జీర్ణకోశ & జీర్ణ వ్యవస్థ

నైరూప్య

Endoscopic Curative Treatment of a Submucosal Invasive Rectal Adenocarcinoma

Carlos Eduardo Oliveira dos Santos, Daniele Malaman, César Vivian Lopes and Júlio Carlos Pereira-Lima

We report a case of a 45-year-old man with the diagnosis of rectal adenocarcinoma, in which a proctocolectomy was proposed and the patient refrained from surgery. A new colonoscopy was performed, which revealed a 2.5 cm diameter sessile lesion with irregular microvascular mesh work, thick capillaries with heterogeneous distribution and avascular areas, suggesting carcinoma with massive invasion of the sub-mucosa (a C3 lesion in the Hiroshima classification). However, we tried endoscopic resection and the lesion has completely elevated after Sub-mucosal hipertonic saline injection. Then the lesion was removed “en block” with a polypectomy snare. Histopathological study evidenced a moderately differentiated adenocarcinoma in a villous adenoma with high grade dysplasia with sub-mucosal invasion of 655 μm; there was no angiolymphatic invasion and the lateral and lower margins were lesion-free.