PMC6157472_01
Images of the colon tumor.. (a) Total colonoscopy reveals a type 2 tumor in the ascending colon. (b) Computed tomography (CT) shows an enhanced mass in the ascending colon without distant metastasis.
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Total colonoscopy revealed a type 2 tumor in the ascending colon, and moderately differentiated adenocarcinoma was diagnosed by examining the biopsy specimen (Fig. 1a). Computed tomography (CT) showed an enhanced mass in the ascending colon and an intraluminal filling defect from the ileocolic vein to the SMV (Figs. 1b and 2a).
Images of the tumor thrombosis.. (a) Contrast-enhanced CT shows an intraluminal filling defect from the ileocolic vein to the superior mesenteric vein (SMV; white arrow). (b) On PET-CT, abnormal FDG uptake extended from the ileocolic vein (ICV) to the SMV (SUV-max: 9.4).
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Computed tomography (CT) showed an enhanced mass in the ascending colon and an intraluminal filling defect from the ileocolic vein to the SMV (Figs. 1b and 2a). Abnormal FDG uptake extended from the ileocolic vein to the SMV (SUV-max: 9.4) (Fig. 2b).
Intraoperative findings.. (a) Tumor thrombosis extended from the ileocolic vein (ICV) to the root of the SMV. (b) Scheme of the tumor thrombosis. (c) After ligation of ICV and thrombectomy, greater saphenous vein grafting was performed. (d) Scheme of the vein grafting.
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Right hemicolectomy with D3 lymphadenectomy, tumor thrombectomy of the SMV, and greater saphenous vein grafting were performed (Fig. 3).
Pathological findings of the resected specimen.. (a) Macroscopic findings of the ileum and ascending colon. Tumor is indicated by a white arrow. (b) Resected specimen of the ICV. (c) Hematoxylin and eosin (HE) staining of the ICV shows intraluminal invasion of moderately differentiated adenocarcinoma. (d) HE staining of a colon tumor shows a moderately differentiated adenocarcinoma reaching the subserosal layer. (e) Venous involvement (v2) is confirmed (CD 31) by immunohistochemistry.
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Pathological examination showed that the tumor was a moderately differentiated adenocarcinoma of the ascending colon, which reached the subserosal layer, with no lymph node metastasis (0/35) or lymphatic duct involvement (ly0) but with venous involvement (v2) (Fig. 4).
Postoperative findings.. (a) The patency of the reconstructed vein was sustained and remnant tumor thrombosis was not detected on the seventh postoperative day. (b) No recurrence has been confirmed at 17 months follow-up CT imaging.
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Remnant tumor thrombosis or vein stricture was not detected in the CT image (Fig. 5a). Currently, 17 months have passed after the surgery, and no recurrence has been detected to date (Fig. 5b).