2021 Volume 54 Issue 1 Pages 66-72
A 67-year-old woman underwent surgery and postoperative radiation therapy for cervical carcinoma 38 years ago. She underwent colonoscopy at another hospital because a physical examination revealed positive fecal occult blood. Radiation proctitis and a slight elevated lesion in the same area were detected, and a pathological study of the biopsy sample revealed a group 3 finding. She was referred to the Department of Gastroenterology at our hospital. Endoscopic treatment was difficult due to poor intestinal mobility, poor endoscopic manipulation, and the unclear extent of the lesion. A pathological study of the biopsy performed 6 months after colonoscopy revealed group 4. She was referred to our department for a surgical treatment. We diagnosed suspected rectal carcinoma (Type 0-IIb, cTisN0M0) with radiation proctitis and performed a Hartmann operation. Pathological findings of the resected specimen showed a flat extension of highly differentiated adenocarcinoma in the mucosa and adenocarcinoma on the wall of the cyst extending from the submucosa to the muscularis propria. A diagnosis of radiation-induced advanced rectal carcinoma (Type 0-IIb, pT2N0M0, fStage I) with surrounding radiation injury was made. This case shows that care is needed to avoid a delay in treatment because the preoperative diagnosis of radiation-induced colorectal carcinoma is difficult.
