PMC10017118_01
Endoscopic findings and histopathologic findings of the resected specimen. (A) Screening colonoscopy image shows a diffuse flat elevated lobular mucosal lesion resembling a starry sky with a yellow-colored patch in the transverse colon. (B) Colonoscopy with the distal attachment shows a 5.0 cm x 2.5 cm yellowish laterally spreading tumor in the transverse colon. (C) Chromo-endoscopy with indigo carmine shows the lesion clearly distinguished from the surrounding area. (D) The lesion was completely removed by endoscopic submucosal dissection using a dual knife without complications. (E) Gross specimen resected is divided into five sections. (F) Mapping of the resected specimen: low-grade tubular adenoma is visible at Segments 2 and 3 (red color) with xanthoma spreading diffusely over the entire segment (yellow color). (G) and (H) Histopathological examination of the endoscopic submucosal dissection specimen shows low-grade dysplasia in the background of CD68(+) and foamy histiocytic distribution (hematoxylin-eosin [H&E] and CD68 staining, respectively; both x1.25). (I) and (J) High-power microscopic view of the circled area in (G) (H&E and CD68 staining, respectively; both x10). (K) and (L) High-power microscopic view of the squared part in (G) (H&E and CD68 staining, respectively; both x10).
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These foamy histiocytic cells were immunoreactive for CD68, suggesting colonic xanthoma (Figure 1).