A case of sigmoid colon cancer with a disrupted tumor top

Abstract

A 86 year-old male who visited a local physician with the chief complaint of blood in the stool. At the initial colonoscopy, a polyp with a partially disrupted top was found in the sigmoid colon. Histopathological examination of a biopsy specimen obtained from the tumor base showed moderately differentiated adenocarcinoma. A second colonoscopy was performed 10 days later, which revealed that the tumor top was almost completely disrupted. The patient was referred to our hospital and admitted for endoscopic therapy 35 days after the initial colonoscopy. A repeat colonoscopy confirmed an increase of the tumor volume and progression of the lesion to a sessile-type cancer. Consequently, the lesion was diagnosed as a submucosal cancer and endoscopic submucosal dissection (ESD) was performed. Histopathological examination showed that the tumor was a well to moderately well differentiated adenocarcinoma, SM 5,000 μm. We recommended radical resection; however, the patient was kept under follow-up because he refused surgery. We present this case as an example of early colon cancer in which the tumor top was rapidly disrupted and morphological change was observed.