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Japanese Journal of Clinical Oncology Advance Access originally published online on June 26, 2009
Japanese Journal of Clinical Oncology 2009 39(8):523-527; doi:10.1093/jjco/hyp051
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© The Author (2009). Published by Oxford University Press. All rights reserved

Pedunculated Polyp of Early Sigmoid Colon Cancer with Invasive Micropapillary Carcinoma

Hiroshi Sonoo1, Masao Kameyama1, Naoki Inatugi2, Akitaka Nonomura3 and Yasunori Enomoto3

1 Department of Surgery, Bell Land General Hospital, Osaka
2 Center of Coloproctology, Dongo Hospital
3 Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan

For reprints and all correspondence: Hiroshi Sonoo, Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai-city, Osaka 599-8247, Japan. E-mail: h_sonoo{at}seichokai.or.jp

Received June 23, 2008; accepted April 10, 2009

A 64-year-old man was admitted to Dongo Hospital (Nara, Japan) with colonic cancer, following the onset of abdominal pain, diarrhea and fever. A pedunculated polyp was detected in the sigmoid colon by colonoscopy, and laparoscopy-assisted sigmoidectomy with regional lymph node resection was performed. Histopathologically, the tumor exhibited massive invasion of the submucosa, and multiple lymph node metastases were detected. The tumor mainly consisted of a micropapillary component. Immunohistochemically, MUC1 was expressed at the stromal edge of the micropapillary component and showed the characteristic ‘inside-out’ pattern of a micropapillary carcinoma. The multiple lymph node metastases were predominantly composed of carcinoma with a micropapillary pattern. Our case suggests that when a micropapillary component is identified in a pre-operative biopsy specimen, even for a pedunculated early colorectal cancer, the extent of surgical resection should be carefully considered due to the high potential for nodal metastasis.

Key Words: micropapillary carcinoma • early colonic cancer • lymph node metastasis


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