Abstract
An 81-year-old female was under medical treatment following diagnosis of ulcerative colitis (pan-ulcerative colitis type) in 1998. Total colonoscopy in 2006 showed a IIa lesion of 3mm in diameter at the rectosigmoid colon with a distinct border. The lesion was biopsied and diagnosed as moderate atypical adenoma. Total colonoscopy performed four years later revealed an elevated lesion (20 mm in diameter) that had an irregular surface and showed redness and that was surrounded by a flat elevated lesion. Biopsy of this lesion revealed a well-differentiated adenocarcinoma. Upon diagnosis of ulcerative colitis-associated cancer, she underwent total colectomy, rectectomy, and ileostomy. Postoperative pathological examination revealed that the lesion was 0-Isp+IIa+IIb+IIc, tub1 (+pap), pM, ly0, v0, pPM0, pRM0, pN0, and Stage p0. In addition, postoperative pathological examination revealed a IIa+IIc-like lesion near the site of the cancer ; however, this lesion could not be endoscopically detected before the total colectomy. Four years earlier, this lesion was IIa and stained positive for p53. We propose that a low-grade dysplasia (flat-elevated type) had progressed to ulcerative colitis-associated cancer in this patient within approximately four years.
