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Submucosal Invasive Cancer of a Serrated Adenoma Origin with Gross Morphological Changes over 3.5 Years, Report of a Case Kazuo Nagura 1 , Akihiko Sugiyama 2 , Eiichi Tomita 2 , Tetsuya Yamada 3 , Junji Nagano 4 , Sachiyo Onishi 5 , Takehiko Sugie 1 , Kengo Ogawa 1 , Tomomichi Matsushita 1 , Yuji Takahashi 1 , Yoichiro Ito 1 1Department of Gastroenterology, Gifu Red Cross Hospital, Gifu, Japan 2Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan 3Pathology Diagnostic Center, Kizawa Memorial Hospital, Minokamo, Japan 4Department of Gastroenterology, Hashima City Hospital, Hashima, Japan 5Internal medicine, Seki Chuo Hospital, Seki, Japan Keyword: 大腸鋸歯状病変 , SSA/P , 早期大腸癌 pp.1196-1206
Published Date 2015/8/25
DOI https://doi.org/10.11477/mf.1403200391
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 A male patient in his 60's exhibited a 10mm Type Is+IIc lesion in his transverse colon that was found by a colonoscopy performed after a positive fecal occult blood test. Type II and type IIIL pits with serrated structures were found in most of the type Is area, and a type II pit with a dilated crypt orifice was observed on the oral side of the lesion by magnifying colonoscopy. Small irregular pits were found in the depressive area, and we diagnosed the pit pattern as VI pits with high-grade irregularities. We considered the lesion to be a cancer of serrated lesion origin. Before treatment, we found no sign of deep submucosal invasion by endoscopic ultrasonography. Endoscopic mucosal resection was performed. The lesion was 10mm in the resected specimen, and a small depressive area was recognized in the lateral part of the lesion. A moderately differentiated tubular adenocarcinoma with submucosal invasion(800μm)was pathologically diagnosed, and a mucinous lake was recognized in the deeper region of the submucosal layer. Serrated ducts with branches and mild dilatation were found in the non-cancerous area, and those findings were equivalent to sessile serrated adenoma. We recognized a hyperplastic lesion that was type IIa with type II pits in the same location in the transverse colon as in the lesion that was observed by the colonoscopy performed 3.5 years ago. This lesion was diagnosed to be an early colorectal cancer of a sessile serrated adenoma origin. This case exhibited confirmed morphological changes over time to colon cancer that was derived from a serrated lesion.


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