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Zhang YJ, Yuan MX, Wen W, Li F, Jian Y, Zhang CM, Yang Y, Chen FL. Mucosa color and size may indicate malignant transformation of chicken skin mucosa-positive colorectal neoplastic polyps. World J Gastrointest Oncol 2024; 16:750-760. [PMID: 38577441 PMCID: PMC10989377 DOI: 10.4251/wjgo.v16.i3.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Lipid metabolism reprogramming is suspected to exist in pre-cancerous lesions, including colorectal adenoma. Screening colonoscopy frequently reveals chicken skin mucosa (CSM; white or yellow-white speckled mucosa) surrounding colorectal polyps, caused by macrophages engulfing and accumulating the lipids decomposed by colon cells or adjacent tumors. CSM-positive colorectal polyps are associated with various diseases; however, their prognosis varies greatly. Cold snare polypectomy is commonly used to resect lesions up to 10 to 15 mm in diameter without signs of submucosal invasion but is controversial for CSM-positive colorectal polyps. Improved imaging is required to diagnose and treat CSM-positive colorectal polyps. AIM To highlight the clinical significance of CSM surrounding colorectal polyps and clarify the associated treatment for endoscopists. METHODS This retrospective cohort study included 177 patients with CSM-positive colorectal polyps diagnosed using endoscopy. All patient-related information was extracted from the Goldisc soft-clinic DICOM system or electronic medical record system. Based on the pathological results, patients were classified as non-neoplastic polyps (five juvenile polyps), neoplastic polyps, non-invasive high-grade neoplasia (NHGN), or submucosal invasive carcinoma (SM stage cancer). We analyzed and compared the clinical features, suspected risk factors for malignant transformation of neoplastic polyps, and early infiltration of submucosal carcinoma. RESULTS The diameters of NHGN and SM polyps were much smaller than those of neoplastic polyps. Most NHGN polyps had a deeper red mucosal color. On logistic regression analyses, diameter and deeper red mucosal color were independent risk factors for malignant transformation of neoplastic polyps. Type 1 CSM was more common in high-grade intraepithelial neoplasia and SM; type 2 CSM was more common in neoplastic polyps. Logistic regression analyses revealed no significant differences in the malignant transformation of neoplastic polyps or early submucosal invasion of CSM-positive colorectal cancer. Changes in the CSM mucosa surrounding neoplastic polyps and submucosal invasion of colorectal cancer disappeared within 12 months. No tumor recurrence was found during either partial or complete endoscopic resection of the CSM. CONCLUSION CSM-positive colorectal polyps > 1 cm in diameter or with deeper red mucosa may be related to NHGN. Resection of CSM surrounding colorectal adenomas did not affect tumor recurrence.
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Affiliation(s)
- Ying-Jie Zhang
- Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Meng-Xia Yuan
- Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Wu Wen
- Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Fan Li
- Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Yi Jian
- Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Chuan-Ming Zhang
- Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Ye Yang
- Graduate School, Chengdu Medical College, Chengdu 610000, Sichuan Province, China
| | - Feng-Lin Chen
- Graduate School, Chengdu Medical College, Chengdu 610000, Sichuan Province, China
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Nagai K, Fuchizaki U, Ueda Y. Solitary juvenile polyp of the rectum with intramucosal adenocarcinoma. Clin J Gastroenterol 2023:10.1007/s12328-023-01798-7. [PMID: 37067731 DOI: 10.1007/s12328-023-01798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 04/18/2023]
Abstract
We describe a case of solitary juvenile polyp of the rectum with intramucosal adenocarcinoma. A 55-year-old man presented to our hospital for evaluation after a positive fecal occult blood test. Colonoscopy revealed a pedunculated polyp of 25 mm in size which has an irregular shape and pale red color on the rectum. The polyp had a proliferation of blood vessels and an invisible surface pattern. Endoscopic mucosal resection was performed. Pathologically, it was diagnosed as a solitary juvenile polyp with intramucosal well-differentiated adenocarcinoma. When we encounter juvenile polyps, the possibility of malignancy should be taken into consideration for treatment.
