A 74-year-old man underwent colonoscopic examination on November 20, 1998. A polyp of the sigmoid colon was removed by snare polypectomy. The specimen was not retrieved and pathological examination was not done. After 7 months, he complained of right abdominal pain and lumbar pain. CT scan revealed multiple hepatic and paraaortic lymph node swelling, and bone scintigram revealed hot lesions in his spines and right leg. Follow up examination of CT scan showed rapid progression of tumors and tumor marker (CEA and CA19-9) increased rapidly.
At surgery, a lot of hepatic tumors were observed and lymph node swelling spread from the mesentery of sigmoid colon to the paraaortic region. Mesenteric wall of proximal sigmoid colon was invaded of the tumor. These findings suggested that the tumors were metastases of the sigmoid colon cancer which was polypectomized in the past. Partial colectomy and hepatic biopsy was performed. The tumors were moderate to poorly differentiated adenocarcinoma histologically. The patient died 58 days after operation.
In case when the histological examination of colonoscopically removed polyp was not available, colonoscopic findings of the lesion should be reviewed meticulously. If there were some possibility of carcinoma, surveillance examination not only for local recurrence but also for distant metastasis should be performed.
