PMC9772830_01
Endoscopic manifestation. (A) White light endoscopy (WLE) shows an elevated red and smooth lesion that is covered with normal mucosa and looks like a polyp. (B) Endoscopic narrow-band image (NBI) shows an elevated lesion with cyan change. (C) Indigo carmine dyeing shows a clear demarcation line and a slightly irregular shape. (D) and (E) Magnifying endoscopy with NBI shows broadened intervening parts (intercrypt regions), an elongated pit, and a dense microvascular network with focal irregularity.
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White light endoscopy (WLE) showed that the elevated lesion was smooth and reddish, covered with normal mucosa, and looked like a polyp ( Figure 1A ). The endoscopic narrow-band image (NBI) showed that the elevated lesion presented as cyan change ( Figure 1B ). Indigo carmine dyeing showed a clear demarcation line and a slightly irregular surface pattern ( Figure 1C ). Magnifying endoscopy with NBI (ME-NBI) showed broadened intervening parts (intercrypt regions), an elongated pit, and a dense microvascular network with focal irregularity ( Figures 1D, E ).
Pathohistologic manifestation. (A) The resected specimen. The stars represent the sites of four-quadrant biopsies. The red lines represent lesion areas in each slice. Oral is the oral margin of the specimen. Anal is the anal margin of the specimen. (B) Pathohistology shows pure signet ring cell carcinoma. The basement of the lesion is occupied by dense fundus glands, and signet ring cell carcinoma cells grow into the lumen to form an elevated lesion. (C) Positive PAS staining. (D) Negative MUC-2 staining. (E) Diffusely positive MUC-5AC staining. (F) Positive Ki-67 staining of 30%. The intense ki67 stain on a deep gland on the far right of the panel is just the proliferative end of the bottom of the crypt. (G) Positive P53 staining.
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Anal is the anal margin of the specimen ( Figure 2A ). The basement of the lesion was occupied by dense fundus glands, and the cancer cells grew into the lumen and formed an elevated lesion ( Figure 2B ) with the characteristics of a gastric phenotype. There were positive Periodic acid-schiff (PAS) staining ( Figure 2C ), negative for mucin mucin 2 (MUC-2) ( Figure 2D ), diffusely positive for mucin (MUC)-5AC ( Figure 2E ), the Ki-67 level of 30% ( Figure 2F ), and positive P53 staining ( Figure 2G ).