Abstract
We report a case of lymph node metastasis in the presacral space from early rectal cancer treated with endoscopic mucosal resection (EMR) 7 years and 11 months ago. The patient was a 54 year-old woman who underwent EMR for early rectal cancer in 1999. Pathological examination showed that the resected specimen was moderately differentiated adenocarcinoma with submucosal extention and vascular invasion, but with clear margin. Follow up examination had been performed for 3 years after EMR, but was stopped thereafter. She was admitted in the hospital because of constipation in 2007. Abdominal computed tomography and magnetic resonance imaging showed a mass of 66 × 40mm in diameter between rectosigmoid colon and sacrum of S1 and S2. Colonofiberscope indicated a submucosal tumor, and barium enema study showed compression of the rectum by an extra-rectal lesion. The tumor decreased in size to 49 × 18mm in diameter after neoadjuvant chemotherapies combined with FOLFOX4 for five times and Bevacizumab for three times. Thereafter, a curative operation was performed. Pathological examination revealed that the recurrence originated from lymph node metastasis. Since the recurrence modes and duration after EMR for early rectal cancer showed wide variation, more effective and sufficient follow-up approaches should established soon.
