Small invasive colon cancer with adenoma observed by endocytoscopy: A case report

BACKGROUND: Endocytoscopy is a next-generation endoscopic system that facilitates real-time histopathologic endoscopic diagnosis of colorectal lesions by virtue of its 520 × maximum magnification. CASE SUMMARY: We present the case of a 63-year-old man with sigmoid colon cancer who was regularly referred for follow-up colonoscopy after endoscopic resection of T1 rectal cancer. Colonoscopy revealed a 12 mm reddish polyp, including a depression and a flat area in the sigmoid colon. Endocytoscopic observation showed unclear gland formation and agglomeration of distorted nuclei (depression), suggesting a submucosal invasive (T1) cancer. In the flat area, slit-like smooth lumens and regular pattern of fusiform nuclei were found, suggesting an adenoma. On the basis of these endocytoscopic findings, we predicted this lesion as T1 cancer (depression) with adenoma (flat area) and performed endoscopic resection corresponding to the final histopathological diagnosis. CONCLUSION: We could perform an optical diagnosis of T1 sigmoid cancer with adenoma by using endocytoscopy before treatment.