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Sessile Serrated Lesion of the Rectum in Ulcerative Colitis Observed by Image-Enhanced Endoscopy

Sessile Serrated Lesion of the Rectum in Ulcerative Colitis Observed by Image-Enhanced Endoscopy THE RED SECTION 771 Image Sessile Serrated Lesion of the Rectum in Ulcerative Colitis Observed by Image-Enhanced Endoscopy 1 1 2 2 1 Keisuke Kawasaki, MD , Shinichiro Kawatoko, MD , Hidetaka Yamamoto, MD and Takehiro Torisu, MD Am J Gastroenterol 2023;118:771. https://doi.org/10.14309/ajg.0000000000002175; published online December 30, 2022 A 74-year-old woman with a 42-year history of extensive ulcerative colitis (UC) was referred to surveillance colonoscopy. Colonoscopy showed a pale reddish and slightly elevated lesion whose left side margin is unclear in the lower rectum (a, black arrows). Texture and color enhancement imaging (TXI) made the boundary clear (a, white arrows). Magnifying endoscopy with narrow-band imaging revealed expanded crypt openings and branching surface structure, and magnifying chromoendoscopy with the use of crystal violet solutions revealed star-like and round-open pit pattern (b). The lesion was subsequently removed by endoscopic submucosal dissection. Histologic examination of the resected specimen showed that the lesion, measuring 8 3 8 mm in size, consisted of serrated crypts with dilation and slightly irregular branching (c). By molecular analysis, the tumor cells were positive for KRAS mutation. We diagnosed this case as rectal sessile serrated lesion (SSL) with KRAS mutation arising in UC. It has been known that SSLs will be encountered in UC. Although TXI is novel image-enhanced endoscopy (IEE), those usefulness for SSL in UC is unknown. Our case suggests that the combination of conventional IEE including magnifying endoscopy with narrow-band imaging and magnifying chromoendoscopy, and novel IEE including TXI may be invaluable for the diagnosis of SSL in UC. (Informed consent was obtained from the patient to publish these images.) 1 2 DepartmentofMedicineand Clinical Science,Graduate School of MedicalSciences, Kyushu University, Fukuoka, Japan; Department ofAnatomicPathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Correspondence: Keisuke Kawasaki, MD. E-mail: kawasaki.keisuke.084@m.kyushu-u.ac.jp. © 2023 by The American College of Gastroenterology The American Journal of GASTROENTEROLOGY Copyright © 2023 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Gastroenterology Wolters Kluwer Health

Sessile Serrated Lesion of the Rectum in Ulcerative Colitis Observed by Image-Enhanced Endoscopy

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Publisher
Wolters Kluwer Health
Copyright
© 2023 by The American College of Gastroenterology
ISSN
0002-9270
eISSN
1572-0241
DOI
10.14309/ajg.0000000000002175
Publisher site
See Article on Publisher Site

Abstract

THE RED SECTION 771 Image Sessile Serrated Lesion of the Rectum in Ulcerative Colitis Observed by Image-Enhanced Endoscopy 1 1 2 2 1 Keisuke Kawasaki, MD , Shinichiro Kawatoko, MD , Hidetaka Yamamoto, MD and Takehiro Torisu, MD Am J Gastroenterol 2023;118:771. https://doi.org/10.14309/ajg.0000000000002175; published online December 30, 2022 A 74-year-old woman with a 42-year history of extensive ulcerative colitis (UC) was referred to surveillance colonoscopy. Colonoscopy showed a pale reddish and slightly elevated lesion whose left side margin is unclear in the lower rectum (a, black arrows). Texture and color enhancement imaging (TXI) made the boundary clear (a, white arrows). Magnifying endoscopy with narrow-band imaging revealed expanded crypt openings and branching surface structure, and magnifying chromoendoscopy with the use of crystal violet solutions revealed star-like and round-open pit pattern (b). The lesion was subsequently removed by endoscopic submucosal dissection. Histologic examination of the resected specimen showed that the lesion, measuring 8 3 8 mm in size, consisted of serrated crypts with dilation and slightly irregular branching (c). By molecular analysis, the tumor cells were positive for KRAS mutation. We diagnosed this case as rectal sessile serrated lesion (SSL) with KRAS mutation arising in UC. It has been known that SSLs will be encountered in UC. Although TXI is novel image-enhanced endoscopy (IEE), those usefulness for SSL in UC is unknown. Our case suggests that the combination of conventional IEE including magnifying endoscopy with narrow-band imaging and magnifying chromoendoscopy, and novel IEE including TXI may be invaluable for the diagnosis of SSL in UC. (Informed consent was obtained from the patient to publish these images.) 1 2 DepartmentofMedicineand Clinical Science,Graduate School of MedicalSciences, Kyushu University, Fukuoka, Japan; Department ofAnatomicPathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Correspondence: Keisuke Kawasaki, MD. E-mail: kawasaki.keisuke.084@m.kyushu-u.ac.jp. © 2023 by The American College of Gastroenterology The American Journal of GASTROENTEROLOGY Copyright © 2023 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited.

Journal

American Journal of Gastroenterology – Wolters Kluwer Health

Published: May 30, 2023

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