Yonsei Med J.  2007 Feb;48(1):135-138. 10.3349/ymj.2007.48.1.135.

Depressed-Type of Early Colon Cancer with Extensive Lymph Node Metastasis

• Kim SA
• Lee JH
• Park SY
• Kim HG
• Kim TI
• Kim WH

• KMID: 1093536
• DOI: http://doi.org/10.3349/ymj.2007.48.1.135

Abstract

Early colorectal cancer (ECC) is defined as invasive tumor limited to the colonic and rectal mucosa or submucosa, regardless of the presence or absence of lymph node metastasis. The incidence of lymph node metastasis in ECC ranges from 0 to 15.4%, and risk factors include depth of submucosal invasion, growth patterns (polypoid or non-polypoid), histologic subclassification, and lymphatic invasion. Of non-polypoid growth patterns, the depressed types of colorectal cancer have higher malignant potential than polypoid types, even for small sizes. Unfortunately, this type is also difficult to detect on colonoscopic examination. In this report, we describe a case of depressed type ECC with extensive lymph node metastasis without regional lymph node involvement.

Keyword

Early colorectal cancer; depressed type; lymph node metastasis

Figure

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  Fig. 1 Colonoscopic findings; indigo carmine contrast spray demonstrates a 1.0cm sized, flat, depressed lesion with distinct margins and marginal elevation.

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  Fig. 2 Abdominal CT (computed tomography) shows questionable wall thickening in proximal T-colon without gross mesocolic extension but with left paraaortic lymph node enlargement.

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  Fig. 3 PET (Positron emission tomography) scan shows multiple lymph node metastases along the left paraaortic, aortocaval, and supraclavicular fossa.

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  Fig. 4 Gross finding; 1.0 × 1.0cm sized, depressed mucosal lesion with marginal elevation (type IIa+IIc) seen on proximal transverse colon.

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  Fig. 5 Histologic examination shows an infiltrative well-differentiated adenocarcinoma is seen at low power magnification, which extends to the lower third of the submucosa A (H&E stain, ×10). Lymphovascular permeation is seen in the peritumoral submucosal lymphatics at high power magnification B (H&E stain, ×200).

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