Size does not determine the grade of malignancy of early invasive colorectal cancer

Figure 1 The lesion was located in the transverse colon. Endoscopic examination revealed a flat, elevated lesion with a central depression, which was macroscopically diagnosed as 0-IIa+IIc. The high-magnification view revealed a typical type VI pit (invasive) pattern on the depressed margin. The final endoscopic diagnosis was a 0-IIa+IIc type early colon cancer with submucosal deep invasion. However, patient strongly hoped EMR as an initial treatment. We performed EMR after injecting normal saline into the submucosa.

Figure 2 The final histopathological diagnosis was early invasive colon cancer, well-differentiated adenocarcinoma, sm-deep, NPG type, ly (-), v (-), cut end (+) (vertical margin positive). Since cancer was exposed in the vertical cut margin, additional surgical resection was performed and LNM was detected.