case_images: PMC5315366_01
case_images: Histological features of the biopsy specimens (a-c) 1 year and 7 months, (d-f) 2 years and 1 month and (g-i) 2 years and 7 months after the first operation. Serrated glands are observed: diagnosis was low-grade dysplasia in the specimen of 2 years and 1 month, but regenerative mucosa in the others.
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case_images: Regeneration was suspected (Figure 1). Low-grade dysplasia was suggested, at least in part (Figure 1). It was accompanied with mild-to-moderate inflammation (Figure 1).
case_images: Macroscopic appearance of the resected ileum and colon showing severe stenosis at the anastomosis site.
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case_images: In the operated material, the anastomosis site was severely stenotic (Figure 2).
case_images: Histological features of the operated specimen. (a-c) Glands with minimal atypia tend to show a serrated appearance in the propria mucosa and were tubular below the submucosa. Nuclear atypia is more conspicuous in invasive glands (c). (d-e) In non-tumorous mucosa, mild-to-moderate inflammation with mild basal lymphoplasmacytosis is observed. Glands are shortened and distorted.. sm: submucosa, mp: muscularis propria.
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case_images: Histologically, atypical glands proliferated from the mucosa to subserosa: glands tended to show a serrated appearance in the propria mucosa and were tubular below the submucosa (Figure 3). In invasive glands, nuclei were somewhat irregular and enlarged (Figure 3). Glands were shortened and distorted (Figure 3).
case_images: Immunohistochemical staining of the operated specimen: (a-c) p53-positive cells are a few. (d-i) Tumor cells show CK7+/CK20- patterns and (j-o) tend to be positive for TNF-alpha and Aurora B, especially in invasive glands. (p-u) CD44v6 and ADAM17 show staining in a reversed manner.. TNF: tissue necrosis factor; ADAM17: a disintegrin and metalloproteinase 17.
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case_images: There were many CK7-positive tumorous glands, but CK20 was positive only in some glands in the mucosa (Figure 4). Invasive glands tended to be stained stronger on immunostaining with CK7, TNF-alpha and Aurora B (Figure 4). Immunoreactivity against the anti-CD44v6 antibody was focally reduced in tumorous glands in the propria mucosa, and disappeared in invasive glands (Figure 4). By contrast, a disintegrin and metalloproteinase 17 (ADAM 17) were expressed more in invasive glands (Figure 4).
case_images: Immunohistochemical staining of the biopsy specimens. Glands of 1 year and 7 months and of 2 years and 5 months are not clearly positive for (a, c) CK7, (d, f) TNF-alpha or (g, i) Aurora B, but (b, e, h) those of 2 years and 1 month are weakly positive or positive. There were glands showing reduced membranous positivity of CD44v6 (j-l), especially in (k).
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case_images: On retrospective examination of biopsy specimens, atypical glands that suggested low-grade dysplasia were positive for CK7 and weakly positive for TNF-alpha and Aurora B (Figure 5). CD44v6 (Figure 5). CK20-positive glands were a few.