Chen D, Zhong DF, Zhang HY, Nie Y, Liu D. Rectal tubular adenoma with submucosal pseudoinvasion misdiagnosed as adenocarcinoma: A case report. World J Gastrointest Surg 2022; 14(12): 1418-1424 [PMID: 36632119 DOI: 10.4240/wjgs.v14.i12.1418]
Corresponding Author of This Article
Dong Liu, MD, Doctor, Department of Hepatobiliary and Pancreatic Gastroenterology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua People's Hospital, No. 267 Danxi East Road, Jindong District, Jinhua 321000, Zhejiang Province, China. li375dong@163.com
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/
World J Gastrointest Surg. Dec 27, 2022; 14(12): 1418-1424 Published online Dec 27, 2022. doi: 10.4240/wjgs.v14.i12.1418
Rectal tubular adenoma with submucosal pseudoinvasion misdiagnosed as adenocarcinoma: A case report
Dan Chen, Ding-Fu Zhong, Hong-Ying Zhang, Ying Nie, Dong Liu
Dan Chen, Ding-Fu Zhong, Hong-Ying Zhang, Ying Nie, Department of Gastroenterology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua People's Hospital, Jinhua 321000, Zhejiang Province, China
Dong Liu, Department of Hepatobiliary and Pancreatic Gastroenterology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua People's Hospital, Jinhua 321000, Zhejiang Province, China
Author contributions: Chen D, Zhong DF, Zhang HY, Nie Y, and Liu D collected and analyzed the data; Chen D and Liu D drafted the manuscript; Liu D critically revised and gave final approval for publication of the paper.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest related to 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: Dong Liu, MD, Doctor, Department of Hepatobiliary and Pancreatic Gastroenterology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua People's Hospital, No. 267 Danxi East Road, Jindong District, Jinhua 321000, Zhejiang Province, China. li375dong@163.com
Received: July 29, 2022 Peer-review started: July 29, 2022 First decision: October 5, 2022 Revised: October 18, 2022 Accepted: November 20, 2022 Article in press: November 20, 2022 Published online: December 27, 2022
Abstract
BACKGROUND
Differential diagnosis of colorectal intramucosal tumors from invasive adenocarcinoma is important in clinical practice due to the different risks of lymph node metastasis and different treatment options. The phenomenon of a colorectal adenoma with part of the gland entering the submucosa is known as pseudoinvasion of the adenoma, which is a major challenge for pathological diagnosis. It is essential to raise awareness of colorectal adenoma with submucosal pseudoinvasion clinically to avoid overtreatment.
CASE SUMMARY
We describe a case of rectal adenoma with submucosal pseudoinvasion in a 48-year-old man. The patient was admitted to Jinhua People's Hospital due to a change in stool habit for 5 d. We performed colonoscopy, and the results suggested a submucosal bulge approximately 1.0 cm × 1.0 cm in size in the rectum 8 cm from the anal verge, with red surface erosion. Ultrasound colonoscopy was also performed and a homogeneous hypoechoic mass about 0.52 cm × 0.72 cm in size was seen at the lesion, protruding into the lumen with clear borders and invading the submucosa. Endoscopic surgery was then performed and the pathological specimen showed a tubular adenoma with high-grade intraepithelial neoplasia (intramucosal carcinoma) involving the adenolymphatic complex. In addition, we performed a literature review of rectal tubular adenoma with submucosal pseudoinvasion to obtain a deeper understanding of this disease.
CONCLUSION
The aim of this study was to improve awareness of this lesion for clinicians and pathologists to reduce misdiagnosis.
Core Tip: Colorectal adenoma with submucosal pseudoinvasion has only been studied in a small number of small cases in the current national and international literature. At present, endoscopists diagnose our patient's lesion by electronic staining endoscopy (NBI), magnification endoscopy and ultrasound enteroscopy. A more accurate diagnosis of the depth of infiltration was obtained by pathological support. And if the pathologist misjudges, it will lead to overtreatment in clinical practice.
