PMC3884191_01
Primary sigmoid cancer. a Macroscopic appearance of the primary sigmoid colon cancer. b Microscopic appearance of the primary sigmoid colon cancer.
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F1
D3 lymph node dissection for both sigmoid colon cancer (fig. 1) and transverse colon cancer. During that operation, lavage of the remnant colon was performed before anastomosis, and automatic anastomotic devices were used. Both the oral and anal margins of the resected colon had a sufficient length: the transverse margin measured 135 mm (oral wedge) and 50 mm (anal wedge), while the sigmoid margin measured 40 mm (oral wedge) and 50 mm (anal wedge) (fig. 1a).
Follow-up colonoscopy after the primary operation. a Colonoscopy showing no evidence of recurrence at the anastomotic site 3 years after the primary operation. b Colonoscopy showing anastomotic recurrence 5 years after the primary operation.
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F2
At 3-year follow-up, colonoscopy and computed tomography revealed no signs of recurrence (fig. 2a). At 5-year follow-up, colonoscopy demonstrated surrounding flaring and swelling in the anastomotic area of the sigmoid colon (fig. 2b).
The resected intestine exhibiting anastomotic recurrence. a Macroscopic appearance of the resected intestine demonstrating anastomotic recurrence. The arrows indicate the previous anastomotic line. b Microscopic appearance of the resected intestine demonstrating anastomotic recurrence.
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F3
The tumor measured 45 x 35 mm and was located at the previous anastomotic site (fig. 3a). Pathology revealed histological features that resembled the pattern of the previous tumor, and there were masses of cancerous cells in the subserosal and muscular layers near the fissured muscular layer, which comprised the anastomotic area (fig. 3b). Furthermore, there were no cancerous cells in the mucous membranes, which indicated that the cells were derived from the primary lesion (fig. 3b).