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Colorectal Case 17

Dr. Serhii Polishchuk
Gastrointestinal endoscopist at LLC “GASTROCENTER” Olymed; Trainer at NGO “EndoAcademy”, Ukraine

Procedure Information

Scope: CF-XZ1200I

Case Findings: Tubular adenoma with LGD – JNET2A

Organ: Colon (ascending colon)

Patient information: 76y.o. male, follow-up after previous colonoscopy with polypectomy (5 years ago)

Medical history: No family history of CRC. No alcohol abuse, no smoking.

1. Tubular adenoma with LGD

TXI light observation (slightly elevated lesion with slightly depressed component), the central area looks like valley sign

Texture and Color Enhancement Imaging (TXI): Mode 1

2. Tubular adenoma with LGD

NBI observation (panoramic view), the central area looks like valley sign

NBI Color Mode 3
Enhancement: B8

3. Tubular adenoma with LGD

NBI observation (panoramic view), the central area looks like valley sign

NBI Color Mode 3
Enhancement: B8

4. Tubular adenoma with LGD

NBI observation + optical magnification (vessel pattern - regular caliber of vessels and regular distribution of meshed vessels; regular tubular surface pattern: central part - Kudo IIIs, peripheral part - Kudo IIIL)

NBI Color Mode 3
Enhancement: B8

5. Tubular adenoma with LGD

NBI observation + optical magnification (vessel pattern - regular caliber of vessels and regular distribution of meshed vessels; regular tubular surface pattern: central part – Kudo IIIs, peripheral part - Kudo IIIL)

NBI Color Mode 3
Enhancement: B8

6. Tubular adenoma with LGD

NBI observation + optical magnification (vessel pattern - regular caliber of vessels and regular distribution of meshed vessels; regular tubular surface pattern: central part - Kudo IIIs, peripheral part - Kudo IIIL)

NBI Color Mode 3
Enhancement: B8

7. Tubular adenoma with LGD

NBI observation + optical magnification (vessel pattern - regular caliber of vessels and regular distribution of meshed vessels)

NBI Color Mode 3
Enhancement: B8

8. Tubular adenoma with LGD

NBI observation + optical magnification (vessel pattern - regular caliber of vessels and regular distribution of meshed vessels)

NBI Color Mode 3
Enhancement: B8

9. Tubular adenoma with LGD

NBI observation + optical magnification (vessel pattern - regular caliber of vessels and regular distribution of meshed vessels)

NBI Color Mode 3
Enhancement: B8

10. Tubular adenoma with LGD

NBI observation + ultra high optical magnification (zoom ~x135): vessel pattern - regular caliber of vessels and regular distribution of meshed vessels

NBI Color Mode 3
Enhancement: B8

11. Tubular adenoma with LGD

TXI light observation + indigo carmine (slightly elevated lesion with slightly depressed component), the central area looks like valley sign

Texture and Color Enhancement Imaging (TXI): Mode 1

12. Tubular adenoma with LGD

TXI light observation + optical magnification + indigo carmine (regular tubular surface pattern - Kudo IIIL)

Texture and Color Enhancement Imaging (TXI): Mode 1

13. Tubular adenoma with LGD
TXI light observation - endoscopic mucosal resection specimen

Texture and Color Enhancement Imaging (TXI): Mode 1

14. Tubular adenoma with LGD
NBI observation - endoscopic mucosal resection specimen

NBI Color Mode 3
Enhancement: B8

Case Video

Tubular adenoma with LGD - JNET2A

Overall Comment

The final optical diagnosis in this case was:

Location: ascending colon

Size: ~18mm

Morphology (Paris classification): 0-ІIa+IIc

Pit pattern: IIIL+IIIs (Kudo classification: tubular pit pattern)

JNET classification: JNET2A (vessel pattern – regular caliber of vessels and regular distribution of meshed vessels; regular tubular surface pattern)

Optical diagnosis: Tubular adenoma with LGD

Treatment: endoscopic mucosal resection (EMR)

Pathology report: Tubular adenoma with low grade dysplasia (ICD-O code: 8211/0). No signs of cytological dysplasia in resection margins (complete removal).

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

Case 16: SM deep invasive cancer of colon - JNET3
Dr. Serhii Polishchuk Case 18: Tubular adenoma with LGD - JNET2A
Dr. Serhii Polishchuk
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