case_images: PMC2800000_01
case_images: Air contrast barium enema showed multiple thumbprint-like lesions (arrows), ranging from 7 to 20 mm in diameter, mainly in the ascending colon.
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case_images: PMC2800000_01_jkms-25-155-g001.jpg
case_images: F1
case_images: On the air contrast barium enema, multiple thumbprint-like lesions ranging from 7 to 20 mm in diameter were observed from the cecum to the hepatic flexure, mainly in the ascending colon (Fig. 1).
case_images: Endoscopic views of a cluster of elevated lesions, with a smooth surface and gentle slope, in the ascending colon. (A, B) The overlying mucosa was intact and appeared thin, and the lesion was soft and compressible.
case_images: jkms-25-155-g002.jpg
case_images: PMC2800000_01_jkms-25-155-g002.jpg
case_images: F2
case_images: The colonoscopy revealed clusters of round submucosal tumors with a gentle slope and smooth surface from the cecum to the hepatic flexure (Fig. 2).
case_images: EUS images of the colon, obtained with a catheter EUS probe (frequency 12 MHz). (A) The EUS image depicting elevated lesions as echo-free cysts (arrowheads) in the submucosal layer. (B) Some submucosal cysts had septal walls (arrows).
case_images: jkms-25-155-g003.jpg
case_images: PMC2800000_01_jkms-25-155-g003.jpg
case_images: F3
case_images: The EUS was performed with a radial scanning catheter probe (12 MHz, Fujinon Inc., Saitama, Japan) that showed each of the submucosal lesions as an echo-free cyst, with a clear border, in the submucosal layer (Fig. 3A). The inner structure was uniform and some of the cysts had septal walls (Fig. 3B).
case_images: Microscopic findings. (A) Endoscopic biopsy revealed submucosal cyst with occasional multinucleated cells (inset), however, there were no fat or blood cell components (H&E, x20; inset: H&E, x400). (B) D2-40 immunostaining showed positive reactivity (arrows) for lining endothelial cells of lymphatic spaces (Polymer method, x200).
case_images: jkms-25-155-g004.jpg
case_images: PMC2800000_01_jkms-25-155-g004.jpg
case_images: F4
case_images: The endoscopic biopsy revealed a submucosal cyst with occasional multinucleated cells; however, there were no fat or blood cell components (Fig. 4A). The D2-40 immunostaining, which is a specific lymphatic endothelial marker, showed positive reactivity for lining endothelial cells of the lymphatic spaces (Fig. 4B).