Subscribe to RSS
DOI: 10.1055/s-0029-1214942
© Georg Thieme Verlag KG Stuttgart · New York
Novel diagnostic methods for early-stage squamous cell carcinoma of the anal canal successfully resected by endoscopic submucosal dissection
Y. SaitoMD, PhD
Endoscopy Division
National Cancer Center Hospital
5-1-1 Tsukiji
Chuo-ku
Tokyo
104-0045
Japan
Fax: +81-3-35423815
Email: ytsaito@ncc.go.jp
Publication History
Publication Date:
28 October 2009 (online)
Although anal canal squamous cell carcinoma (ACSCC) is quite rare, it can be recognized clearly using iodine staining [1]. Early-stage esophageal squamous cell carcinoma (SCC) has recently been diagnosed using both narrow-band imaging (NBI) [2] and autofluorescence imaging (AFI) [3]. Here we report on the first case of early-stage ACSCC diagnosed by NBI and AFI and treated successfully by endoscopic submucosal dissection (ESD).
A 70-year-old woman was referred to our hospital for treatment of ACSCC. Conventional colonoscopy (PCF-Q240Z, Olympus Optical Co., Tokyo, Japan) revealed a slightly protruded lesion approximately 10 mm in size and located close to the dentate line ([Fig. 1]). The superficial microvessels of the lesion were examined by white light and NBI systems with magnification ([Fig. 2]), and appeared similar to esophageal intraepithelial papillary capillary loops (IPCLs) [4]. The AFI image was purple in color ([Fig. 3 d]), and the lesion was unstained following iodine staining. NBI, AFI, and iodine staining images were similar to those of esophageal SCC ([Fig. 3]) [3] [4].
An endoscopic diagnosis of carcinoma in situ was made because of the IPCL-like microvessels; ESD was performed ([Fig. 4]) [5] because the location of the lesion caused technical difficulties in achieving an en-bloc endoscopic mucosal resection. Histopathological analysis of the resected specimen revealed SCC, with microinvasion of 0.4 mm but no lymphovascular invasion ([Fig. 5]). Chemoradiation therapy, with a dose-reduction of 25 %, was carried out because of the microinvasion. A follow-up colonoscopy performed 23 months later revealed the ESD scar ([Fig. 6]), and the biopsy specimen was negative for malignancy.
Endoscopic diagnosis of ACSCC and an accurate prediction of invasion were both based on similarity to esophageal IPCLs. En-bloc ESD of early-stage ACSCC followed by chemoradiation therapy resulted in a successful treatment and better patient quality of life; it is possible, therefore, that this could become a standard treatment protocol in the future for early-stage ACSCC.
Endoscopy_UCTN_Code_TTT_1AQ_2AD
#References
- 1 Yamaguchi T, Moriya Y, Fujii T. et al . Anal canal squamous-cell carcinoma in situ, clearly demonstrated by indigo carmine dye spraying: report of a case. Dis Colon Rectum. 2000; 43 1161-1163
- 2 Goda K, Tajiri H, Kaise M. et al . Flat and small squamous cell carcinoma of the esophagus detected and diagnosed by endoscopy with narrow-band imaging system. Dig Endosc. 2006; 18 S9-S12
- 3 Uedo N, Iishi H, Tatsuta M. et al . A novel videoendoscopy system by using autofluorescence and reflectance imaging for diagnosis of esophagogastric cancers. Gastrointest Endosc. 2005; 62 521-528
- 4 Inoue H, Honda T, Nagai K. et al . Ultra-high magnification endoscopic observation of carcinoma in situ of the esophagus. Dig Endosc. 1997; 9 16-18
- 5 Saito Y, Uraoka T, Matsuda T. et al . Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc. 2007; 66 966-973
Y. SaitoMD, PhD
Endoscopy Division
National Cancer Center Hospital
5-1-1 Tsukiji
Chuo-ku
Tokyo
104-0045
Japan
Fax: +81-3-35423815
Email: ytsaito@ncc.go.jp
References
- 1 Yamaguchi T, Moriya Y, Fujii T. et al . Anal canal squamous-cell carcinoma in situ, clearly demonstrated by indigo carmine dye spraying: report of a case. Dis Colon Rectum. 2000; 43 1161-1163
- 2 Goda K, Tajiri H, Kaise M. et al . Flat and small squamous cell carcinoma of the esophagus detected and diagnosed by endoscopy with narrow-band imaging system. Dig Endosc. 2006; 18 S9-S12
- 3 Uedo N, Iishi H, Tatsuta M. et al . A novel videoendoscopy system by using autofluorescence and reflectance imaging for diagnosis of esophagogastric cancers. Gastrointest Endosc. 2005; 62 521-528
- 4 Inoue H, Honda T, Nagai K. et al . Ultra-high magnification endoscopic observation of carcinoma in situ of the esophagus. Dig Endosc. 1997; 9 16-18
- 5 Saito Y, Uraoka T, Matsuda T. et al . Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc. 2007; 66 966-973
Y. SaitoMD, PhD
Endoscopy Division
National Cancer Center Hospital
5-1-1 Tsukiji
Chuo-ku
Tokyo
104-0045
Japan
Fax: +81-3-35423815
Email: ytsaito@ncc.go.jp