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Endoscopic tattooing: a risk for tumor implantation

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Endoscopic tattooing is considered to be a safe procedure to mark a lesion for subsequent surgical resection, and the reported complications are relatively minor. However, here the present case shows tumor traveling through needle tract with tumor inoculation following endoscopic tattooing.

Methods and Results

A 68-year-old female who had a clinical stage I rectal cancer underwent laparoscopic rectal low anterior resection. The pathologic examination of the surgical specimen showed a pathologic stage pT1 invasive adenocarcinoma with a 3-mm focus of tumor cells traveling through a transmural tract and a 0.5-mm tumor inoculation in the peri-colonic fat tissue. These two foci of tumor cells were mixed with pigmented substance convincing its association with the endoscopic tattooing.


This present case raises the awareness of a severe complication as tumor inoculation by inappropriate endoscopic tattooing which may cause tumor stage upgrading and tumor spreading.

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Correspondence to Belinda Sun.

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Sun, B. Endoscopic tattooing: a risk for tumor implantation. Int J Colorectal Dis 35, 571–574 (2020). https://doi.org/10.1007/s00384-019-03495-9

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  • Endoscopic tattooing
  • Complication
  • Tumor implantation