A 50-year-old female was referred to our hospital for examination and treatment of a rectal tumor. A colonoscopic examination revealed a 20-mm-diameter, laterally spreading, granular-type tumor in the lower rectum. A conventional image showed a villous tumor in the middle area and narrow-band imaging (NBI) showed a Japan NBI Expert Team type-2A tumor. The biopsy specimen was interpreted as well-differentiated tubular adenocarcinoma. No endoscopic findings suspicious of advanced rectal cancer were obtained; therefore. we planned to perform endoscopic submucosal dissection. However, computed tomography (CT) and magnetic resonance imaging showed multiple enlarged mesorectal lymph nodes. Therefore, a laparoscopic low-anterior resection with lateral pelvic lymph-node dissection was performed. A histological examination showed rectal cancer of por>tub, pT3 N3 M0, and pStage IIIc. The patient rejected adjuvant chemotherapy, and multiple liver and lymph-node metastases were detected at 3 months postoperatively. Although systemic chemotherapy was started, the patient died of cancer 9 months postoperatively.
