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Yoshikawa C, Koyama F, Morita K, Kuge H, Nakamoto T, Obara S, Iwasa Y, Kunishige T, Ohbayashi C, Sho M. Serrated polyposis syndrome with multiple inverted lesions in the colon: Case report and elucidation of morphogenetic mechanism. DEN OPEN 2022; 2:e13. [PMID: 35310715 PMCID: PMC8828188 DOI: 10.1002/deo2.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 11/16/2022]
Abstract
A 70‐year‐old man underwent surveillance colonoscopy following surgery for occlusive sigmoid colon cancer. The procedure revealed nine sessile serrated lesions (SSLs), including three inverted lesions. Endoscopic and surgical resections were performed. All nine lesions were confirmed pathologically as SSL, and the patient was diagnosed with serrated polyposis syndrome (SPS). Three inverted SSLs (iSSLs) showed endophytic growth without epithelial misplacement. Crypt analysis revealed that iSSL crypts were wider at the bottom than the opening, roughly resembling a frustoconical shape. Our results suggest that a horizontal arrangement of frustoconical crypts leads to hemispherical deformation of the muscularis mucosa, forming an inverted shape. This is the first report to reveal the morphogenesis of iSSLs from the shape of the crypt.
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Affiliation(s)
| | - Fumikazu Koyama
- Department of Surgery Nara Medical University Nara Japan
- Division of Endoscopy Nara Medical University Hospital Nara Japan
| | - Kohei Morita
- Department of Diagnostic Pathology Nara Medical University Nara Japan
| | - Hiroyuki Kuge
- Department of Surgery Nara Medical University Nara Japan
| | - Takayuki Nakamoto
- Department of Surgery Nara Medical University Nara Japan
- Division of Endoscopy Nara Medical University Hospital Nara Japan
| | - Shinsaku Obara
- Department of Surgery Nara Medical University Nara Japan
| | - Yosuke Iwasa
- Department of Surgery Nara Medical University Nara Japan
| | | | - Chiho Ohbayashi
- Department of Diagnostic Pathology Nara Medical University Nara Japan
| | - Masayuki Sho
- Department of Surgery Nara Medical University Nara Japan
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Takashima K, Oono Y, Kojima M, Ikematsu H, Akimoto T, Yano T. Clinicopathological features and endoscopic characteristics of inverted sessile serrated adenomas/polyps. Endosc Int Open 2019; 7:E330-E336. [PMID: 30834291 PMCID: PMC6395096 DOI: 10.1055/a-0820-2179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/22/2018] [Indexed: 01/17/2023] Open
Abstract
Background and study aims This study was designed to clarify clinicopathological, endoscopic, and genetic characteristics of inverted sessile serrated adenomas/polyps. Patients and methods In this retrospective study, we reviewed the pathology reports of patients treated in our hospital between January 2010 and June 2015 and identified sessile serrated adenomas/polyps that were diagnosed with endoscopic resected specimens. Clinicopathological, endoscopic, and genetic features were compared between the inverted and ordinary types. Results Among the 104 sessile serrated adenomas/polyps, 37 lesions were inverted (35.6 %). The inverted types had two patterns of invasion: expansive and infiltrating growth. Expansive growth was observed in 15 cases (40.5 %) and infiltrating in 22 (59.5 %). Regarding the clinicopathological findings and endoscopic characteristics of the inverted types, presence of adherent mucous, location in the right-side colon, an expanded type-II pit pattern, irregularly dilated vessels, and a depression were demonstrated in 89 % (33/37), 73 % (27/37), 54 % (20/37), 75 % (28/37), and 35 % (13/37), respectively. Contrastingly, these were demonstrated in 86 % (58/67), 84 % (56/67), 55 % (37/67), 58 % (39/67), and 0 % (0/67), respectively, in the ordinary type. In the univariate analysis, male sex and a depression in the adenoma/polyp were significantly associated with inverted types ( P < 0.001). BRAF mutation at codon 600 was found in six of seven ordinary types and in 11 of 11 of the inverted types. KRAS, NRAS, and PIK3CA mutations were not found in the ordinary and inverted types. Conclusion More than 30 % of sessile serrated adenomas/polyps were pathologically diagnosed as inverted, and approximately 40 % of them were of the expansive growth type and easily diagnosed with endoscopy.
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Affiliation(s)
- Kenji Takashima
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan,Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Kashiwa. Chiba, Japan,Corresponding author Kenji Takashima Endoscopy DivisionNational Cancer Center Hospital East6-5-1 Kashiwanoha, KashiwashiChiba 277-8577Japan+81-47-134-6928
| | - Yasuhiro Oono
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Motohiro Kojima
- Department of Pathology Division and Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tetsuo Akimoto
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Kashiwa. Chiba, Japan,Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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