Abstract
A 61-year-old man underwent endoscopic examinations because of anemia. Colonoscopy revealed type 0-Ip lesions in the rectum and the right side of the transverse colon. Both lesions were removed via endoscopic resection. Pathologically, the lesion with a depressed area in the transverse colon was diagnosed as a 5-mm-sized tub2 carcinoma in serrated adenoma. The carcinoma, which corresponded to the depressed area, invaded the submucosa (pT1b) and lymphatic vessels. Furthermore, a poorly differentiated solid adenocarcinoma was observed in the submucosal layer. Computed tomography (CT) showed two swollen lymph nodes along the middle colic artery and abdominal aorta. Therefore, additional surgery was required. Histological examination of the resected specimen showed that the transverse colon cancer had spread to the two lymph nodes detected on CT. Postoperative adjuvant chemotherapy was administered, but the patient died of cancer development 2 years and 9 months after additional surgery. We report this rare case of submucosal invasive (T1) colon cancer with skip and distant lymph node metastases.
