PMC10169570_01
(A) A whitish superficial flat lesion with scattered reddish spots was discovered with WLI. (B,C) Lesion observed under NBI. (D,E) Hematoxylin and eosin staining of biopsy specimens, and (F) Immunochemistry stained by Ki-67, in which the Ki-67 positive proliferating cells are more than half of the epithelial layer. (G) Immunochemistry stained by P16.
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When observing the anal canal using white light, a whitish superficial flat (0-IIb) lesion with scattered reddish spots was discovered (Figure 1A). In NBI without magnification, a 6 x 5 mm well-demarcated brownish lesion with dark brown dots was identified (Figures 1B,C). The biopsy was pathologically diagnosed to be HSIL (Figures 1D,E), with Ki-67 positive proliferating cells in more than half of the epithelial layer (Figure 1F) and P16 protein positive in immunochemistry (Figure 1G), which would have a good prognosis if successfully resected.
(A,B) Lesion observed with NBI (A) and ME-NBI (B) before ESD. (C) Lesion observed after iodine spraying. (D,E) Operation procedure of ESD. (F) Specimen resected by ESD (after iodine spraying). (G-I) Colonoscopy follow-up pictures 1 year after ESD.
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The ME-NBI endoscopy was conducted, and we found a lesion with a clear margin and tortuous dilated vessels usually seen in early SCC of the esophagus (Figures 2A,B). After iodine spraying, the lesion stayed to be unstained, and the margin could be seen more clearly (Figure 2C). ESD was performed to resect the lesion en bloc (Figures 2D-F). After 1 year of the endoscopic treatment, colonoscopy follow-up was performed, and no suspicious lesions were found (Figures 2G-I), and the abdominal enhanced CT follow-up revealed no suspicious malignant lymph nodes or lesions.
(A,B) Resected specimen (16 x 9 mm) sectioned at 2 mm intervals, and the red lines indicate LSIL areas. (C,D) Hematoxylin and eosin staining. (E) Immunochemistry stained by Ki-67, in which the Ki-67 positive proliferating cells are less than half of the epithelial layer. (F) Immunochemistry stained by P16.
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The resected specimen (16 x 9 mm) was sectioned at 2 mm intervals (Figure 3A), and the pathological examination revealed that the specimen resected was LSIL (Figures 3B-D) with Ki-67 positive proliferating cells less than half of the epithelial layer (Figure 3E) and P16 protein positive in immunochemistry (Figure 3F), with both vertical and horizontal margins free of tumor.
Timeline and corresponding events.
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The timeline and corresponding events of the patient's diagnosis and treatment process are displayed in Figure 4.