INTRODUCTION: squamous cell metaplasia in the rectum is found in patients with longstanding inflammation or infectious lesions [1]. Colonoscopy plays a major role in the diagnostic of squamous cell metaplasia, especially with the use of Narrow Band Imaging (NBI) or Blue Light Imagining (BLI), which allows for targeted visualization of intraepithelial capillary loopspeculiar for the squamous epithelium [1,2]. The final conclusion cannot be reached without morphological diagnostics. We would like to show on two clinical cases of patients with a longstanding ulcerative colitis the occurrence of squamous cell metaplasia in the rectum. These areas of metaplasia may be the source of squamous cell cancer.CLINICAL CASES: a clinical cases of squamous cell metaplasia in the rectum in two patients with a longstanding ulcerative colitis (9 and 14 years) are presented. The total ulcerative colitis was verified in both patients by colonoscopy. Against the background of endoscopic remission, flat whitish areas of irregular shape, up to 3 cm in size, in the form of “tongues” of metaplastic epithelium with clear boundaries were found in the low rectum. When examined in a Narrow Band Imaging (NBI) and Blue Light Imagining (BLI), the microvascular pattern in the detected areas was identical in structure to the microvascular pattern of the squamous epithelium. The biopsies confirmed the presence of squamous cell epithelium.CONCLUSION: patients with a longstanding ulcerative colitis may have squamous cell metaplasia of the rectal mucosa, which can be detected by colonoscopy in white light. Using a Narrow Band Imaging (NBI) followed by a targeted biopsy allows the most accurate diagnosis to be established. Patients of this group require repeated colonoscopies using the above methods, since areas of metaplasia can be a source of squamous cell cancer of the rectum.
Introduction. Granular cell tumor (GCT, synonym – Abrikossoff’s tumor) is a benign neoplasm of neuroectodermal differentiation from epithelioid cells originating from Schwann’s cells, with a characteristic sign of the presence of lysosomal granules in the cytoplasm. 5–10% of GCTs are found in the gastrointestinal tract, with the most frequent localization in the esophagus, large intestine (the right colon) and perianal zone. Most often, the tumor occurs at the age of 40–60 years, in women. As a rule, the tumor is single, but it can be multiple and associated with various hereditary syndromes, in particular, type 1 neurofibromatosis. A rare malignant variant of GCT with local spread and the possibility of metastasis has been described. At the moment, less than 100 clinical cases with tumor localization in the cecum have been described.Clinical case. A 36-year-old patient with nonspecific complaints of constipation and recurrent abdominal pain during diagnostic colonoscopy a submucosal formation in the cecum up to 1 cm in diameter, dense, fixed in the submucosa, with an unchanged mucous membrane above it was revealed. A biopsy was taken, in which a granular cell tumor was suspected. The tumor was removed by the endoscopic submucosal dissection, and the subsequent morphological and immunohistochemical studies, which confirmed a granular cell tumor (Abrikossoff’s tumor).Conclusion. Granular cell tumor of the colon is a rare, non-specific tumor that can be detected during routine diagnostic endoscopic examination. The diagnosis of GCT is established by morphological examination and immunophenotyping of the removed neoplasm. Removal of the tumor by the endoscopic submucosal dissection can be a radical method of treatment for patients with GCT in the colon.
Меланоз толстой кишки характерен для пациентов с длительным анамнезом запоров и применением слабительных средств -антраценовых производных, которые довольно часто назначаются как врачами, так и пациентами самостоятельно. Как правило, меланоз развивается после 4-9 мес. приема слабительных средств этой группы и наиболее часто встречается у женщин в старшей возрастной группе. Патогенетически меланоз характеризуется отложением пигмента в собственной пластинке слизистой оболочки, проявляющимся выраженным темным окрашиванием слизистой оболочки кишки. В зависимости от степени пигментации толстой кишки меланоз подразделяют на три степени. Наиболее частая локализация -в правых отделах толстой кишки, но описаны случаи с распространением пигментации на левые и другие отделы. Диагностика не вызывает трудностей: меланоз толстой кишки выявляется при выполнении рутинного эндоскопического исследования, подтверждается при патоморфологическом исследовании. Меланоз является актуальной проблемой с точки зрения риска развития колоректального рака. Уже существуют убедительные данные, доказывающие, что частота выявления аденом повышается не только из-за отсутствия накопления ими пигмента, но и описаны патогенетические аспекты влияния меланоза на возникновение и развитие аденом. Протеомный анализ позволяет определить экспрессию различных белков, что подтверждает роль меланоза в развитии колоректального рака. Также интересно отметить, что порой существуют некоторые трудности в дифференциальной диагностике меланоза, например, с ишемическими поражениями толстой кишки. Пациенты с меланозом толстой кишки требуют пристального внимания, своевременной диагностики и лечения. Немедикаментозный метод лечения меланоза является наиболее распространенным.
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