Advanced adenocarcinoma in a laterally spreading adenoma within a colonic diverticulum, followed-up for 4 years.

摘要

To the Editor, Colonic neoplasia can arise from normal mucosa near or within a diverticulum. However, an adenocarcinoma arising within a diverticulum is a very rare phenomenon' and to date only sporadic cases have been reported (1-8). Due to the lack of muscular layers within the diverticulum, the use of endoscopic porypectomy of a tumour within the diverticulum carries a risk of colonic perforation. Additionally, it is usually difficult to determine whether the tumour component is benign or malignant; hence, special precautions should be implemented in the diagnosis and treatment of such patients. A 71-year-old man was admitted to Nishijin Hospital because of mele-na on November 5, 2009. A laterally spreading tumour (LST) of adenoma developing in a right-sided colonic diverticulum was observed on colonoscopy, and pathological examination revealed moderate atypia from a biopsy obtained in April, 2005. There were no changes observed in the tumour four years later as determined by endoscopic examination on his latest admission. Surgical intervention was consequently recommended but refused by the patient.