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Colon adenocarcinoma with dome-like phenotype: characteristic endoscopic ultrasonography (EUS) findings.

Takagi W, Yamamoto K, Amano T, Sakamoto A, Otake Y, Saiki H, Kondo H, Urabe M, Takahashi K, Yamamoto M, Hayashi S, Nakajima S, Nishida T, Komori T, Morita S, Adachi S, Inada M - Endosc Int Open (2015)

Bottom Line: Endoscopic ultrasonography demonstrated that a hypoechoic mass was located in the submucosal layer, and a biopsy specimen obtained from the surface of the lesion showed evidence of adenocarcinoma.We then performed sigmoidectomy on the patient.We finally diagnosed the lesion as adenocarcinoma with a dome-like phenotype of the sigmoid colon.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan.

ABSTRACT
An 80-year-old man underwent colonoscopy for proctorrhagia. Conventional white-light imaging showed a superficially flat and elevated lesion that appeared to be a submucosal tumor of the sigmoid colon. Chromoendoscopy with Indigo Carmine showed that the margin of the tumor was covered with normal epithelium but that there was a slight depression on its surface. Magnification endoscopy with Crystal Violet staining revealed the amorphous surface structure of the depressed lesion, but the surrounding mucosa showed a normal pit pattern. Endoscopic ultrasonography demonstrated that a hypoechoic mass was located in the submucosal layer, and a biopsy specimen obtained from the surface of the lesion showed evidence of adenocarcinoma. We then performed sigmoidectomy on the patient. Immunohistochemically, the tumor cells were positive for two mismatch repair proteins (MLH1 and MSH2), but in situ hybridization revealed that the specimen was negative for the Epstein - Barr virus. We finally diagnosed the lesion as adenocarcinoma with a dome-like phenotype of the sigmoid colon.

No MeSH data available.


Related in: MedlinePlus

 Immunohistochemical analysis of MLH-1 and MSH-2 protein expression in the tumor. The cancer cells and internal controls (lymphocytes) were positive for MLH-1 (a, b) and MSH-2 (c, d).
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FI168-5:  Immunohistochemical analysis of MLH-1 and MSH-2 protein expression in the tumor. The cancer cells and internal controls (lymphocytes) were positive for MLH-1 (a, b) and MSH-2 (c, d).

Mentions: An 80-year-old man presented with proctorrhagia and underwent colonoscopy. He had no family history of colorectal cancer. Conventional white-light imaging revealed an elevated lesion of 10 mm in diameter with a flat top that appeared to be an SMT in the sigmoid colon (Fig. 1). Chromoendoscopy with Indigo Carmine showed that the margin of the tumor was covered with normal epithelium but that there was a slight depression on the surface of the tumor (Fig. 2 a). Magnification endoscopy with narrow-band imaging (ME-NBI) revealed that the depressed lesion had a demarcated area and a nearly avascular and loose microvascular area ( Fig. 2 b), and it was classified as capillary pattern type IIIB according to the Sano classification 3. Magnification endoscopy with Crystal Violet staining showed a decrease in the number of pits and showed the amorphous structure of the depressed lesion (Fig. 2 c), which was distinguished by a type VN pit pattern 4; however, the surrounding mucosa showed a normal pit pattern. EUS revealed that the tumor was hypoechoic with a slightly hyperechoic component compared with the second layer and a peripherally hypoechoic rim, resembling a hypoechoic focus ( Fig. 3). Based on the ME-NBI and EUS findings, we considered a neuroendocrine tumor, malignant lymphoma, or SMT-like adenocarcinoma in the differential diagnosis. A biopsy specimen collected from the surface of the lesion indicated adenocarcinoma. We diagnosed the patient to have adenocarcinoma with massive submucosal invasion of the sigmoid colon and performed a sigmoidectomy. Histologic examination revealed that the lesion was located in the subepithelial layer ( Fig. 4 a), and a well-circumscribed and intense lymphocytic infiltrate surrounded the invasive well-differentiated adenocarcinoma with cystically dilated tumor glands in the submucosal layer (Fig. 4 b, c). The tumor cells were positive for two mismatch repair proteins (MLH1 [Fig. 5 a, b] and MSH2 [Fig. 5 c, d]), suggesting a microsatellite-stable phenotype. The absence of EBV in the carcinoma cells was confirmed by in situ hybridization. We finally diagnosed the tumor as a dome-like carcinoma with lymphoid stroma of the sigmoid colon.


