Omori Kaoru, Yoshida Kanako, Tamiya Sadafumi, Daa Tsutomu, Kan Masahiro
Department of Gastroenterology and Hepatology, Sato Daiichi Hospital, 77-1 Hokyoji, Usa, Oita 879-0454, Japan.
Department of Pathology, Kitakyushu Medical Center, 2-1-1 Bashaku, Kitakyushu, Fukuoka 802-0077, Japan.
Case Rep Gastrointest Med. 2016;2016:6576351. doi: 10.1155/2016/6576351. Epub 2016 Jun 29.
A sessile serrated adenoma/polyp (SSA/P) with cytological dysplasia in the right colon, which transformed to an invasive submucosal adenocarcinoma finally, was endoscopically observed in a 76-year-old woman. A whitish soft SSA/P (approximately 25 mm in diameter) was detected in the cecum. Biopsy samples were obtained from the small nodule, and the lesion was eventually diagnosed as an SSA/P with cytological dysplasia, considering endoscopic observations, among which the narrow-band imaging features suggested that the lesion was adenomatous, that is, a round-oval pattern, and hyperplastic, that is, comprising a circular pattern with dots and an invisible capillary vessel. After 11 months, an SSA/P had rapidly developed into a submucosal adenocarcinoma with lymphatic infiltrations, and the most aggressive deep invasion was observed in the central depression. This case suggests that right-side SSA/Ps with cytological dysplasia should be removed immediately, considering the potential for rapid progression to a larger size and eventually to deep and extensive cancer.
一名76岁女性接受了内镜观察，其右半结肠有一个伴有细胞学异型增生的无蒂锯齿状腺瘤/息肉（SSA/P），最终转变为浸润性黏膜下腺癌。在盲肠发现一个白色柔软的SSA/P（直径约25毫米）。从小结节处获取活检样本，结合内镜观察结果，最终诊断为伴有细胞学异型增生的SSA/P，其中窄带成像特征提示病变为腺瘤性，即呈圆形-椭圆形模式，且为增生性，即由带点状的圆形模式和不可见的毛细血管组成。11个月后，一个SSA/P迅速发展为伴有淋巴浸润的黏膜下腺癌，在中央凹陷处观察到最具侵袭性的深度浸润。该病例表明，考虑到伴有细胞学异型增生的右侧SSA/P有迅速增大并最终发展为深部广泛癌症的可能性，应立即将其切除。
