NODULE-AGGREGATING LESIONS OF THE COLORECTUM : ENDOSCOPIC DIAGNOSIS AND CLINICAL MANAGEIMENT

Abstract

To determine the management of colorectal sessile tumor with nodule-aggregating surface, we investigated the endoscopic, histalogic, and stereomicroscopic findings of the tumors in 25 cases detected by colonoscopy. The specimens resected endoscopicaly or surgically revealed 11 adenomas and 14 carcinoma in adenomas, which included 10 intramucosal carcinomas and 4 submucosal invasive carcinomas. Endoscopic findings of the surface were classified into the following four types uniformly conglomerated nodular surface in 5 cases, gyrus-like appearance in 12, large sized nodules in conglomerated nodular surface in 7, and mixed type in one. The cases with large sized nodules and gyrus-like appearance frequently contained cancerous foci. Stereomicroscopic examination indicated that the frequency of malignancy was strikingly high in the cases with cerehriform appearance with sharply elongated and irregularly distorted pits and that substantial invasive carcinoma was demonstrated in one case with the devastated mucosal appearance. These results suggest that careful observation under endoscapy is useful to detect the cancerous foci and the invasive depth in the sessile tumor with nodule-aggregating surface. Indication of endoscopic treatment should be determined bythe surface structure and the location of the tumor.