Colon adenocarcinoma with dome-like phenotype: characteristic endoscopic ultrasonography (EUS) findings.

Takagi W, Yamamoto K, Amano T, Sakamoto A, Otake Y, Saiki H, Kondo H, Urabe M, Takahashi K, Yamamoto M, Hayashi S, Nakajima S, Nishida T, Komori T, Morita S, Adachi S, Inada M - Endosc Int Open (2015)

 Immunohistochemical analysis of MLH-1 and MSH-2 protein expression in the tumor. The cancer cells and internal controls (lymphocytes) were positive for MLH-1 (a, b) and MSH-2 (c, d).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554511&req=5

FI168-5:  Immunohistochemical analysis of MLH-1 and MSH-2 protein expression in the tumor. The cancer cells and internal controls (lymphocytes) were positive for MLH-1 (a, b) and MSH-2 (c, d).
Mentions: An 80-year-old man presented with proctorrhagia and underwent colonoscopy. He had no family history of colorectal cancer. Conventional white-light imaging revealed an elevated lesion of 10 mm in diameter with a flat top that appeared to be an SMT in the sigmoid colon (Fig. 1). Chromoendoscopy with Indigo Carmine showed that the margin of the tumor was covered with normal epithelium but that there was a slight depression on the surface of the tumor (Fig. 2 a). Magnification endoscopy with narrow-band imaging (ME-NBI) revealed that the depressed lesion had a demarcated area and a nearly avascular and loose microvascular area ( Fig. 2 b), and it was classified as capillary pattern type IIIB according to the Sano classification 3. Magnification endoscopy with Crystal Violet staining showed a decrease in the number of pits and showed the amorphous structure of the depressed lesion (Fig. 2 c), which was distinguished by a type VN pit pattern 4; however, the surrounding mucosa showed a normal pit pattern. EUS revealed that the tumor was hypoechoic with a slightly hyperechoic component compared with the second layer and a peripherally hypoechoic rim, resembling a hypoechoic focus ( Fig. 3). Based on the ME-NBI and EUS findings, we considered a neuroendocrine tumor, malignant lymphoma, or SMT-like adenocarcinoma in the differential diagnosis. A biopsy specimen collected from the surface of the lesion indicated adenocarcinoma. We diagnosed the patient to have adenocarcinoma with massive submucosal invasion of the sigmoid colon and performed a sigmoidectomy. Histologic examination revealed that the lesion was located in the subepithelial layer ( Fig. 4 a), and a well-circumscribed and intense lymphocytic infiltrate surrounded the invasive well-differentiated adenocarcinoma with cystically dilated tumor glands in the submucosal layer (Fig. 4 b, c). The tumor cells were positive for two mismatch repair proteins (MLH1 [Fig. 5 a, b] and MSH2 [Fig. 5 c, d]), suggesting a microsatellite-stable phenotype. The absence of EBV in the carcinoma cells was confirmed by in situ hybridization. We finally diagnosed the tumor as a dome-like carcinoma with lymphoid stroma of the sigmoid colon.

Bottom Line: Endoscopic ultrasonography demonstrated that a hypoechoic mass was located in the submucosal layer, and a biopsy specimen obtained from the surface of the lesion showed evidence of adenocarcinoma.We then performed sigmoidectomy on the patient.We finally diagnosed the lesion as adenocarcinoma with a dome-like phenotype of the sigmoid colon.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan.

ABSTRACT
An 80-year-old man underwent colonoscopy for proctorrhagia. Conventional white-light imaging showed a superficially flat and elevated lesion that appeared to be a submucosal tumor of the sigmoid colon. Chromoendoscopy with Indigo Carmine showed that the margin of the tumor was covered with normal epithelium but that there was a slight depression on its surface. Magnification endoscopy with Crystal Violet staining revealed the amorphous surface structure of the depressed lesion, but the surrounding mucosa showed a normal pit pattern. Endoscopic ultrasonography demonstrated that a hypoechoic mass was located in the submucosal layer, and a biopsy specimen obtained from the surface of the lesion showed evidence of adenocarcinoma. We then performed sigmoidectomy on the patient. Immunohistochemically, the tumor cells were positive for two mismatch repair proteins (MLH1 and MSH2), but in situ hybridization revealed that the specimen was negative for the Epstein - Barr virus. We finally diagnosed the lesion as adenocarcinoma with a dome-like phenotype of the sigmoid colon.

No MeSH data available.


Related in: MedlinePlus