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1.  Impact of clinical experience on type V pit pattern analysis using magnifying chromoendoscopy in early colorectal cancer: a cross-sectional interpretation test 
BMC Gastroenterology  2014;14:100.
Although type V pit pattern analysis is effective in determining the invasion depth of early colorectal cancers, the clinical results may vary because findings are operator-dependent. This study aimed to assess the benefits of type V pit pattern analysis in estimating the invasion depth using magnifying chromoendoscopy compared to that with conventional colonoscopy.
A cross-sectional interpretation test involving 32 endoscopists with varying levels of experience performing colonoscopies was conducted. Fifty histopathologically diagnosed cases of intramucosal or submucosal cancer were selected retrospectively. The lesions were classified as superficial or deep by the endoscopists, based on magnifying chromoendoscopic and non-magnifying endoscopic images. The endoscopists were classified into 3 groups based on the number of colonoscopies performed: I (<500), II (501–5000), and III (>5000). Differences in the interpretation of invasion depth between group III and groups I and II were assessed using the Mann–Whitney U test.
There was no significant difference in the median number of correct interpretations using non-magnifying endoscopic images among the groups. However, a significant difference (P = 0.007) was observed between the results of groups III and I when the analysis was performed using magnifying chromoendoscopic images.
When performed by less experienced endoscopists, pit pattern analysis of colonic lesions using magnifying chromoendoscopy is not a reliable modality for estimating invasion depth in early colorectal cancer.
PMCID: PMC4046150  PMID: 24885943
Magnifying chromoendoscopy; Early colorectal cancer; Pit pattern; Type V pit
2.  A case of rectal tumor in which the shape altered with regression in short period 
BMC Gastroenterology  2013;13:146.
Histological regression of solid tumors in adults receiving no treatment is rare. Specifically, spontaneous partial and complete regression of colorectal cancers account for less than 2% of such cases and those without metastasis are exceedingly rare.
Case presentation
A 60-year-old male underwent total colonoscopy following a positive fecal occult blood test at the referring hospital. A flat elevated lesion with central reddish depression, 10 mm in diameter, was detected in the lower rectum. Biopsy results from the referring hospital showed a well-differentiated adenocarcinoma and the patient was referred to our hospital for diagnosis and treatment. Preoperative colonoscopy was performed to determine the therapeutic strategy; however, we found only scar tissue and there were no endoscopic features to suggest malignancy. Biopsy from the scar revealed normal rectal mucosa and we performed diagnostic endoscopic submucosal resection with a ligation device (ESMR-L) one week later. The resected specimen showed a 1 mm well-differentiated adenocarcinoma with low-grade atypia and no lymphovascular invasion. The macroscopic type was 0-IIb, the depth of invasion was intramucosal, and the vertical and lateral margins were negative. There has been no evidence of recurrence for 18 months following treatment.
We report a case of a rectal tumor showing regression over a short period without treatment. Spontaneous regression of malignant tumors is a rare and unexplained phenomenon. Further research and understanding of the mechanism holds the key for treatment and prevention of cancer in the future.
PMCID: PMC3850788  PMID: 24090181
Rectal tumor; Regression; Endoscopic submucosal resection with a ligation device (ESMR-L)
3.  Dome-type carcinoma of the colon; a rare variant of adenocarcinoma resembling a submucosal tumor: a case report 
BMC Gastroenterology  2012;12:21.
Dome-type carcinoma (DC) is a distinct variant of colorectal adenocarcinoma and less than 10 cases have been described in the literature. Most of the previously reported cases were early lesions and no endoscopic observations have been described so far. We herein report a case of a DC invading the subserosal layer, including endoscopic findings.
Case presentation
A highly elevated lesion in the transverse colon was diagnosed by colonoscopy in a 77-year-old man. The tumor appeared to be similar to a submucosal tumor (SMT), however, a demarcated area of reddish and irregular mucosa was observed at the top of the tumor. There were no erosions or ulcers. Laparoscopic-assisted right hemicolectomy was performed and pathological examination revealed a well-circumscribed tumor invading the subserosal layer. The tumor was a well-differentiated adenocarcinoma associated with a dense lymphocytic infiltration and showed expansive growth. The overlying mucosal layer showed high-grade dysplasia.
The present lesion was diagnosed as a DC of the colon invading the subserosal layer. Because the association of mucosal dysplasia is common in DCs, the detection of dysplastic epithelium would be important to discriminate DCs from SMTs.
PMCID: PMC3311598  PMID: 22400807
Colorectal carcinoma; Gut-associated lymphoid tissue; Dome-type carcinoma
4.  Small invasive colon cancer with systemic metastasis: A case report 
BMC Gastroenterology  2011;11:59.
