Abstract
A 51-year-old female referred to our hospital because of a swelling of the right lower extremity on April in 2002. She underwent endoscopic mucosal resection for lower rectal cancer measuring 14mm 4 years and 8 months ago. Though the resected specimen revealed well differentiated adenocarcinoma invading massively into the submucosal layer, no lymphvascular invasion was detected. Surgical resection was not performed and she was followed up for 3 years and 5 months. After admission, wide spreading lymph node metastasis was disclosed by abdominal and pelvic CT scan and MRI, which caused the extrinsic compression of the right common and an external iliacvein. Lymphadenectomy and postoperative combined chemoradiotherapy was performed. Patients with submucosal invasive carcinoma having adverse prognostic factors should be treated with colorectal resection and lymphnode dissection, but otherwise, meticulous follow up is necessary for long period.
