Liu XW, Zhou B, Wu XY, Yu WB, Zhu RF. T1 rectal mucinous adenocarcinoma with bilateral enlarged lateral lymph nodes and unilateral metastasis: A case report. World J Clin Cases 2022; 10(33): 12404-12409 [PMID: 36483826 DOI: 10.12998/wjcc.v10.i33.12404]
Corresponding Author of This Article
Xian-Wei Liu, MD, PhD, Doctor, Department of General Surgery, Jiujiang No. 1 People’s Hospital, No. 48 Taling South Road, Jiujiang 332000, Jiangxi Province, China. jacky3251.love@163.com
Research Domain of This Article
Oncology
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/
Xian-Wei Liu, Xiao-Yu Wu, Wen-Bing Yu, Ren-Fang Zhu, Department of General Surgery, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
Bing Zhou, Department of Pathology, Jiujiang No. 1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
Author contributions: Liu XW, Zhou B and Wu XY participated in data collection and manuscript writing; Liu XW, Yu WB and Zhu RF completed the surgery; and all authors read and approved the final manuscript.
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 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: Xian-Wei Liu, MD, PhD, Doctor, Department of General Surgery, Jiujiang No. 1 People’s Hospital, No. 48 Taling South Road, Jiujiang 332000, Jiangxi Province, China. jacky3251.love@163.com
Received: August 31, 2022 Peer-review started: August 31, 2022 First decision: September 26, 2022 Revised: September 30, 2022 Accepted: October 24, 2022 Article in press: October 24, 2022 Published online: November 26, 2022
Abstract
BACKGROUND
There are a few cases of lateral lymph node (LLN) metastasis (LLNM) of T1 rectal cancer. Moreover, LLNM is easily missed, especially in patients with early-stage rectal cancer. To our knowledge, the possibility of bilateral LLNM before surgery has not been reported in previous studies.
CASE SUMMARY
A 36-year-old woman underwent endoscopic submucosal dissection at a local hospital owing to a clinical diagnosis of a rectal polyp. The pathology report showed a diagnosis of T1 rectal mucinous adenocarcinoma. She was considered to have bilateral LLNM after the examination at our hospital. Laparoscopic total mesorectal excision plus bilateral LLN dissection was performed and the pathological outcomes indicated unilateral LLNM. The patient received long-course adjuvant chemoradiotherapy with no recurrence or metastasis observed during the 1-year follow-up period.
CONCLUSION
T1 rectal cancer could lead to LLNM and possibly, bilateral LLNM. Therefore, adequate clinical evaluation is essential for these patients.
Core Tip: T1 rectal cancer is rarely accompanied by lymph node metastases, and even fewer lateral lymph node (LLN) metastases (LLNM). To our knowledge, the published case reports to date have mainly reported cases of heterochronous LLNM, only two cases with simultaneous metastases, and only one case of missed LLNM after endoscopic submucosal dissection (ESD). For patients with no residual tumor after ESD, in whom LLNM is suspected, it is also inconclusive whether only LLN dissection could be performed.
