Abstract
We report herein, a patient with a rectal carcinoid tumor of less than 1 cm in diameter with lymph node metastasis, and discuss a surgical policy for these lesions with reference to other such cases reported in the literature. A 40 year old female was admitted with a rectal mass and colonoscopy revealed a subpedunculated lesion, 1 cm in diameter, with a depression in its tip. A diagnosis of carcinoid was made by biopsy and transsacral excision performed. The excised specimen revealed a subpedunculated lesion measuring 7×6×6 mm with a central depression. The tumor was histologically confined to the submucosa but lymphatic invasion with pararectal lymph node involvement was observed. A radical proctectomy was thus performed. The incidence of metastasis from rectal carcinoids with a diameter of 1 cm or less is very low ranging from 1.5 to 3.4 per cent, and it therefore seems that most lesions of 1 cm or less in diameter can be treated by local excision alone. Thus, although it is recommended that local excision be performed first to determine the extent of spread, lymphatic vessel invasion and lymph node metastasis, radical surgery is indicated if lymphatic invasion or nodal involvement is present, even when muscle invasion is absent.
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Cardarola VT, Jackman RJ, Moertel CG, Dockerty MB. Carcinoid tumors of the rectum. Amer J Surg 1964; 107: 844–849.
Bates HR. Carcinoid tumors of the rectum: A statistical review. Dis Colon Rectum 1966; 9: 90.
Soga J. Carcinoids of the rectum: Tumors of the carcinoid family—urgut endocrinomas. Acta Med Biol 1982; 29: 157–201.
Naunheim KS, Zeitels J, Kaplan EL, Sugimoto J, Shen KL, Lee CH, Straus FH. Rectal carcinoid tumors—treatment and prognosis. Surgery 1983; 94: 670–676.
Kotake K, Yoneyama K, Miyata J, Haga Y, Tsukamoto T, Hayashi T. Carcinoid tumors of the rectum—Report of five cases and a review of Japanese literature. Nippon Daichou Koumon Byou Gakkai Zasshi (J Jpn Soc Colo-Proct) 1984; 37: 261–266. (in Japanese with English Abst.)
Grablowsky OM, Ribaudo JM, Ray JE. Carcinoid tumors of the rectum. Experience with 38 cases. Dis Colon Rectum 1974; 17: 532–535.
Orloff MJ. Carcinoid tumors of the rectum. Cancer 1971; 28: 175–180.
Tomoda H, Furusawa M, Hayashi I. The policy of surgery for small carcinoid tumors of the rectum. Jpn J Surg 1989; 15: 544–548.
Kataoka M, Sakakibara K, Maeda S, Naruse M, Hashimoto T, Tobioka N, Shimura A, Masaoka A. Carcinoid tumors of the rectum—4 cases report and review of the literaure— Nippon Shokaki Geka Gakkai Zasshi (Jpn J Gastroenterol Surg) 1983; 16: 1554–1558. (in Japanese)
Yamamoto H, Kikkawa N, Yano T, Imamoto N, Endo S, Takazuka Y, Sugitate A, Ino T, Kawahara T. Two cases of interesting rectal carcinoids. Nippon Daichou Koumon Byou Gakkai Zasshi (J Jpn Soc Colo-Proct) 1983; 36: 280. (in Japanese)
Yagyu T, Kikkawa N, Endo S, Kawahara T. Small carcinoid tumor of the rectum with lymph node metastasis: A case report. Nippon Daichou Koumon Byou Gakkai Zasshi (J Jpn Soc Colo-Proct) 1987; 40: 419–422. (in Japanese with English Abst.)
Shindo K, Kurooka K, Hatta M, Morikawa E, Kubo R, Hida J, Funai S, Matsuda T, Yasutomi M. Diagnosis and treatment of colo-rectal cancer from a viewpoint of the malignant potential. Geka Chiryou (Surg Ther) 1988; 1: 1–5. (in Japanese)
Kosaka T, Kawata T, Ishida T, Kato M, Yamaguchi A, Yonemura Y, Miyazaki I. Clincopathological studies of nuclear DNA distribution in colorectal cancer. Nippon Geka Gakkai Zasshi (J Jpn Surg Soc) 1987; 88: 1705–1709. (in Japanese with English Abst.)
Korenaga D, Okamura T, Saito A, Baba H, Sugimachi K. DNA ploidy is closely linked to tumor invasion, lymph node metastasis, and prognosis in clinical gastric cancer. Cancer 1988; 62: 309–313.
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Tomoda, H., Furusawa, M., Hayashi, I. et al. A rectal carcinoid tumor of less than 1 cm in diameter with lymph node metastasis: A case report and a review of the literature. The Japanese Journal of Surgery 20, 468–471 (1990). https://doi.org/10.1007/BF02470834
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DOI: https://doi.org/10.1007/BF02470834