| Theme | Problems of endoscopic mucosal resection in colorectal neoplasia | |
|---|---|---|
| Title | Local recurrence of adenomas and carcinomas of the colon and rectum after polypectomy and EMR | |
| Publish Date | 1999/01 | |
| Author | Tsutomu Ishikawa | Department of Diagnostic Radiology, Tochigi Cancer Center |
| [ Summary ] | We analyzed 11 local recurrent cases (12 lesions) of colorectal adenomas and/or carcinomas, after polypectomy and endoscopic mucosal resection (EMR), in the National Cancer Center Hospital. Their histological findings from the initial polypectomy and EMR were adenomas ; four lesions, cancers in adenomas ; five lesions, and submucosal cancers ; three lesions. As for the macroscopical difference between the initial lesion and the recurrent one in the cases of adenoma and cancer in adenoma, three out of five type Ip lesions were recognized as type Is, type IIa and those with nodule-aggregating appearance at recurrence, and one type Is lesion as type IIa, one nodule-aggregating lesion as a nodule. Accordingly, recurrent lesions were supposed to have a tendency to become short, compared with their initial height before polypectomy. Also, converging folds and ulcer scars were considered to be characteristic. Histologically, two out of the four adenomas changed to cancers in adenoma, and four out of the five cancers in adenoma became adenomas at recurrence. Those which changed to submucosal invasive cancers and advanced cancers were not found among the nine lesions. In the three polypectomized cases of submucosal cancer (sm ca), advanced cancers were found at the same site as the initial lesion on the sixth and seventh follow-up examinations. Endoscopically, and radiographically, no abnormal finding was recognized on the mucosal surface until then. Two cases of three sm ca, revealed X-ray and endoscopical findings similar to a submucosal tumor at recurrence. |
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