| Series | ||
|---|---|---|
| Title | A case of carcinoma in sessile serrated adenoma / polyp with multiple endoscopic findings | |
| Publish Date | 2015/11 | |
| Author | Eiji Harada | Department of Gastroenterology, Akita Red Cross Hospital / Shinseikai Harada Clinic |
| Author | Hiro-o Yamano | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Hiro-o Matsushita | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Kenjiro Yoshikawa | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Ryo Takagi | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Hironori Aoki | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Yoshihito Tanaka | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Michiko Nakaoka | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Ryogo Himori | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Makoto Nagatsuka | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Yuko Yoshida | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Tamotsu Sugai | Department of Molecular Diagnostic Pathology, Iwate Medical University |
| Author | Noriyuki Uesugi | Department of Molecular Diagnostic Pathology, Iwate Medical University |
| Author | Eiichiro Yamamoto | DDepartment of Gastroenterology, Rheumatology and Clinical Immunology of Internal Medicine / Department of Molecular Biology, Sapporo Medical University |
| Author | Hiromu Suzuki | Department of Molecular Biology, Sapporo Medical University |
| [ Summary ] | We report on a case of carcinoma in a sessile serrated adenoma/polyp (SSA/P) in an elderly woman of approximately 70 years of age. The patient presented with a Type IIa+IIc lesion (20 mm in diameter that exhibited regions of high and low elevation, with a depression in the top of the highly elevated region in the cecum (the first section of the colon). Magnifying endoscopy indicated a Type II-open pit attern in regions of low elevation, Type Ⅱ-open/Type IIIL pit patterns in regions of high elevation, a Type VN pit pattern in the depression, and a Type VI pit pattern surrounding the depression, in which a small, tight structure could also be visualized, from a different angle. From these findings and background (e.g., location and structure), we diagnosed the lesion as a suspected Stage T1b carcinoma in SSA/P, with an additional, medullary carcinoma sited within the depression. In view of the patient's background, endoscopic mucosal resection was performed, and a histological diagnosis of carcinoma in SSA/P, cancer：well to poorly differentiated adenocarcinoma [solid type (Por1) medullary carcinoma], T1b (2,500μm), ly0, v0 was confirmed. Genetic screening of the lesion identified a BRAF mutation and CIMP in each region of the carcinoma and SSA/P. Methylation of hMLH1 was evident in the SSA/P and well-differentiated carcinoma regions, but was absent from poor to moderately differentiated carcinoma regions. We conclude that this lesion is microsatellite instability-positive colon carcinoma originating from the SSA/P. Additionally, we also conclude that the medullary carcinoma located within the depression must have arisen from a different source. |
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