Akimoto Yoshika, Kudo Shin-Ei, Ichimasa Katsuro, Kouyama Yuta, Misawa Masashi, Hisayuki Tomokazu, Kudo Toyoki, Nemoto Tetsuo
Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Japan.
Department of Pathology, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Japan.
World J Gastrointest Endosc. 2020 Sep 16;12(9):304-309. doi: 10.4253/wjge.v12.i9.304.
Endocytoscopy is a next-generation endoscopic system that facilitates real-time histopathologic endoscopic diagnosis of colorectal lesions by virtue of its 520 × maximum magnification.
We present the case of a 63-year-old man with sigmoid colon cancer who was regularly referred for follow-up colonoscopy after endoscopic resection of T1 rectal cancer. Colonoscopy revealed a 12 mm reddish polyp, including a depression and a flat area in the sigmoid colon. Endocytoscopic observation showed unclear gland formation and agglomeration of distorted nuclei (depression), suggesting a submucosal invasive (T1) cancer. In the flat area, slit-like smooth lumens and regular pattern of fusiform nuclei were found, suggesting an adenoma. On the basis of these endocytoscopic findings, we predicted this lesion as T1 cancer (depression) with adenoma (flat area) and performed endoscopic resection corresponding to the final histopathological diagnosis.
We could perform an optical diagnosis of T1 sigmoid cancer with adenoma by using endocytoscopy before treatment.
内镜超声是一种新一代内镜系统，凭借其520倍的最大放大倍数，有助于对结直肠病变进行实时组织病理学内镜诊断。
我们报告一例63岁乙状结肠癌男性患者，该患者在T1期直肠癌内镜切除术后定期接受结肠镜随访。结肠镜检查发现乙状结肠有一个12毫米的红色息肉，包括一个凹陷和一个平坦区域。内镜超声观察显示腺体形成不清晰以及核变形聚集（凹陷处），提示黏膜下浸润性（T1）癌。在平坦区域，发现了裂隙状光滑管腔和梭形核的规则排列，提示为腺瘤。基于这些内镜超声检查结果，我们将该病变预测为伴有腺瘤（平坦区域）的T1期癌（凹陷处），并根据最终组织病理学诊断进行了内镜切除。
我们可以在治疗前通过内镜超声对伴有腺瘤的T1期乙状结肠癌进行光学诊断。
