Korean J Clin Oncol.  2019 Dec;15(2):135-140. 10.14216/kjco.19024.

Suspicious T1 colon cancer with synchronous liver metastasis not detected by preoperative imaging study

• Park CH
• Moon SH
• Lee HW
• Bae SU
• Jeong WK
• Baek SK

• KMID: 2470679
• DOI: http://doi.org/10.14216/kjco.19024

Abstract

Colorectal carcinoma invading the submucosa but not the muscularis propria (pT1) represents the earliest form of clinically relevant colorectal cancer in most patients. T1 colorectal cancer with synchronous liver metastasis is considered to be rare. We report a rare case of T1 colon cancer with synchronous liver metastasis not detected by preoperative imaging study. A 54-year-old male patient presented to our department for treatment of sigmoid colon cancer following an endoscopic submucosal dissection. Histopathological examination revealed the pedunculated mass was moderately differentiated adenocarcinoma without lymphovascular invasion and the depth of submucosal invasion was 2,000 µm, the resection margin was not involved. We performed a laparoscopic anterior resection with lymph node dissection. After the 3 months, the patient's carcinoembryonic antigen level elevated from 1.4 to 7.26 ng/mL (normal level: <1.5 ng/mL) and the abdominal computed tomography and FDG-PET/CT (positron emission tomography-computed tomography) showed multiple hepatic metastases in both hepatic lobes (SUVmax: 5.6) without evidence of local recurrence or lymphadenopathy. We strongly suspected a synchronous liver metastasis not detected by imaging study as opposed to a systemic recurrence. Therefore, evaluation and follow-up protocol of T1 colorectal cancer should be changed for discovery and prediction of synchronous liver metastasis; because we cannot exclude the possibility of synchronous liver metastasis.

Keyword

T1 colorectal cancer; Synchronous liver metastasis; Preoperative imaging study

MeSH Terms

Adenocarcinoma
Carcinoembryonic Antigen
Colon*
Colonic Neoplasms*
Colorectal Neoplasms
Follow-Up Studies
Humans
Liver*
Lymph Node Excision
Lymphatic Diseases
Male
Middle Aged
Neoplasm Metastasis*
Recurrence
Sigmoid Neoplasms
Carcinoembryonic Antigen