Murakami Y, Tanabe H, Ono Y, Sugiyama Y, Kobayashi Y, Kunogi T, Sasaki T, Takahashi K, Ando K, Ueno N, Kashima S, Yuzawa S, Moriichi K, Mizukami Y, Fujiya M, Okumura T. Local recurrence after successful endoscopic submucosal dissection for rectal mucinous mucosal adenocarcinoma: A case report. World J Gastrointest Oncol 2023; 15(1): 186-194 [PMID: 36684048 DOI: 10.4251/wjgo.v15.i1.186]
Corresponding Author of This Article
Hiroki Tanabe, MD, PhD, Associate Professor, Division of Metabolism and Biosystemic Science, Department of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa 078-8510, Hokkaido, Japan. tant@asahikawa-med.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yuki Murakami, Hiroki Tanabe, Yuya Sugiyama, Yu Kobayashi, Takehito Kunogi, Takahiro Sasaki, Keitaro Takahashi, Katsuyoshi Ando, Nobuhiro Ueno, Shin Kashima, Kentaro Moriichi, Yusuke Mizukami, Mikihiro Fujiya, Toshikatsu Okumura, Division of Metabolism and Biosystemic Science, Department of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
Yusuke Ono, Yusuke Mizukami, Institute of Biomedical Research, Sapporo-Higashi Tokushukai Hospita, Sapporo 065-0033, Hokkaido, Japan
Sayaka Yuzawa, Department of Diagnostic Pathology, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
Author contributions: Murakami Y designed this case report and performed the whole study; Tanabe H helped to write the manuscript. Ono Y and Mizukami Y performed the genetic analyses. Sugiyama Y, Kobayashi Y, Takahashi K, Sasaki T, and Takahashi K were involved in the patient’s diagnosis and endoscopic treatment. Ando K and Ueno N organized the patient’s treatment in the hospital. Moriichi K and Kashima S processed the experimental data and performed the analysis. Yuzawa S performed the histological analysis. Fujiya M and Okumura T supervised the research.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hiroki Tanabe, MD, PhD, Associate Professor, Division of Metabolism and Biosystemic Science, Department of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa 078-8510, Hokkaido, Japan. tant@asahikawa-med.ac.jp
Received: October 8, 2022 Peer-review started: October 8, 2022 First decision: October 17, 2022 Revised: October 31, 2022 Accepted: December 6, 2022 Article in press: December 6, 2022 Published online: January 15, 2023 Processing time: 94 Days and 3.2 Hours
Abstract
BACKGROUND
Mucinous adenocarcinoma of the colorectum is a rare histological subtype characterized by an abundant mucinous component. Mucinous tumors are frequently diagnosed at an advanced stage, which indicates an aggressive subtype. However, few case reports have been published, and little information is available concerning genetic alterations in mucinous adenocarcinoma.
CASE SUMMARY
A 76-year-old man underwent en bloc endoscopic submucosal dissection (ESD) for the management of a type 0-Is+IIa lesion. Histological examination revealed an intramucosal mucinous adenocarcinoma with signet-ring cell carcinoma and well-to-moderately differentiated tubular adenocarcinoma. Three years after the ESD, local recurrence was detected by an endoscopic examination, revealing a new 0-Is+IIa lesion with a phenotype similar to the previously resected lesion. Re-ESD was chosen for the management of the recurrent tumor, and the histological examination showed positive tumor infiltration at the vertical margin. Additional surgical resection was performed for the curative treatment. Genetic analysis showed pathogenic alterations in RNF43 and TP53 in the adenoma and an additional SMAD4 alteration in the carcinoma.
CONCLUSION
This mucinous mucosal adenocarcinoma case was suggested to have an aggressive phenotype and a careful and close follow-up are required.
Core Tip: Colorectal mucinous adenocarcinoma, as characterized by an abundant mucinous component, is a rare histological subtype frequently diagnosed at an advanced stage. Intramucosal mucinous adenocarcinoma was dissected by endoscopic submucosal dissection and local recurrence was detected three years after the treatment. Genetic analysis showed pathogenic alterations of RNF43, TP53, and SMAD4. This case of mucinous mucosal adenocarcinoma was suggested to have an aggressive phenotype based on the treatment course and advanced genotype identified by target sequencing. Careful and close follow-up should be performed, and additional surgery should be considered when managing patients with mucinous adenocarcinoma.
