This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB. This is a 74-year-old woman who has a long history of polyps, was referred for resection of a lesion in the cecum, but this lesion is seen just a couple of folds distal to the ileocecal valve. You can see a tattoo closer to the ileocecal valve that was to mark the lesion that was down near the cecum. So this lesion will be examined initially in white light and now we switched over to narrow band imaging and we also are in close focus so we have the optical magnification activated and we also are going to wash the lesion because it has a little bit of blood on it which makes it difficult in NBI and look at the left hand edge of it closely. So that is coming up here in just a second. The question is going to be what is this lesion? So this lesion is clearly malignant. It has an ulcer occupying two thirds to three quarters of the surface area and if you notice in the video there were nice three or KUDO5 changes in the base of that ulcer, completely disrupted vasculature. So it's cancer. We have to look at any residual benign part to try to determine if it arose in an SSL or in an adenoma. If we look at the area that's within this red line, you can see that there is a regular pit pattern there. There's almost no blood vessels and that's the nice type one pattern. So this is an SSL that developed cancer.

74-year-old woman

polyps

cecum resection

malignant lesion

narrow band imaging