I wish to present 1 family 2 sisters with familial colonic polyposis.
Case 1 is a 25-year-old woman, complaining of diarrhea with massive blood coagula. She was found to have diffuse colonic polyposis with rectal cancer and was performed total colectomy. Her father had died of rectal cancer. Her eldest sister, that is, case 2 was also found by laparatomy to have diffuse colonic polyposis with sigmoid cancer. Her youngest sister was found by sigmoidscopy to have rectal polyposis (3 polyps were found in the rectum). So, I can say to have a family of familial colonic polyposis.
In order to determine whether there was a presence of precancerous lesions, a patho-histological study of all polyps was carried out on the numerous polyps of the colon and rectum of case 1. These results were as follows:
1) The total number of polyps was 920 and they were pathohistologically all sessil adenomatous polyps except for one which was pedunculated.
2) These polyps were classified into five groups according to their degree of malignancy from atypia 0, atypia 1, atypia 2, atypia 3 and cancer. The result was atypia 0-260 (28.2 %), atypia 1-234 (25.4 %), atypia 2-256 (27.8 %), atypia 3-137 (14.9 %) and cancer-33 polyps (3.6 %).
3) The highest incidence of site for malignant polyps was found in the order of descending colon, sigmoid colon, rectum, rectosigmoid, and transverse colon.
4) Most of the malignant polyps were large in size, but 75 polyps (8.1 %) were less than 2 mm. in diameter.
5) The polyps were equally distributed among the colon.
Cass 2 is a sister of case 1. She was also founb to have colonic polyposis with sigmoid cancer. Only sigmoidectomy was carried out and 42 polyps surrounding a sigmoid cancer were removed. None of 42 polyps were cancerous, but 18 of them were of the atypia 2 type.
The electron microscopic findings of a few of case 2 patient's polyps showed slight atypia such as gathering of chromatin, irregularly shaped nucleolus, and very few microvilli. There were relatively few Goblet Cells in the polyps. The findings of another one showed a more severe degree of malignacy such as almost no microvilli and slightly increased in number of endoplasma reticulum.

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Preoperative lymphoadenographies were routinely performed for 57 persons who diagnosed as cancers of the rectum and anus during 1967-1969 to detect the extension of regional lymphatic spread and decide range of radical lymphadnectomy.
The main route received the intramural lymph flow from the rectum is the superior zone along the super rectal artery and this zone is not visualized by foot direct lymphography. But this zone is inevitably removed at surgery, so there is no much surgical significance.
Regions which visualized by foot lymphography are limited only the lateral, middle and inferior zones.
If malignant metastatic spreads in these regions are visualized by lymphography preoperatively, it is clear that lateral or inferior invasions are progressed and complete lymphaduectomy is necessary.
Topographic anatomy and dynamics of the inguinal, external and common iliac, aortic lymphatic systems were clarified by lymphography.
Lymphographic findings to be suspect invasion of cancer are as follows.
1) Filling defect in lymph nodes. This finding was occured by the fact that oily contrast medium was impervious to the carcinomatous tissue. At first this filling defect was appeared at marginal sinus and then extended into central region.
2) The form and size of lymph nodes affected by cancer were generally increased.
3) Obstruction of the lymphatic flow followed lymphangiectasia, collateral circulation and other abnormal lymphatic condition.
Metastasis into the external iliac group was proved in 10% cases which tumors were existed beneath the Houston's middle valve. These invasions were assured by histological examination. The other way no lymphographical metastasis in these region which visualized by lymphography of cancers above the middle valve were characterized.
So it was possible to conclude that preoperative lymphography for cancer of the rectum and anus, especially ones lower than this valve, is very important and necessary.

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