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Affiliation(s)
- Kazuki Nagai
- Department of Gastroenterology, Kahoku Central Hospital, Tsubata, Ishikawa, 929-0323, Japan.
| | - Uichiro Fuchizaki
- Department of Gastroenterology, Kahoku Central Hospital, Tsubata, Ishikawa, 929-0323, Japan
| | - Yoshimichi Ueda
- Department of Pathology, Keiju Medical Center, Nanao, Ishikawa, 926-8605, Japan
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Lee YM, Song KH, Koo HS, Lee CS, Ko I, Lee SH, Huh KC. Colonic Chicken Skin Mucosa Surrounding Colon Polyps Is an Endoscopic Predictive Marker for Colonic Neoplastic Polyps. Gut Liver 2022; 16:754-763. [PMID: 35000932 PMCID: PMC9474497 DOI: 10.5009/gnl210271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/13/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
Background/Aims Narrow band imaging provides an accurate diagnosis of colonic polyps. However, these diagnostic modalities are not used as standard endoscopic tools in most institutions. This study aims to investigate whether the chicken skin mucosa (CSM) surrounding the colon polyp yields additional information about colorectal polyps, including histological differentiation of neoplastic and non-neoplastic polyps, under conventional white light colonoscopy. Methods This study prospectively observed 173 patients who underwent endoscopic polypectomy and reviewed the clinical data and pathologic reports of 313 polyps from a university hospital. Two endoscopists each performed colonoscopy and polypectomy and assessed the CSM. The association between CSM surrounding colorectal polyps and histology was analyzed. Results The majority (91.3%) of CSM-positive polyps were neoplastic (sensitivity, 37.90%; specificity, 86.15%; p<0.001). In logistic regression, the neoplastic polyps were associated with positive CSM (adjusted odds ratio [OR], 3.51; 95% confidence interval [CI], 1.45 to 9.25; p=0.007), protruded polyps (adjusted OR, 4.85; 95% CI, 1.65 to 17.23; p=0.008), and neoplastic histology–associated pit pattern (pit III, IV, and V) (adjusted OR, 10.14; 95% CI, 4.85 to 22.12; p=0.000). Furthermore, advanced adenomas were associated with positive CSM (adjusted OR, 5.64; 95% CI, 1.77 to 20.28; p=0.005), protruded polyps (adjusted OR, 3.30; 95% CI, 1.15 to 9.74; p= 0.026), and ≥10 cm polyp size (adjusted OR, 18.56; 95% CI, 3.89 to 147.01; p=0.001). Conclusions Neoplastic and advanced polyps were associated with CSM-positive polyps. These findings suggest that CSM is a useful marker in differentiating neoplastic polyps and advanced polyps under conventional white colonoscopy.
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Affiliation(s)
- Yu Mi Lee
- Health Screening and Promotion Center, Konyang University Hospital, Daejeon, Korea.,Department of Gastroenterology, College of Medicine, Konyang University, Daejeon, Korea
| | - Kyung Ho Song
- Department of Gastroenterology, CHA University Ilsan Medical Center, Ilsan, Korea
| | - Hoon Sup Koo
- Department of Gastroenterology, College of Medicine, Konyang University, Daejeon, Korea
| | - Choong-Sik Lee
- Department of Pathology, College of Medicine, Konyang University, Daejeon, Korea
| | - Inseok Ko
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Korea
| | - Sang Hyuk Lee
- Department of Gastroenterology, College of Medicine, Konyang University, Daejeon, Korea
| | - Kyu Chan Huh
- Department of Gastroenterology, College of Medicine, Konyang University, Daejeon, Korea
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Abstract
Colonoscopy with polypectomy is frequently performed in pediatric patients based on symptoms, with the majority of polyps identified being benign juvenile pedunculated polyps with a vascular stalk. This is in distinction to adults where polypectomy is often performed as part of a colon cancer screening and prevention strategy and a higher fraction of polyps are sessile and or dysplastic. In adults, polypectomy techniques emphasize a need for deeper resection to ensure complete resection of adenomas or potential carcinoma in situ. Adenomatous polyps can occur in the pediatric age group and may be associated with an underlying polyposis, hereditary or chronic inflammatory conditions. Polypectomy techniques include use of cold biopsy forceps for very small polyps, cold snare polypectomy for small sessile polyps and hot snare polypectomy for the majority of polyps in the pediatric age group. Adjuvant techniques include epinephrine volume reduction, saline-assisted polypectomy and hemostatic techniques including injection, clip application and loop application to prevent or treat post-polypectomy bleeding. Electrosurgical principles guide the settings and type of current utilized during hot snare polypectomy. Polypectomy utilizing thermal techniques is associated with a higher risk of complications compared with diagnostic colonoscopy.
