Widespread recurrence of pT1 colon cancer three years and three months after endoscopic mucosal resection

Most authors consider Endoscopic Mucosal Resection (EMR) a safe and effective procedure to treat sessile and pedunculated intramucosal colonic cancers (Tis), as very few cases of local or distant (lymph nodes, liver, lung) metastases have been reported. EMR can be effective also in T1 cancers, which infiltrates submucosa and are associated to an overall 10% rate of lymph nodes metastases, with a rate increasing parallel to their distal site. We report here the case of a 62 years old woman affected by Hashimoto’s thyroiditis, sclerodermia and severe congestive heart failure, who, notwhithstanding a strict endoscopic and imaging follow-up after EMR of a T1 sigmoid cancer, 3 years and 3 months later was admitted to the Emergency Room (ER) of our Hospital complaining of abdominal pain, and was diagnosed by a Ultrasounds (US) scan to have hepatic metastases, confirmed by a whole body Computed Tomography (CT) scan and a Positron Emission Tomography (PET)-CT scan which showed also local parietal recurrence and diffuse lymph nodes metastases. Four months later, the patient is doing well after 3 cycles of chemotherapy; a CT scan will be performed after the fourth cycle