Early colon cancer within a diverticulum treated by magnifying chromoendoscopy and laparoscopy

We report a unique case of intramucosal carcinoma in a tubulovillous adenoma arising from a single diverticulum.Endoscopic mucosal resection(EMR)was carried out successfully and completely with the assistance of laparoscopy.A 71-year-old man was admitted to our hospital because of melena and anemia.Emergent colonoscopy showed diverticulosis in the right-sided colon.However,endoscopy could not exactly detect the bleeding site.A flat elevated polyp was found within a single diverticulum located in the descending colon and diagnosed as an intramucosal carcinoma,as magnifying chromoendoscopy revealed a type Ⅳ pit pattern.As his diverticular bleeding repeated,a rightsided hemicolectomy was decided for treatment,the polyp within the diverticulum was also completely removed by EMR with the assistance of laparoscopy.Although a colonic perforation was detected immediately after EMR,the perforation was closed with endoclips intraluminally and also repaired laparoscopically from the serosal side.Histologically,the resected lesion was an intramucosal well-differentiated adenocarcinoma and the surgical margin was free of tumor.

Early colon cancer with enteropathy-associated T-cell lymphoma involving the whole gastrointestinal tract:A case report

BACKGROUND Enteropathy-associated T-cell lymphoma(EATL)is a rare invasive lymphoma derived from gastrointestinal epithelial T lymphocytes.EATL involving the whole gastrointestinal tract accompanied with early colon cancer is extremely rare.CASE SUMMARY We present the case of a 67-year-old man with diarrhea for more than 5 mo whose colonoscopy in another hospital showed multiple colonic polyps,which indicated moderate to severe dysplasia and focal early cancer.Therefore,he was referred to our hospital for further endoscopic treatment.Colonoscopy after admission showed that the mucosa of the terminal ileum and the entire colon were slightly swollen and finely granular.Endoscopic mucosal resection was performed for colonic polyps located in the liver flexure of the colon and descending colon,respectively.Histopathological findings revealed diffuse infiltration of mediumsized lymphoid cells in the colonic mucosa and visible lymphoepithelial lesions.The histopathology of the polyp in the descending colon indicated moderately differentiated adenocarcinoma limited to the mucosa with negative resection margins.Additionally,immunohistochemical analysis showed positive staining for CD7 and CD8.Therefore,we arrived at a diagnosis of EATL with early colon cancer.Subsequently,the patient was transferred to the hematology department for chemotherapy.The patient’s diarrhea was not significantly relieved after receiving chemotherapy,and he ultimately died of severe myelosuppression.CONCLUSION EATL should be considered in unexplained chronic diarrhea.EATL progresses rapidly with a poor prognosis,especially when accompanied with early colon cancer.

Early gastrointestinal cancer:The application of artificial intelligence

Early gastrointestinal(GI)cancer has been the core of clinical endoscopic work.Its early detection and treatment are tightly associated with patients’prognoses.As a novel technology,artificial intelligence has been improved and applied in the field of endoscopy.Studies on detection,diagnosis,risk,and prognosis evaluation of diseases in the GI tract have been in development,including precancerous lesions,adenoma,early GI cancers,and advanced GI cancers.In this review,research on esophagus,stomach,and colon was concluded,and associated with the process from precancerous lesions to early GI cancer,such as from Barrett’s esophagus to early esophageal cancer,from dysplasia to early gastric cancer,and from adenoma to early colonic cancer.A status quo of research on early GI cancers and artificial intelligence was provided.

