A 74-year-old man was referred for evaluation after a positive fecal occult-blood test. He had no history of cancer and no family history of colorectal cancer. A colonoscopy was performed with the use of a magnifying videoscope, and an irregularity of the colonic wall at the transverse colon was detected (Panel A). The laterally spreading tumor became clear after a 0.2 percent indigo carmine solution was sprayed in the area (Panel B, arrows). A radiograph obtained after the administration of a double-contrast barium enema showed a flat, radiolucent area (Panel C, arrows). The patient underwent a laparoscopically assisted colectomy, and a tumor 5 cm in diameter was removed. Histologic examination showed invasion of the cancer in the submucosa, without invasion of the vessels or involvement of the lymph nodes (Panel D, hematoxylin and eosin). Follow-up after discharge was uneventful. After eight months, there has been no evidence of metastasis.
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