PMC2800000_01
Air contrast barium enema showed multiple thumbprint-like lesions (arrows), ranging from 7 to 20 mm in diameter, mainly in the ascending colon.
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F1
On the air contrast barium enema, multiple thumbprint-like lesions ranging from 7 to 20 mm in diameter were observed from the cecum to the hepatic flexure, mainly in the ascending colon (Fig. 1).
Endoscopic views of a cluster of elevated lesions, with a smooth surface and gentle slope, in the ascending colon. (A, B) The overlying mucosa was intact and appeared thin, and the lesion was soft and compressible.
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F2
The colonoscopy revealed clusters of round submucosal tumors with a gentle slope and smooth surface from the cecum to the hepatic flexure (Fig. 2).
EUS images of the colon, obtained with a catheter EUS probe (frequency 12 MHz). (A) The EUS image depicting elevated lesions as echo-free cysts (arrowheads) in the submucosal layer. (B) Some submucosal cysts had septal walls (arrows).
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F3
The EUS was performed with a radial scanning catheter probe (12 MHz, Fujinon Inc., Saitama, Japan) that showed each of the submucosal lesions as an echo-free cyst, with a clear border, in the submucosal layer (Fig. 3A). The inner structure was uniform and some of the cysts had septal walls (Fig. 3B).
Microscopic findings. (A) Endoscopic biopsy revealed submucosal cyst with occasional multinucleated cells (inset), however, there were no fat or blood cell components (H&E, x20; inset: H&E, x400). (B) D2-40 immunostaining showed positive reactivity (arrows) for lining endothelial cells of lymphatic spaces (Polymer method, x200).
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F4
The endoscopic biopsy revealed a submucosal cyst with occasional multinucleated cells; however, there were no fat or blood cell components (Fig. 4A). The D2-40 immunostaining, which is a specific lymphatic endothelial marker, showed positive reactivity for lining endothelial cells of the lymphatic spaces (Fig. 4B).