PMC5348453_01
Colonoscopy showing multiple laterally spreading tumors, non-granular type, located in every part of the colorectum: (a) ascending colon, (b) ascending colon, (c) transvers colon, (d) descending colon, (e) sigmoid colon, and (f) sigmoid colon.
1349-7235-56-0295-g001.jpg
PMC5348453_01_1349-7235-56-0295-g001.jpg
g001
On colonoscopy, we found more than 10 laterally spreading tumors-nongranular (LST-NGs), some of them >20 mm in size, and countless small (<10 mm), flat neoplasms in every part of the colorectum (Fig. 1).
(a) White-light views of the rectal tumor. Type 0-Is+IIa. (b) Chromoendoscopy view using indigo carmine. (c) Magnified view of narrow band imaging showing irregular thick vessels. (d) Magnified view with crystal violet dye showing Type VN. (e) Histological findings of the rectal tumor resected by endoscopic submucosal dissection (x20), which show well-differentiated adenocarcinoma in adenoma, pT1b (SM 2,200 mum), LY1, V1, HM0, VM0.
1349-7235-56-0295-g002.jpg
PMC5348453_01_1349-7235-56-0295-g002.jpg
g002
Some were suspected of being adenocarcinoma in situ based on magnifying colonoscopy findings, and one tumor located in the lower rectum, which had not been pointed out on previous colonoscopy, was strongly suspected of being invasive cancer (Fig. 2). Histology showed moderately differentiated adenocarcinoma with vascular and submucosal invasion (2,200 mum in depth) (Fig. 2).
Views of the resected specimen of the colorectum showing multiple flat neoplasms in each section (red circles contain LST-NG): (a) Ascending colon, (b) transverse colon to descending colon, and (c) sigmoid colon to rectum.
1349-7235-56-0295-g003.jpg
PMC5348453_01_1349-7235-56-0295-g003.jpg
g003
Finally, proctocolectomy with ileal pouch-anal anastomosis was performed (Fig. 3). The surgically resected specimen showed dozens of LST-NGs, some of which were pathologically diagnosed as well-differentiated intramucosal adenocarcinomas, and the rest were diagnosed as adenomas with high-grade dysplasia (Fig. 3).
Immunohistochemical staining for p53. (x20) (a) Rectal adenocarcinoma with submucosal invasion, as in Fig. 2e, (b) one of the LST-NGs in the transverse colon showing tubular adenoma with severe atypia.
1349-7235-56-0295-g004.jpg
PMC5348453_01_1349-7235-56-0295-g004.jpg
g004
Strong positive immunohistochemical staining of p53 was found in every part of all neoplasms, including both adenocarcinomas (Fig. 4a) and adenomas (Fig. 4b).
Hematoxylin and Eosin (H&E) staining and immunohistochemical staining for p53 of apparently normal mucosa (a), H&E staining (x20); mucosa without depression or elevation (b), H&E staining (x40); the ductal epithelium is apparently normal for H&E staining (c), (d) immunohistochemical staining for p53. (c): (x20) (d): (x40); Some parts of the ductal epithelium had positive p53 staining.
1349-7235-56-0295-g005.jpg
PMC5348453_01_1349-7235-56-0295-g005.jpg
g005
Some parts of the ductal epithelium of mucosa without elevation or depression and that were apparently normal by Hematoxylin and Eosin (HE) staining (Fig. 5a and b) also had positive p53 staining (Fig. 5c and d).