Search

Background. Biliopancreatic tumors (BPT) are among the most aggressive solid malignancies, and their incidence is rising. Good patient outcome relies heavily on a multidisciplinary approach to therapy, including timely access to endoscopy, surgery and chemo/radiotherapy. We aimed to evaluate current practices as reflected in the management and outcome of patients diagnosed with BPT in the setting of a low-resource medical system in order to identify areas suitable for improvement.

Adenoma-like adenocarcinoma is a rare subtype of colorectal carcinoma recognized by WHO in 2019 that has a histological appearance similar to that of adenomatous polyps. These tumors are characterized by the presence of dysplastic glandular structures that resemble those found in adenomas. Compared to other subtypes of conventional colorectal carcinomas, patients have significantly lower rate of nodal metastasis, distant metastasis and mortality. We present the case of a 68 years old male, with complex cardio-vascular pathology associated, chronic renal failure and diabetes mellitus, who was endoscopically evaluated two years ago. At that moment, the patient was diagnosed with an apparently benign transverse polyp, having the indication for polypectomy but was therapeutically neglected. During the current year, the patient was referred to our service for colonoscopic reevaluation. We identified the prior described sesile polyp, measuring 3cm, with glandular architecture KUDO V, with a strong macroscopic malignant aspect so we didn't considered it appropriate for endoscopic resection. For this reason, we took multiple tissue samples and tattooed the lesion for surgical further management. The pathology reported high grade dysplasia adenoma so the patient received the recommendation of endoscopic resection. At the second colonoscopy in our department, efficient elevation was obtained injecting methylene blue solution with subsequent diathermic en-block resection. The final pathology report concluded adenoma like adenocarcinoma subtype of CRC with resection margins < 0.5mm from the submucosal invasion, without tumoral budding or perineural and lympho-vascular invasion. After the tumor board discussion, the patient was referred for surgical treatment. Segmentary colectomy was performed, with favorable outcome in the absence of oncological treatment necessity. In conclusion, adenoma-like adenocarcinoma is a particular subtype of colorectal carcinoma that has a challenging endoscopic and histological diagnosis, as it can mimic adenoma on biopsy in the context of a macroscopic malignant appearance, therefore influencing treatment decisions. [ABSTRACT FROM AUTHOR]