Management of malignant colon polyps:Current status and controversies

Colon cancer remains a significant clinical problem worldwide and in the United States it is the third most common cancer diagnosed in men and women.It is generally accepted that most malignant neoplasms of the colon arise from precursor adenomatous polyps.This stepwise progression of normal epithelium to carcinoma,often with intervening dysplasia,occurs as a result of multiple sequential,genetic mutations-some are inherited while others are acquired.Malignant polyps are defined by the presence of cancer cells invading through the muscularis mucosa into the underlying submucosa(T1).They can appear benign endoscopically but the presence of malignant invasion histologically poses a difficult and often controversial clinical scenario.Emphasis should be initially focused on the endoscopic assessment of these lesions.Suitable polyps should be resected en-bloc,if possible,to facilitate thorough evaluation by pathology.In these cases,proper attention must be given to the risks of residual cancer in the bowel wall or in the surrounding lymph nodes.If resection is not feasible endoscopically,thenthese patients should be referred for surgical resection.This review will discuss the important prognostic features of malignant polyps that will most profoundly affect this risk profile.Additionally,we will discuss effective strategies for their overall management.

A laterally-spreading tumor in a colonic interposition treated by endoscopic submucosal dissection

Herein we describe an early colonic carcinoma which developed in a colonic interposition 14 years after surgery for esophageal cancer, which was successfully treated by endoscopic submucosal dissection (ESD). An 80-year-old man underwent colonic interposition between the upper esophagus and stomach after surgery for an early esophageal squamous cell carcinoma in 1994. He received a surveillance endoscopy, and a laterally-spreading tumor of granular type, approximately 20 mm in size, was identified in the colonic interposition. An endoscopic biopsy revealed moderately differentiated adenocarcinoma histologically, however, we diagnosed the lesion as an intramucosal carcinoma based on the endoscopic findings. The lesion was safely and completely removed en bloc by ESD using a bipolar knife. Histologically, the lesion was an intramucosal moderately differentiated adenocarcinoma in a tubular adenoma.

Advanced endoscopic submucosal dissection with traction

Endoscopic submucosal dissection(ESD)has been established as a standard treatment for early stage gastric cancer(EGC)in Japan and has spread worldwide.ESD has been used not only for EGC but also for early esophageal and colonic cancers.However,ESD is as-sociated with several adverse events,such as bleeding and perforation,which requires more skill.Adequate tissue tension and clear visibility of the tissue to be dissected are important for effective and safe dissection.Many ESD methods using traction have been devel-oped,such as clip-with-line method,percutaneous trac-tion method,sinker-assisted method,magnetic anchor method,external forceps method,internal-traction method,double-channel-scope method,outerroute method,double-scope method,endoscopic-surgical-platform,and robot-assisted method.Each method has both advantages and disadvantages.Robotic endos-copy,enabling ESD with a traction method,will become more common due to advances in technology.In thenear future,simple,noninvasive,and effective ESD us-ing traction is expected to be developed and become established as a worldwide standard treatment for superficial gastrointestinal neoplasias.

Characteristics of microbial community involved in early biofilms formation under the influence of wastewater treatment plant effluent

Effluents from wastewater treatment plants（WWTPs） containing microorganisms and residual nutrients can influence the biofilm formation. Although the process and mechanism of bacterial biofilm formation have been well characterized, little is known about the characteristics and interaction of bacteria, archaea and eukaryotes in the early colonization, especially under the influence of WWTP effluent. The aim of this study was to characterize the important bacterial, archaeal and eukaryotic species in the early stage of biofilm formation downstream of the WWTP outlet. Water and biofilm samples were collected 24 and 48 hr after the deposition of bio-cords in the stream. Illumina Miseq sequencing of the 16 S and 18 S rDNA showed that, among the three domains, the bacterial biofilm community had the largest alpha and beta diversity. The early bacterial colonizers appeared to be ＂biofilm-specific＂, with only a few dominant operational taxonomic units（OTUs） shared between the biofilm and the ambient water environment. Alpha-proteobacteria and Ciliophora tended to dominate the bacterial and eukaryotic communities, respectively, of the early biofilm already at 24 hr, whereas archaea played only a minor role during the early stage of colonization. The network analysis showed that the three domains of microbial community connected highly during the early colonization and it might be a characteristic of the microbial communities in the biofilm formation process where co-occurrence relationships could drive coexistence and diversity maintenance within the microbial communities.