Demarcated redness associated with increased vascular density/size: a useful marker of flat-type dysplasia in patients with ulcerative colitis

Akiyoshi Ikebata; Masayuki Shimoda; Koji Okabayashi; Toshio Uraoka; Tadateru Maehata; Shinya Sugimoto; Makoto Mutaguchi; Makoto Naganuma; Kaori Kameyama; Naohisa Yahagi; Takanori Kanai; Yuko Kitagawa; Yae Kanai; Yasushi Iwao

doi:10.1055/a-1352-2709

Demarcated redness associated with increased vascular density/size: a useful marker of flat-type dysplasia in patients with ulcerative colitis

Endosc Int Open. 2021 Apr;9(4):E552-E561. doi: 10.1055/a-1352-2709. Epub 2021 Apr 12.

Authors

Akiyoshi Ikebata^{1

2}, Masayuki Shimoda¹, Koji Okabayashi², Toshio Uraoka^{3

4}, Tadateru Maehata³, Shinya Sugimoto⁵, Makoto Mutaguchi⁵, Makoto Naganuma⁵, Kaori Kameyama⁶, Naohisa Yahagi³, Takanori Kanai⁵, Yuko Kitagawa², Yae Kanai¹, Yasushi Iwao⁷

Affiliations

¹ Department of Pathology, Keio University School of Medicine, Tokyo, Japan.
² Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
³ Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
⁴ Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan.
⁵ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
⁶ Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan.
⁷ Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan.

Abstract

Background and study aims Recent advances in endoscopic equipment and diagnostic techniques have improved the detection of dysplasia in the inflamed mucosa of patients with ulcerative colitis (UC). However, it remains difficult to endoscopically identify flat-type dysplasia which has been formerly recognized as invisible dysplasia. Patients and methods In this retrospective, single-center study, we endoscopically identified 10 cases of flat-type-predominant dysplasia by targeted biopsy among 38 intramucosal dysplasia lesions from patients with UC who underwent surgical or endoscopic resection from 2007 to 2017. Their endoscopic and histological features were examined, including color changes, intramucosal vascular density/size, and vascular endothelial growth factor (VEGF) expression. Results All flat-type-predominant dysplasias were endoscopically recognized as demarcated red-colored areas and histologically diagnosed as low- (LGDs) or high-grade dysplasias (HGDs). Immunohistochemical examination using resected specimens revealed that flat-type dysplasia was characterized by significantly increased CD34-positive vascular density (LGDs, 1.7-fold, P < 0.01; HGDs, 2.2-fold, P < 0.01) and size (LGDs, 1.03-fold, P < 0.01; HGDs, 1.11-fold, P < 0.01) in the mucosa, compared to adjacent non-neoplastic areas. Increased numbers of vessels were observed at the base of the mucosa in LGDs, whereas HGDs contained increased/enlarged vessels throughout the mucosa. Moreover, VEGF expression was elevated in all dysplastic epithelia. Conclusions Demarcated red-colored areas, histologically characterized by an increased vascular density/size in the mucosa, are an endoscopic sign of formerly invisible flat-type dysplasia in patients with UC and should be considered for targeted biopsy. Prospective studies focusing on the mucosal color change for their early detection would be desirable in the future.

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