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Early stage signet ring cell carcinoma of the colon examined by magnifying endoscopy with narrow-band imaging: a case report


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Title: Early stage signet ring cell carcinoma of the colon examined by magnifying endoscopy with narrow-band imaging: a case report
Authors: Ohnita, Ken / Isomoto, Hajime / Akashi, Taro / Hashiguchi, Keiichi / Matsushima, Kayoko / Minami, Hitomi / Akazawa, Yuko / Yamaguchi, Naoyuki / Takeshima, Fuminao / To, Kazuo / Takeshita, Hiroaki / Yasui, Haruna / Abe, Kuniko / Nakao, Kazuhiko
Issue Date: 24-Jul-2015
Publisher: BioMed Central
Citation: BMC Gastroenterology, 15, 86; 2015
Abstract: Background: Signet ring cell carcinoma of the colon and rectum is rare, and most cases are detected at an advanced stage. We present a case of primary signet ring cell carcinoma detected at an early stage by magnifying endoscopy with narrow-band imaging (NBI) and crystal violet staining. Case presentation: A 73-year-old man visited our hospital for screening colonoscopy. Six years previously, he had undergone endoscopic submucosal dissection (ESD) for early gastric cancer. The pathological diagnosis was a well-differentiated adenocarcinoma, invading into the mucosa without lymphovascular invasion. Colonoscopy revealed a flat elevated lesion with a slightly depressed area, 20 mm in diameter, in the cecum. Further, magnifying endoscopy with NBI revealed that the surface pattern was slightly irregular and microvessels had a regular diameter and distribution in the margin of the lesion, but in the central part of the lesion, irregularity in the tumor surface pattern and form as well as in the diameter and distribution of microvessels was noted. Additionally, due to mucus, avascular areas were also observed. Magnifying endoscopy combined with 0.05 % crystal violet staining showed IIIL and VI pit patterns in the margin of the lesion, and a VI pit pattern in the central part of the lesion; however, due to mucus exudate, this finding could not be established with certainty. The lesion was successfully removed en bloc using ESD without complications. The tumor was composed mainly of signet ring cell carcinoma, partially mixed with moderately differentiated (tub2) and well-differentiated (tub1) adenocarcinomas. The tumor cells infiltrated 250 μm into the submucosal layer and involved lymphatic vessels. Therefore, the patient underwent an additional laparoscopic ileocecal resection, and the resected specimen revealed no residual carcinoma or lymph node metastasis. Conclusion: In this case report, we present a case of primary signet ring cell carcinoma detected at an early stage and identified by magnifying endoscopy with NBI and crystal violet staining.
Keywords: Colon cancer / Narrow band imaging / Pit pattern / Signet ring cell carcinoma
URI: http://hdl.handle.net/10069/35777
DOI: 10.1186/s12876-015-0317-z
Rights: © 2015 Ohnita et al. / This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Type: Journal Article
Text Version: publisher
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/35777

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