2021 Volume 63 Issue 6 Pages 1262-1268
A 63-year-old woman underwent lower gastrointestinal endoscopy at a local clinic, which revealed a 25-mm-sized 0-Ⅱa lesion in the cecum. Biopsy examination revealed a well-to-moderately differentiated adenocarcinoma, and the patient was referred to our hospital for medical treatment. Narrow-band imaging magnified observation revealed a glandular duct with an uneven caliber; it also revealed an abnormal blood vessel running in two ridges of redness, in which the abnormal blood vessel was more prominent in areas with strong redness. On magnified observation with crystal violet, the two red ridges were found to have type VI irregular pits and the surrounding surface ridges were found to have type Ⅱ pits. Based on the above findings, we diagnosed intramucosal cancer associated with a sessile serrated lesion and performed endoscopic submucosal dissection. The pathological diagnosis was a 4 mm×3 mm mucosal cancer and 3 mm×2 mm submucosal cancer against the background of a sessile serrated lesion. Since the submucosal layer infiltrated the part containing poorly differentiated components, additional surgery was performed. No residual cancer or tumor components or lymph node metastasis was observed. This was an interesting case where cancerous changes were observed in two places in a single lesion with submucosal infiltration.
