Video Tip: Diagnosing Sessile Serrated Lesion with Cytological Dysplasia | September 2022-Diagnosing sessile serrated lesion with cytological dysplasia

Video Transcription

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's undergoing a surveillance colonoscopy. We're in the mid ascending colon.  You can see in the distance the ileocecal valve and so we're looking at this lesion and inspecting it first in white light and then in just a moment we will switch to narrow  band imaging. And we have initially here some views of this lesion, just for a second we had the close focus on.  Here we're getting in close again to take a look at the lesion and so what is this lesion?  The correct answer is sessile serrated lesion with cytological dysplasia. The endoscopic appearance of these lesions reflects their histologic appearance.  That is they have a component of sessile serrated lesion that's demonstrated here on the right within the white line encompassed by the white line.  That's an area that has large open pits on it.  It has very few blood vessels and then the area on the left which has the classic appearance  of an adenoma that is the NICE classification type 2 or the KUDO classification 3 or 4 with large thick brown blood vessels in narrow band imaging and large tubular pits.  So a sessile serrated lesion with cytological dysplasia is basically an SSL that has a focus of adenoma within it, of dysplasia within it.  They're often in this area can be microsatellite instability. This is a more advanced lesion than a sessile serrated lesion with no dysplasia in it.  Recall that sessile serrated lesions without cytological dysplasia are non-dysplastic lesions. They're considered neoplastic because they have the potential to turn into cancer but  they have no dysplasia. Usually the focus of dysplasia is quite small, 2 or 3 millimeters. This is an unusual one because it occupies about half the surface area of the lesion.  But this is the typical endoscopic appearance of an SSL with dysplasia. An area within the white line that is NICE type 1 in the serrated class and an area within  the yellow line that is NICE type 2, the endoscopic features of an adenoma.

Video Summary

This video, sponsored by Braintree, a part of Cibela Pharmaceuticals, explores a surveillance colonoscopy procedure on a 74-year-old woman. The video shows the examination of a lesion using white light and narrow band imaging. The lesion is identified as a sessile serrated lesion with cytological dysplasia, indicating it has both characteristics of a serrated lesion and an adenoma. This type of lesion has the potential to become cancerous, unlike non-dysplastic sessile serrated lesions. The video highlights the endoscopic features of this advanced lesion, including large open pits and blood vessels.

Keywords

video

colonoscopy

surveillance

sessile serrated lesion

cytological dysplasia