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Rifu K, Koinuma K, Horie H, Mori K, Naoi D, Tojo M, Homma Y, Murahashi S, Kihara A, Mimura T, Kitayama J, Sata N. Successfully Resected Isolated Lateral Lymph Node Recurrence in a Patient with T1 Lower Rectal Cancer: Case Report and Literature Review. J Anus Rectum Colon 2024; 8:259-264. [PMID: 39086877 PMCID: PMC11286367 DOI: 10.23922/jarc.2024-003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/11/2024] [Indexed: 08/02/2024] Open
Abstract
Lateral lymph node (LLN) metastasis in T1 rectal cancer has an incidence of less than 1%. However, its clinical features are largely uncharted. We report a case of LLN metastasis in T1 rectal cancer and review the relevant literature. A 56-year-old female underwent rectal resection for lower rectal cancer 2 years previously (pT1bN0M0). During follow-up, an elevated tumor marker CA19-9 was documented. Enhanced CT and MRI showed a round shape nodule 2 cm in size on the left side of pelvic wall. PET-CT showed high accumulation of FDG in the same lesion, leading to a diagnosis of isolated LLN recurrence. Because no other site of recurrence was detected, surgical resection of the LLN was performed. Microscopic findings were consistent with metastatic lymph node originating from the recent rectal cancer. Adjuvant chemotherapy for six months was given, and patient remains free of recurrent disease seven months after LLN resection. Although LLN recurrence after surgery for T1 rectal cancer is rare, post-surgical follow-up should not be omitted. When LLN metastasis is suspected on CT, MRI and/or PET-CT will be recommended. Surgical resection of LLN metastasis in patients with T1 rectal cancer may lead to favorable outcomes, when recurrence in other areas is not observed.
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Affiliation(s)
- Kazuma Rifu
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Koji Koinuma
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Hisanaga Horie
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Katsusuke Mori
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Daishi Naoi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Mineyuki Tojo
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Yuko Homma
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Satoshi Murahashi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Atsushi Kihara
- Department of Pathology, Jichi Medical University Hospital, Tochigi, Japan
| | - Toshiki Mimura
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Joji Kitayama
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University Hospital, Tochigi, Japan
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Liu XW, Zhou B, Wu XY, Yu WB, Zhu RF. T1 rectal mucinous adenocarcinoma with bilateral enlarged lateral lymph nodes and unilateral metastasis: A case report. World J Clin Cases 2022; 10:12404-12409. [PMID: 36483826 PMCID: PMC9724534 DOI: 10.12998/wjcc.v10.i33.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/30/2022] [Accepted: 10/24/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are a few cases of lateral lymph node (LLN) metastasis (LLNM) of T1 rectal cancer. Moreover, LLNM is easily missed, especially in patients with early-stage rectal cancer. To our knowledge, the possibility of bilateral LLNM before surgery has not been reported in previous studies.
CASE SUMMARY A 36-year-old woman underwent endoscopic submucosal dissection at a local hospital owing to a clinical diagnosis of a rectal polyp. The pathology report showed a diagnosis of T1 rectal mucinous adenocarcinoma. She was considered to have bilateral LLNM after the examination at our hospital. Laparoscopic total mesorectal excision plus bilateral LLN dissection was performed and the pathological outcomes indicated unilateral LLNM. The patient received long-course adjuvant chemoradiotherapy with no recurrence or metastasis observed during the 1-year follow-up period.
CONCLUSION T1 rectal cancer could lead to LLNM and possibly, bilateral LLNM. Therefore, adequate clinical evaluation is essential for these patients.
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Affiliation(s)
- Xian-Wei Liu
- Department of General Surgery, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Bing Zhou
- Department of Pathology, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Xiao-Yu Wu
- Department of General Surgery, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Wen-Bing Yu
- Department of General Surgery, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Ren-Fang Zhu
- Department of General Surgery, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
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Ponnatapura J, Lalwani N. Imaging of Colorectal Cancer: Screening, Staging, and Surveillance. Semin Roentgenol 2020; 56:128-139. [PMID: 33858639 DOI: 10.1053/j.ro.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Janardhana Ponnatapura
- Department of Radiology, Wake Forest University Baptist Hospital Sciences, Medical Center Bovlevard, Winston-Salem, NC.
| | - Neeraj Lalwani
- Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, VA
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Zhang X, He D, Ding Y, Liu S, Wang Z. Lateral lymph node dissection after endoscopic submucosal dissection for T1 rectal cancer: a case report. ANZ J Surg 2020; 90:2369-2370. [PMID: 32096900 DOI: 10.1111/ans.15762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Du He
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanling Ding
- Department of Cardiology, Anqing Municipal Hospital (Anqing Hospital Affiliated to Anhui Medical University), Anqing, China
| | - Sheng Liu
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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Ishikawa T, Homma S, Nishikawa M, Nakamoto H, Yokoyama R, Taketomi A. Laparoscopic abdominoperineal resection with lateral lymph node dissection for advanced rectal and prostate cancer with synchronous lateral lymph node metastases. Asian J Endosc Surg 2019; 12:118-121. [PMID: 29745478 DOI: 10.1111/ases.12598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/13/2018] [Accepted: 04/10/2018] [Indexed: 11/29/2022]
Abstract
Here we report a case of advanced rectal and prostate cancer with synchronous lateral lymph node (LLN) metastases that was treated with laparoscopic surgery. A 71-year-old man presented with fecal occult blood and was diagnosed with rectal cancer. A metastatic right LLN was suspected after CT examination of a 19-mm lymph node (proximal internal iliac artery region) and a 13-mm lymph node (distal internal iliac artery region) in the right lateral region. We planned neoadjuvant chemotherapy to suppress local and distant recurrence. This treatment decreased the size of the primary rectal tumor. We performed laparoscopic abdominoperineal resection and right LLN dissection. The histopathological diagnosis was LLN metastases from the rectal and prostate cancers. It is rare for synchronous metastases from rectal and prostate cancers to be observed in the LLN. It may be difficult to determine an appropriate treatment strategy in cases like this.
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Affiliation(s)
- Takahisa Ishikawa
- Department of Surgery, Hokkaido Prefectural Welfare Federation of Agricultural Cooperatives Abashiri-Kosei General Hospital, Abashiri, Japan
| | - Shigenori Homma
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Makoto Nishikawa
- Department of Surgery, Hokkaido Prefectural Welfare Federation of Agricultural Cooperatives Abashiri-Kosei General Hospital, Abashiri, Japan
| | - Hiroki Nakamoto
- Department of Surgery, Hokkaido Prefectural Welfare Federation of Agricultural Cooperatives Abashiri-Kosei General Hospital, Abashiri, Japan
| | - Ryoji Yokoyama
- Department of Surgery, Hokkaido Prefectural Welfare Federation of Agricultural Cooperatives Abashiri-Kosei General Hospital, Abashiri, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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