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Logo of bmcgastBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Gastroenterology
 
BMC Gastroenterol. 2012; 12: 50.
Published online May 24, 2012. doi:  10.1186/1471-230X-12-50
PMCID: PMC3493301
Interval colon cancer in a Lynch syndrome patient under annual colonoscopic surveillance: a case for advanced imaging techniques?
Amy S Oxentenko1 and Thomas C Smyrkcorresponding author2
1Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
2Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology;Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
corresponding authorCorresponding author.
Amy S Oxentenko: Oxentenko.amy/at/mayo.edu; Thomas C Smyrk: smyrk.thomas/at/mayo.edu
Received January 19, 2012; Accepted May 14, 2012.
Abstract
Background
Lynch syndrome confers increased risk for various malignancies, including colorectal cancer. Colonoscopic surveillance programs have led to reduced incidence of colorectal cancer and reduced mortality from colorectal cancer. Colonoscopy every 1–2 years beginning at age 20–25, or 10 years earlier than the first diagnosis of colorectal cancer in a family, with annual colonoscopy after age 40, is the recommended management for mutation carriers. Screening programs have reduced colon cancer mortality, but interval cancers may occur.
Case presentation
We describe a 48-year-old woman with Lynch syndrome who was found to have an adenoma with invasive colorectal cancer within one year after a normal colonoscopy.
Conclusion
Our patient illustrates two current concepts about Lynch syndrome: 1) adenomas are the cancer precursor and 2) such adenomas may be “aggressive,” in the sense that the adenoma progresses more readily and more rapidly to carcinoma in this setting compared to usual colorectal adenomas. Our patient’s resected tumor invaded only into submucosa and all lymph nodes were negative; in that sense, she represents a success for annual colonoscopic surveillance. Still, this case does raise the question of whether advanced imaging techniques are advisable for surveillance colonoscopy in these high-risk patients.
Keywords: Lynch syndrome, Colorectal carcinoma, Surveillance
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