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Chung EJ, Lee JY, Choe J, Chang HS, Kim J, Yang DH, Ye BD, Byeon JS, Kim KJ, Yang SK, Kim JH, Myung SJ. Colonic Chicken Skin Mucosa is an Independent Endoscopic Predictor of Advanced Colorectal Adenoma. Intest Res 2015; 13:318-25. [PMID: 26576137 PMCID: PMC4641858 DOI: 10.5217/ir.2015.13.4.318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/03/2015] [Accepted: 07/04/2015] [Indexed: 12/19/2022] Open
Abstract
Background/Aims Chicken skin mucosa (CSM), surrounding colorectal adenoma, is an endoscopic finding with pale yellow-speckled mucosa; however, its clinical significance is unknown. This study aimed to evaluate the prevalence and clinical characteristics of CSM, and the association between colorectal carcinogenesis and CSM. Methods This cross-sectional study was performed in 733 consecutive patients who underwent endoscopic polypectomy for colorectal adenoma after the screening of colonoscopy at the Asan Health Promotion Center between June 2009 and December 2011. The colonoscopic and pathological findings of colorectal adenoma including number, size, location, dysplasia, morphology, and clinical parameters were reviewed. Results The prevalence of CSM was 30.7% (225 of 733 patients), and most CSM-related adenomas were located in the distal colon (93.3%). Histological analysis revealed lipid-laden macrophages in the lamina propria of the mucosa. Multivariate analyses showed that CSM was significantly associated with advanced pathology, including villous adenoma and high-grade dysplasia (odds ratio [OR], 2.078; 95% confidence interval [CI], 1.191-3.627; P=0.010), multiple adenomas (i.e., ≥2 adenomas; OR, 1.692; 95% CI, 1.143-2.507; P=0.009), and a protruding morphology (OR, 1.493; 95% CI, 1.027-2.170; P=0.036). There were no significant differences in polyp size or clinical parameters between patients with and without CSM. Conclusions CSM-related adenoma was mainly found in the distal colon, and was associated with advanced pathology and multiple adenomas. CSM could be a potential predictive marker of the carcinogenetic progression of distally located colorectal adenomas.
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Affiliation(s)
- Eun Ju Chung
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Young Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaewon Choe
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Sook Chang
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jongcheol Kim
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Jo Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Ho Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chicken skin mucosa surrounding adult colorectal adenomas is a risk factor for carcinogenesis. Am J Clin Oncol 2013; 35:527-32. [PMID: 21654311 DOI: 10.1097/coc.0b013e31821dedf7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Transformation of normal mucosa to colorectal adenoma could occur over a span of 5 to 20 years, whereas transformation of colorectal adenoma to colorectal cancer could take an additional 5 to 15 years. This study aims to investigate whether chicken skin mucosa (CSM) surrounding adult colorectal adenomas may be a risk factor for carcinogenesis. METHODS Patients with colorectal mucosa, colorectal adenomas without CSM, or colorectal adenomas with CSM were enrolled in this study. Immunohistochemistry and enzyme-linked immunosorbent assays were used to determine the expression levels of proliferation markers (ki-67 and COX-2) and apoptosis factors (survivin and caspase-3) in tissues. RESULTS The expression of ki-67 was significantly higher in colorectal adenomas with CSM compared with colorectal adenoma tissues (P < 0.01). Colorectal adenocarcinoma showed significantly higher levels of COX-2 protein compared with normal colorectal mucosa and colorectal adenoma tissues (P < 0.001). COX-2 expression was significantly higher in adenomas with CSM compared with normal colorectal mucosa (P < 0.001). Adenomas with CSM and adenocarcinomas exhibited significantly higher levels of survivin when compared with colorectal adenoma without CSM and normal tissues (P < 0.001). Although we found no significant difference in caspase-3 levels between adenocarcinomas and adenomas with CSM, caspase-3 expression was significantly lower in these tissues when compared with colorectal adenomas without CSM and normal mucosa (P < 0.001). CONCLUSIONS The biological characteristics of colorectal adenomas with CSM were different from those of colorectal adenomas without CSM. Colorectal adenomas with CSM exhibited active cell proliferation and inhibition of apoptotic pathways, suggesting an increased risk of carcinogenesis in these adenomas.
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