Colonic Chicken Skin Mucosa is an Independent Endoscopic Predictor of Advanced Colorectal Adenoma

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.

Chicken skin mucosa surrounding small colorectal cancer could be an endoscopic predictive marker of submucosal invasion

BACKGROUND

Chicken skin mucosa (CSM) surrounding colon polyps is a common endoscopic finding with pale yellow-speckled mucosa during a colonoscopy screening. Although reports about CSM surrounding small colorectal cancer are scarce, and its clinical significance in intramucosal and submucosal cancers is unclear, previous studies have suggested it could be an endoscopic predictive marker for colonic neoplastic and advanced polyps. Currently, because of the inaccurate preoperative evaluation by endoscopists, many small colorectal cancers, particularly lesions with a diameter < 2 cm, are improperly treated. Therefore, more effective methods are required to better assess the depth of the lesion before treatment.

AIM

To explore potential markers of small colorectal cancer early invasion under white light endoscopy, providing patients with better treatment alternatives.

METHODS

This retrospective cross-sectional study included 198 consecutive patients [233 early colorectal cancers (ECCs)] who underwent endoscopy or surgical procedures at the Digestive Endoscopy Center of Chengdu Second People’s Hospital between January 2021 and August 2022. The participants had pathologically confirmed colorectal cancer with a lesion diameter < 2 cm and received endoscopic or surgical treatment, including endoscopic mucosal resection and submucosal dissection. Clinical pathology and endoscopy parameters, including tumor size, invasion depth, anatomical position, and morphology, were reviewed. Fisher’s exact test, the χ² test, and Student’s t-test were used to analyze the patient’s basic characteristics. Logistic regression analysis was used to examine the relationship between morphological characteristics, size, CSM prevalence, and ECC invasion depth under white light endoscopy. Statistical significance was set at P < 0.05.

RESULTS

The submucosal carcinoma (SM stage) was larger than the mucosal carcinoma (M stage) with a significant difference (17.2 ± 4.1 vs 13.4 ± 4.6 mm, P < 0.01). M- and SM-stage cancers were common in the left colon; however, no significant differences were found between them (151/196, 77% and 32/37, 86.5%, respectively, P = 0.199). The endoscopic features of colorectal cancer revealed that CSM, depressed areas with clear boundaries, and erosion or ulcer bleeding were more common in the SM-stage cancer group than in the M-stage cancer group (59.5% vs 26.2%, 46% vs 8.7%, and 27.3% vs 4.1%, respectively, P < 0.05). CSM prevalence in this study was 31.3% (73/233). The positive rates of CSM in flat, protruded, and sessile lesions were 18% (11/61), 30.6% (30/98), and 43.2% (32/74), respectively, with significant differences (P = 0.007).

CONCLUSION

CSM-related small colorectal cancer was primarily located in the left colon and could be a predictive marker of submucosal invasion in the left colon.

Characteristics and potential malignancy of colorectal juvenile polyps in adults: a single-center retrospective study in China

BACKGROUND

Colorectal juvenile polyps are rare and generally considered benign in adults. Carcinogenesis or neoplastic changes are rarely mentioned in the literature. We systematically evaluated the characteristics and potential malignancy of colorectal juvenile polyps in adults.

METHODS

We retrospectively reviewed the medical records of 103 adults diagnosed with colorectal juvenile polyps from September 2007 to May 2020 at our hospital. The characteristics, endoscopic findings, occurrence of intraepithelial neoplasia, carcinogenesis and diagnostic value of chicken skin mucosa (CSM) were analyzed.

RESULTS

The average age of patients with juvenile polyps was 43.2 years (range, 19 to 78 years). A total of 101 patients (101/103, 98.1%) had a single juvenile polyp, and two patients had multiple polyps (107 polyps in total). Polyp sizes ranged from 0.5 to 5 cm. One (1/107, 0.9%) juvenile polyp was cancerous, and 7 (7/107, 6.5%) developed low-grade intraepithelial neoplasia. Neoplasia and cancerization did not appear in the two patients with multiple polyps. A 27-year-old female had a 2-cm polyp with well-differentiated adenocarcinoma in the mucosa in the sigmoid colon with erosion on the surface. CSM was observed adjacent to 17 polyps, which were all located in the rectum and sigmoid colon, and one polyp showed low-grade intraepithelial neoplasia.

CONCLUSIONS

Colorectal juvenile polyps occur in a wide range of locations and in variable sizes and numbers. These polyps are solitary in most patients and have neoplastic potential. CSM is not a tumorigenic marker in colorectal juvenile polyps and usually occurs in the distant colorectum. Colorectal juvenile polyps in adults may progress from low-grade intraepithelial neoplasia to high-grade intraepithelial neoplasia and then to carcinoma and should be treated when discovered and regularly followed as colorectal adenomas.

Mucosa color and size may indicate malignant transformation of chicken skin mucosa-positive colorectal neoplastic polyps

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.