Recently, especially in Japan, several researchers have suggested that colorectal cancer can develop not only through an adenoma-carcinoma sequence but also from normal mucosa via a de novo pathway, and that these de novo cancers have more aggressive malignant potential. We report a case of aggressive colon cancer resulting in systemic metastasis despite small tumour size.
Case Presentation
A 35-year-old woman presented at the referring hospital with swelling of the left cervical lymph node. Biopsy of the lymph node revealed metastatic adenocarcinoma; however, CT scan and mammography were unable to identify the site of the primary lesion. She was diagnosed with unknown primary cancer and referred to our hospital for further examination. Immunohistochemical reevaluation showed the cervical lymph node biopsy specimen to be positive for CDX2 and CK20 and negative for CK7 expression, leading us to suspect the presence of a primary colorectal cancer. We performed a total colonoscopy, and detected a small protruding lesion in the transverse colon. The tumour was only 12 mm in diameter, with a central depressed component and a severely thickened stalk, which suggested direct cancer invasion of the deep submucosa. We concluded that this lesion was the site of origin of the metastasis despite the small tumour size, and performed diagnostic endoscopic mucosal resection. The lesion was found to have an intramucosal cancer component, demonstrating that this lesion represented primary colon cancer. The patient was referred to the gastrointestinal oncology division for systemic chemotherapy.
In this case, immunohistochemical findings strongly suggested the existence of a colorectal cancer. The non-polypoid gross appearance of the tumour suggested that it can originate de novo , thus providing a valuable case in support of the aggressive malignant potential of a de novo colorectal cancer pathway.
PMCID: PMC3123646  PMID: 21595976
Nonpolypoid colorectal cancer; CDX2; CK20; CK7; systemic metastasis
5.  Recurrent advanced colonic cancer occurring 11 years after initial endoscopic piecemeal resection: a case report 
BMC Gastroenterology  2010;10:87.
The high frequency of local recurrence occurring after endoscopic piecemeal resection (EPMR) for large colorectal tumors is a serious problem. However, almost all of these cases of local recurrence can be detected within 1 year and cured by additional endoscopic resection. We report a rare case of recurrent advanced colonic cancer diagnosed 11 years after initial EPMR treatment.
Case presentation
A 65-year-old male was diagnosed with a sigmoid colon lesion following a routine health check-up. Total colonoscopy revealed a 12 mm type 0-Is lesion in the sigmoid colon, which was diagnosed as an adenoma or intramucosal cancer and treated by EPMR in 1996. The post-resection defect was closed completely using metallic endoclips to avoid delayed bleeding. In 2007, at the third follow up, colonoscopy revealed a 20 mm submucosal tumor (SMT) like recurrence at the site of the previous EPMR. The recurrent lesion was treated by laparoscopic assisted sigmoidectomy with lymph node dissection.
When it is difficult to evaluate the depth and margins of resected tumors following EPMR, it is important that the defect is not closed in order to avoid tumor implantation, missing residual lesions and to enable earlier detection of recurrence. It is crucial that the optimal follow-up protocol for EPMR cases is clarified, particularly how often and for how long they should be followed.
PMCID: PMC2925815  PMID: 20684791
6.  Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms 
BMC Gastroenterology  2010;10:33.
Capillary patterns (CP) observed by magnifying Narrow Band Imaging (NBI) are useful for differentiating non-adenomatous from adenomatous colorectal polyps. However, there are few studies concerning the effectiveness of magnifying NBI for determining the depth of invasion in early colorectal neoplasms. We aimed to determine whether CP type IIIA/IIIB identified by magnifying NBI is effective for estimating the depth of invasion in early colorectal neoplasms.
A series of 127 consecutive patients with 130 colorectal lesions were evaluated from October 2005 to October 2007 at the National Cancer Center Hospital East, Chiba, Japan. Lesions were classified as CP type IIIA or type IIIB according to the NBI CP classification. Lesions were histopathologically evaluated. Inter and intraobserver variabilities were assessed by three colonoscopists experienced in NBI.
There were 15 adenomas, 66 intramucosal cancers (pM) and 49 submucosal cancers (pSM): 16 pSM superficial (pSM1) and 33 pSM deep cancers (pSM2-3). Among lesions diagnosed as CP IIIA 86 out of 91 (94.5%) were adenomas, pM-ca, or pSM1; among lesions diagnosed as CP IIIB 28 out of 39 (72%) were pSM2-3. Sensitivity, specificity and diagnostic accuracy of the CP type III for differentiating pM-ca or pSM1 (<1000 μm) from pSM2-3 (≥1000 μm) were 84.8%, 88.7 % and 87.7%, respectively. Interobserver variability: κ = 0.68, 0.67, 0.72. Intraobserver agreement: κ = 0.79, 0.76, 0.75
Identification of CP type IIIA/IIIB by magnifying NBI is useful for estimating the depth of invasion of early colorectal neoplasms.
PMCID: PMC2868042  PMID: 20346170

Results 1-6 (6)