A case of local recurrent cancer in sigmoid colon with submucosal spread 4 years and 8 months after polypectomy

A case of local recurrent cancer in the sigmoid colon with submucosal spread 4 year and 8 months following endoscopic polypectomy was reported. A 64 year old male underwent endoscopic polypectomy for semipedunculated polyp of 15 mm in diameter. Histological examination disclosed the polyp was cancer in adenoma with penetration into the muscularis mucosa. Surveillance colonoscopy was done 2 weeks, 15 months, and 3 years and 1 month after polypectomy, but did not show any pathological findings at the polypectomy site. Surveillance barium enema study did not indicate any recerrent lesion except indentation of the polypectomy site 3 months after polypectomy. Elevated lesion with ulcer was found in the sigmoid colon by surveillance colonoscopy 4 years and 8 months after polypectomy. Barium enema study showed a severe indentation with ulcer. Laparotomy revealed cancer in the sigmoid colon with node metastases. Sigmoidectomy with lymph adenectomy was performed. Resected specimen showed a tumor, growing mainly in the intramural and pericolic fat layer, of 3 cm in diameter with ulceration of 0.8 cm in diameter. Most of the tumor was covered with the normal mucosa except an ulceration. Histological examination revealed well differentiated adenocarcinoma with node metastases (ss, ly2, v0, n2). Re-examination of the polypectomy specimen revealed well differentiated adenocarcinoma with moderate invasion into the submucosal layer and lymph vessel invasion. Recurrent cancer was considered to have originated from residual cancer cells.