative resection, follow-up may be chosen instead of additional surgical resection. However, careful follow-up should be considered, because recurrence including TD may happen several years after ESD.

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来源期刊
Clinical Journal of Gastroenterology
Clinical Journal of Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
2.00
自引率
0.00%
发文量
182
期刊介绍: The journal publishes Case Reports and Clinical Reviews on all aspects of the digestive tract, liver, biliary tract, and pancreas. Critical Case Reports that show originality or have educational implications for diagnosis and treatment are especially encouraged for submission. Personal reviews of clinical gastroenterology are also welcomed. The journal aims for quick publication of such critical Case Reports and Clinical Reviews.
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