Mucosa color and size may indicate malignant transformation of chicken skin mucosa-positive colorectal neoplastic polyps

BACKGROUND Lipid metabolism reprogramming is suspected to exist in pre-cancerous lesions,including colorectal adenoma.Screening colonoscopy frequently reveals chicken skin mucosa(CSM;white or yellow-white speckled mucosa)surrounding colo-rectal polyps,caused by macrophages engulfing and accumulating the lipids decomposed by colon cells or adjacent tumors.CSM-positive colorectal polyps are associated with various diseases;however,their prognosis varies greatly.Cold snare polypectomy is commonly used to resect lesions up to 10 to 15 mm in diameter without signs of submucosal invasion but is controversial for CSM-positive colorectal polyps.Improved imaging is required to diagnose and treat CSM-positive colorectal polyps.METHODS This retrospective cohort study included 177 patients with CSM-positive colorectal polyps diagnosed using endoscopy.All patient-related information was extracted from the Goldisc soft-clinic DICOM system or electronic medical record system.Based on the pathological results,patients were classified as non-neoplastic polyps(five juvenile polyps),neoplastic polyps,non-invasive high-grade neoplasia(NHGN),or submucosal invasive carcinoma(SM stage cancer).We analyzed and compared the clinical features,suspected risk factors for malignant transformation of neoplastic polyps,and early infiltration of sub-mucosal carcinoma.RESULTS The diameters of NHGN and SM polyps were much smaller than those of neoplastic polyps.Most NHGN polyps had a deeper red mucosal color.On logistic regression analyses,diameter and deeper red mucosal color were independent risk factors for malignant transformation of neoplastic polyps.Type 1 CSM was more common in high-grade intraepithelial neoplasia and SM;type 2 CSM was more common in neoplastic polyps.Logistic regression analyses revealed no significant differences in the malignant transformation of neoplastic polyps or early submucosal invasion of CSM-positive colorectal cancer.Changes in the CSM mucosa surrounding neoplastic polyps and submucosal invasion of colorectal cancer disappeared within 12 months.No tumor recurrence was found during either partial or complete endoscopic resection of the CSM.CONCLUSION CSM-positive colorectal polyps>1 cm in diameter or with deeper red mucosa may be related to NHGN.Resection of CSM surrounding colorectal adenomas did not affect tumor recurrence.

Chicken skin mucosa surrounding small colorectal cancer could be an endoscopic predictive marker of submucosal invasion

BACKGROUND Chicken skin mucosa(CSM)surrounding colon polyps is a common endoscopic finding with pale yellow-speckled mucosa during a colonoscopy screening.Although reports about CSM surrounding small colorectal cancer are scarce,and its clinical significance in intramucosal and submucosal cancers is unclear,previous studies have suggested it could be an endoscopic predictive marker for colonic neoplastic and advanced polyps.Currently,because of the inaccurate preoperative evaluation by endoscopists,many small colorectal cancers,particularly lesions with a diameter<2 cm,are improperly treated.Therefore,more effective methods are required to better assess the depth of the lesion before treatment.AIM To explore potential markers of small colorectal cancer early invasion under white light endoscopy,providing patients with better treatment alternatives.METHODS This retrospective cross-sectional study included 198 consecutive patients[233 early colorectal cancers(ECCs)]who underwent endoscopy or surgical procedures at the Digestive Endoscopy Center of Chengdu Second People’s Hospital between January 2021 and August 2022.The participants had pathologically confirmed colorectal cancer with a lesion diameter<2 cm and received endoscopic or surgical treatment,including endoscopic mucosal resection and submucosal dissection.Clinical pathology and endoscopy parameters,including tumor size,invasion depth,anatomical position,and morphology,were reviewed.Fisher’s exact test,theχ2 test,and Student’s t-test were used to analyze the patient’s basic characteristics.Logistic regression analysis was used to examine the relationship between morphological characteristics,size,CSM prevalence,and ECC invasion depth under white light endoscopy.Statistical significance was set at P<0.05.RESULTS The submucosal carcinoma(SM stage)was larger than the mucosal carcinoma(M stage)with a significant difference(17.2±4.1 vs 13.4±4.6 mm,P<0.01).M-and SM-stage cancers were common in the left colon;however,no significant differences were found between them(151/196,77%and 32/37,86.5%,respectively,P=0.199).The endoscopic features of colorectal cancer revealed that CSM,depressed areas with clear boundaries,and erosion or ulcer bleeding were more common in the SM-stage cancer group than in the M-stage cancer group(59.5%vs 26.2%,46%vs 8.7%,and 27.3%vs 4.1%,respectively,P<0.05).CSM prevalence in this study was 31.3%(73/233).The positive rates of CSM in flat,protruded,and sessile lesions were 18%(11/61),30.6%(30/98),and 43.2%(32/74),respectively,with significant differences(P=0.007).CONCLUSION CSM-related small colorectal cancer was primarily located in the left colon and could be a predictive marker of submucosal invasion in the left colon.