| Theme |
Magnifying Endoscopic Diagnosis of Gastro‒intestinal Carcinomas |
| Title |
Magnified Characteristics of Coexistent Cancer with Sessile Serrated Adenoma/Polyp |
| Author |
Shigeo Banno |
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center |
| Author |
Toshio Uraoka |
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center |
| Author |
Reiji Higashi |
Department of Endoscopy, Hiroshima City Hospital Organization Hiroshima City Hiroshima Citizens Hospital |
| Author |
Satoshi Kinoshita |
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center |
| Author |
Hideki Mori |
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center |
| Author |
Toshihiro Nishizawa |
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center |
| [ Summary ] |
Sessile serrated adenoma and polyp (SSA/P) has been considered a precancerous lesion of colorectal serrated adenocarcinoma. Several guidelines for colon polyps have been indicated for the endoscopic treatment of SSA/P in the last several years. Although SSA/P is sometimes detected during cancer surveillance colonoscopy, cases with a coexistent cancer are remarkably rare. Hence, the colonoscopic characterization of these lesions could be difficult. We reviewed a few reports and our cases, and described the colonoscopic characteristics of coexistent cancer with SSA/P, especially in terms of magnified endoscopic findings. Our results showed that many coexistent dysplastic lesions present with double elevation, central depression, and reddishness in white light imaging. In magnified imaging, a type II pit pattern based on Kudo and Tsuruta's classification, in addition to type IIIL and IV pit patterns, seems to indicate adenomatous change, and tpye VI or VN pit patterns seem to indicate a cancerous lesion. Capillary pattern type III in Sano's classification also indicates cancer. Although some colonoscopic characteristics of coexistent cancer with SSA/P have been clarified in recent years, the prediction of depth of invasion and the diagnostic accuracy compared with white light imaging remains unclear. Further studies should be conducted to resolve these problems. |