Clinical Gastroenterology Vol.26 No.12(1)

Theme Reappraisal of Colorectal Protruded and Flat Lesions Which are Encountered During Endoscopy
Title Endoscopic Diagnosis of Colorectal Polyps -- Including Macroscopic Feature of Adenoma
Publish Date 2011/11
Author Takeshi Terai Terai Clinic
Author Naoto Sakamoto Terai Clinic
Author Kenshi Matsumoto Terai Clinic
Author Kazuko Beppu Terai Clinic
Author Tomoyoshi Shibuya Terai Clinic
Author Taro Osada Terai Clinic
Author Akihito Nagahara Terai Clinic
Author Tatsuo Ogihara Terai Clinic
Author Sumio Watanabe Department of Gastroenterology, Juntendo University, School of Medicine
Author Hidenobu Watanabe PCL Japan, Inc
[ Summary ] Colorectal polyps consist of solitary protruding lesions in the colon and rectum. Their diagnosis is important to determine whether the lesion originated in the epithelium or non-epithelial, sources, as well as whether the lesion may be considered a neoplasm or non-neoplasm. The appearance of lesions originating from non-epithelial sources exhibits the same structures as those lesions in surrounding tissue. Nonneoplastic lesions originating from the epithelium exhibit hyperplasic polyps, which are flat and elevated and may be normal in color or discolored. Juvenile polyps, Peutz-Jeghers type polyps, or inflammatory polyps display deep reddish color. Protruding neoplastic lesions associated with mucosal cancer express expand forms or endoscopic hardness. Invasive cancer displays a lack of surface grooves or convergence of folds. Laterally spreading tumors of the homogeneous granular type are usually considered to be benign. Nodular mixed granular type or Pseudo-depressed non-granular type are generally considered to be invasive forms of cancer. IIa+IIc type lesions are considered to be invasive cancer with deeply depressed areas, expanded forms in depressed areas, or convergent folds. Pit pattern diagnosis indicates deeper submucosal invading cancer with type V and a higher irregularity of pit patterns or type V non-structural pit patterns.
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