PMC9929658_01
Lifting agent granuloma in a 58-year-old female (Case 1). (A) Gross pathology specimen, cross section of colonic wall with lesion. (B) Lifting agent granuloma underlying residual invasive adenocarcinoma (hematoxylin & eosin, 40x).
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Upon gross pathological evaluation, a well-defined raised sub-mucosal solid yellow-tan lesion (1.2 cm x 1.1 cm x 0.8 cm) was noted extending to the original distal staple line (Figure 1A). Histological evaluation revealed a submucosal microscopic focus of residual adenocarcinoma measuring 1.0 mm in maximum dimension with an underlying mass-forming lifting agent granuloma measuring 1.2 cm in maximum dimension (Figure 1B).
PMC9929658_02
Lifting agent granuloma in a 61-year-old male (Case 2). (A) Gross pathology specimen, cross section of colonic wall with lesion. (B) Lifting agent granuloma underlying residual adenoma (hematoxylin & eosin, 40x). (C) Sub-serosal blood vessel infiltration by lifting agent granuloma (hematoxylin & eosin, 40x). (D) Positive smooth muscle actin immunohistochemical staining highlighting the muscular wall of sub-serosal blood vessel involved by lifting agent granuloma (immunohistochemistry, 100x).
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Gross pathological evaluation revealed an ill-defined mass (1.6 cm x 1.4 cm) that appears to invade the muscularis propria and abuts to the serosa (Figure 2A). Histological examination revealed a mass-forming lifting agent granuloma at the hepatic flexure with overlying residual adenoma (Figure 2B). Small discrete sub-serosal nodules were noted and represented involvement of blood vessels by the granulomatous process (Figure 2C). Positive immunohistochemical staining for smooth muscle actin (SMA) highlights the muscular wall of involved blood vessels (Figure 2D).
PMC9929658_03
Lifting agent granuloma in a 65-year-old male (Case 3). (A) Gross pathology specimen, cross section of colonic wall with lesion. (B) Sub-serosal blood vessel infiltration by lifting agent granuloma (hematoxylin & eosin, 40x). (C) Positive smooth muscle actin immunohistochemical staining highlighting the muscular wall of sub-serosal blood vessel involved by lifting agent granuloma (immunohistochemistry, 100x).
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Subsequent pathological evaluation revealed an ill-defined tan mass (2.8 cm x 2.0 cm x 0.8 cm) within the ascending colon (Figure 3A). The lesion extended into the subserosa and involved a sub-serosal blood vessel (Figure 3B). Positive immunohistochemical staining for SMA highlights the muscular wall of the involved blood vessel (Figure 3C).