A Ⅱa＋Ⅱc-LIKE ILEAL ADENOMA SUCCESSFULLY TREATED BY ENDOSCOPIC MUCOSAL RESECTION (WITH A VIDEO)

Abstract

Adenomas develop only rarely in the ileum, and Ⅱa＋Ⅱc-like ileal adenomas are extremely rare. Therefore, there is no standardized diagnostic and therapeutic method for Ⅱa＋Ⅱc-like ileal adenomas. A 65-year-old man with an unremarkable family history was referred to our hospital to identify the cause of fecal occult blood. Colonoscopy revealed a Ⅱa＋Ⅱc-like tumor of 23 mm in diameter, located in the terminal ileum 10 cm proximal to the ileocecal valve. The diagnosis was further confirmed using narrow-band imaging with magnifying endoscopy (NBI-ME), which revealed a type 2A colorectal lesion according to the classification of the Japan NBI Expert Team (JNET) and which had histopathological findings of adenoma or low-grade mucosal cancer. Pathological examination of a biopsy specimen taken from the depressed part of the lesion revealed tubular adenoma with high-grade atypia. En bloc resection was achieved by endoscopic mucosal resection (EMR) without any adverse events, and complete resection was proven histopathologically. Surveillance endoscopy was performed one year after EMR, and there were no findings of recurrence. For suspected Ⅱa＋Ⅱc-like tumors in the ileum, NBI-ME and EMR should be considered.