On-Demand Library

Filter

Colorectal Cases

Add to View

Home
Gastroenterology
EVIS X1 Atlas
Colorectal Cases

Table of Contents

Disclaimer

The techniques and clinical opinions presented in this material reflect the personal experience and professional judgment of the healthcare professional and do not necessarily represent the views of Olympus. This material is intended for healthcare professionals only. Users should always refer to the applicable Instructions for Use (IFU) and use Olympus products in accordance with the approved indications and local regulatory requirements. The healthcare professional presenting this material has been engaged by Olympus and compensated at fair market value for their services.

Colorectal Case 36

Yasushi Sano^1.2

MD, PhD, FJGES, and ANBIIG ³

Clinical Professor, Kansai Medical University Osaka, Japan
Director & Chief of Gastrointestinal Center Sano Hospital, Kobe, Japan
Secretary, Asian Novel Bio-Imaging and Intervention Group

Procedure information

Scope: CF-EZ1500DI

Case: Detection 0-IIa, SSL with CD

Site of lesion: Sigmoid colon

Patient information: F, 70s

Medical history: FOBT+

1. WLI

On white-light imaging, a superficially flat lesion is seen at the sigmoid colon/sigmoid-descending junction, showing loss of normal vascular transparency while remaining nearly isochromatic with the surrounding mucosa.

2. TXI

With TXI, the lesion surface is more clearly appreciated, revealing multiple small nodular elevations of varying size.

3. NBI

On NBI, the lesion shows characteristic surface findings, including white dots and black dots. The vascular pattern is not clearly visible, and focal whitish changes are observed on the lesion surface.

4. NBI+TXI

On NBI-TXI, subtle brownish change is appreciated in the nodular components; however, the vascular pattern remains indistinct.

5. NBI+TXI

Magnifying NBI demonstrates the surface pattern more clearly, with distinct white dots and black dots, while no clear vascular pattern is observed.

6. NBI+TXI

Magnifying NBI-TXI shows similar surface findings, with more prominent whitish change on the lesion surface. Based on these findings, the lesion was diagnosed as JNET Type 1.

7. Chromoendoscopy

Indigo carmine chromoendoscopy clearly delineates the lateral extent of the lesion, allowing a macroscopic diagnosis of laterally spreading tumor, granular type (LST-G).

8. Chromoendoscopy

The elevated nodular component shows a Kudo type II pit pattern.

9. Chromoendoscopy

The flat component also demonstrates a Kudo type II pit pattern.

10. Pathological image

11. Pathological diagnosis

Pathological diagnosis: IIa, 32mm, Sigmoid colon SSL with cytological dysplasia (SuSA with traditional serrated adenoma-like appearance)

12. Pathological image

Case Video

Overall Comment

This case demonstrates a 32-mm sigmoid colon lesion that appeared macroscopically as LST-G, but was histologically diagnosed as SSL with cytological dysplasia (SuSA with traditional serrated adenoma-like appearance). On white-light imaging, the lesion was relatively subtle because it was nearly isochromatic with the surrounding mucosa, and loss of vascular transparency was an important clue to detection. TXI improved recognition of the lesion by highlighting multiple small nodular elevations of varying size. On NBI and magnifying NBI, the lesion was characterized by surface findings such as white dots and black dots, while the vascular pattern remained indistinct. Magnifying NBI-TXI further emphasized the whitish surface change, and the lesion was optically diagnosed as JNET Type 1. Indigo carmine chromoendoscopy clearly delineated the lesion extent and allowed a macroscopic diagnosis of LST-G, while magnification showed a Kudo type II pit pattern in both elevated and flat areas. This highly educational case illustrates that SuSA/SSL with cytological dysplasia may present as an LST-G-like lesion, and that careful assessment of surface morphology is essential for accurate endoscopic characterization.

* Specifications, design and accessories are subject to change without any notice or obligation on the part of the manufacturer.

Cases 35: Detection
Prof. Yasushi Sano Cases 37:Characterization JNET 2B
Prof. Yasushi Sano

Keyword