Pedunculated polypoid carcinoma with regional lymph node metastasis-report of a case.

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Recently, we experienced a case of pedunculated polypoid carcinoma with regional lymph node metastasis of the sigmoid colon. Patient was 59 year-old-female. A barium enema demonstrated diverticulosis and coexisting polyp of the sigmoid colon. On endoscopic examination, the polyp had a long, broad-based stalk, and the head of the polyp showed concave surface with irregular nodular appearance and marked erythema of overlying mucosa. Initially, endoscopic excision was judged to be relevant, however, surgical management was adopted because of the possibility of presence of invasive carcinoma. Histologically, almost the entire head of the polyp was made up of well differentiated adenocarcinoma and regional lymph node involvement was evident. Nowadays, the proper treatment of adenoma-tous colonic polyps containing small foci of invasive cancer as well as pedunculated polypoid carcinoma is controversial, because the matastatic potential of these lesions is not precisely known. Generally, pedunculated polyps are amenable to endoscopic resection even though they might have invasive cancer. The present case suggested that fully careful examination is required concerning the management of malignant polyps even if lesions are pedunculated and that transabdominal bowel resection should be recommended when pathologic examina-tion showed insufficiency of endoscopic excision.
日本大腸肛門病学会の論文