Clin Endosc.  2019 Jul;52(4):377-381. 10.5946/ce.2018.129.

Colonic Intramucosal Cancer in the Interposed Colon Treated with Endoscopic Mucosal Resection: A Case Report and Review of Literature

• Baek SH
• Lee JH
• Yoo DR
• Kim HY
• Jin M
• Jang AR
• Yang DH
• Byeon JS

• KMID: 2455637
• DOI: http://doi.org/10.5946/ce.2018.129

Abstract

Colon interposition is a surgical procedure used for maintenance of luminal conduit after esophagectomy. Although epithelial neoplasia, such as adenoma and adenocarcinoma, may develop in the interposed colon, there are only few case reports on the condition. Due to the rarity of this condition, there is no definite consensus on recommending screening endoscopy for the early detection of neoplasia in the interposed colons. Here, we report a case of intramucosal adenocarcinoma in an interposed colon. Initial endoscopic resection for this tumor failed to accomplish complete resection. A subsequent endoscopic resection was performed 1 month later and complete resection was achieved. Based on our experience and recommendation on screening endoscopy for gastric cancer in Korea, we suggest that regular screening esophagogastroduodenoscopies should be performed following esophagectomy to detect early neoplasia in the stomach and interposed colon and avoid adverse results induced by delayed detection.

Keyword

Colon interposition; Adenocarcinoma; Endoscopic resection; Screening endoscopy

MeSH Terms

Adenocarcinoma
Adenoma
Colon*
Consensus
Endoscopy
Endoscopy, Digestive System
Esophagectomy
Korea
Mass Screening
Phenobarbital
Stomach
Stomach Neoplasms
Phenobarbital

Figure

• 

  Fig. 1. Esophagogastroduodenoscopy performed at another hospital. (A) Endoscopic image showing a 20-mm sessile polyp in the interposed colon. (B, C) Endoscopic resection was attempted and piecemeal resection was performed. (D) Complete resection was not achieved, and the remnant residual lesion is visible.

• 

  Fig. 2. Histological examination of the endoscopically resected specimen (Hematoxylin and eosin stain). (A) A very low-power scan view image (×12.5) showing simple crypt-like dysplastic glands (arrowheads), a characteristic of villotubular adenoma. The complicated glandular structure suggests adenocarcinomatous changes (arrows). (B) A low-power field view image (×100) showing cribriform formation and back-to-back appearance of a glandular structure with loss of polarity (arrow), suggesting adenocarcinoma.

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  Fig. 3. Repeated endoscopic resection of residual colonic neoplasia at the interposed colon. (A) White light endoscopic image showing a 12-mm residual polyp in the interposed colon. (B, C) Endoscopic mucosal resection was conducted, and the lesion was completely resected by piecemeal fashion in two pieces. Argon plasma coagulation was also performed to eliminate possible microscopic residual lesions.

• 

  Fig. 4. Histological examination of the specimen resected by repeated endoscopic resection (Hematoxylin and eosin stain). (A) A very low-power scan view (×12.5) showing the typical gross features of the tubular adenoma (arrows). (B) A low-power field view (×100) showing enlarged, hyperchromatic, and elongated nuclei arranged in a stratified configuration along the basement membrane, which is compatible with tubular adenoma.

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  Fig. 5. Follow-up esophagogastroduodenoscopy one year after complete resection of lesion at the interposed colon. A scar was visible at white-light examination (A) and narrow band imaging (B), with no sign of recurrent lesion.

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