Early Pedunculated Colorectal Cancer with Nodal Metastasis: A Case Report

Abstract Background: Among early colorectal cancers, pedunculated polyps have a higher complete resection rate than non-pedunculated cases and rarely require additional surgery. However, this time, we experienced a case of pedunculated colorectal cancer, which was histologically poorly differentiated adenocarcinoma. Lymphatic invasion was also found, so additional intestinal resection was performed and nodal metastasis was found.Case presentation: A 43-year-old woman underwent colonoscopy because of positive fecal occult blood. A 20 mm-sized pedunculated polyp was found in the descending colon, and endoscopic resection was performed. Histopathological examination revealed non-solid poorly differentiated adenocarcinoma, invading to the submucosa (3,500 μm from the muscularis mucosae) with lymphatic invasion. In spite of its early stage cancer, the risk of nodal metastasis was considered to be high, and bowel resection was additionally performed. Although there was no residual cancer in the site after endoscopic resection, a metastasis was found in one regional lymph node. The patient is undergoing postoperative adjuvant chemotherapy. There was no evidence of recurrence after three months after the additional surgery. Conclusions: For pedunculated polyps, additional bowel resection was performed for patients with multiple risk factors for nodal metastasis such as poorly differentiated adenocarcinoma and positive lymphatic invasion. Then, we experienced a case of nodal metastasis, so we report it with a review of the literature.