Spreading of a colon adenoma: a case report

The capacity to spread beyond the limits of the tissue in which it was originated and to survive is the prerogative of malignant tumors, the feature at the basis of the concept of malignancy. In 90% of cases, a colon cancer originates from its dysplastic precursor, the adenomatous polyp; evidence that 60-70% of that cancer is localized in the distal colon suggests that environmental factors affects the progression of the tumor, like the activation of HIF-1 transcription factor and the physiological hypoxia that exists in this environment. Here we describe the finding of a clinical case where a benign tubulovillous adenoma appears able to survive and colonize the colonic mucosa away from the primary lesion. It was supported by visual inspection, histological evidence and fractal analysis (each tested morphometrical parametersbox dimension, information dimension, mass dimension, perimeter-area dimension, algorithmic complexityoverlapped each other, p<0.03). If this finding will be confirmed in a high number of patients and by experimental studies, the current diagnostic/therapeutic approaches of the colon tumors should be modified, not only regarding colorectal adenomas, but also the superficial cancer of the large bowel. Correspondence to: Giorgio Bianciardi, Department of Medical Biotechnologies, Pathologic Anatomy, Siena University, Italy, E-mail: [email protected] Received: October 25, 2015; Accepted: November 20, 2015; Published: November 25, 2015 Introduction The mechanisms of spread of a malignant tumor in other tissues (metastasis) are well known since the previous century (bloodstream, lymphatic circulation, contiguity, via transcelomatic dissemination). It is a process affected by many factors, like as the ability to overcome hypoxia and to be provided with a vascular network [1-4]. During a colonscopy, two benign lesions (adenomas, one large vegetating proximal lesion and one small lesion, distally) were revealed in a patient, the position and the aspect at gross and microscopic levels suggesting that the small lesion could be derived from the other. In this work we face a clinical case that may suggest the possibility of an adenomatous polyp, a benign tumor, to spread and colonize the colonic mucosa remotely, with mechanisms considered, so far, prerogative of a malignant tumor.