Intest Res.  2015 Oct;13(4):318-325. 10.5217/ir.2015.13.4.318.

Colonic Chicken Skin Mucosa is an Independent Endoscopic Predictor of Advanced Colorectal Adenoma

• Chung EJ
• Lee JY
• Choe J
• Chang HS
• Kim J
• Yang DH
• Ye BD
• Byeon JS
• Kim KJ
• Yang SK
• Kim JH
• Myung SJ

• KMID: 2070747
• DOI: http://doi.org/10.5217/ir.2015.13.4.318

Abstract

BACKGROUND/AIMS
Chicken skin mucosa (CSM), surrounding colorectal adenoma, is an endoscopic finding with pale yellow-speckled mucosa; however, its clinical significance is unknown. This study aimed to evaluate the prevalence and clinical characteristics of CSM, and the association between colorectal carcinogenesis and CSM.
METHODS
This cross-sectional study was performed in 733 consecutive patients who underwent endoscopic polypectomy for colorectal adenoma after the screening of colonoscopy at the Asan Health Promotion Center between June 2009 and December 2011. The colonoscopic and pathological findings of colorectal adenoma including number, size, location, dysplasia, morphology, and clinical parameters were reviewed.
RESULTS
The prevalence of CSM was 30.7% (225 of 733 patients), and most CSM-related adenomas were located in the distal colon (93.3%). Histological analysis revealed lipid-laden macrophages in the lamina propria of the mucosa. Multivariate analyses showed that CSM was significantly associated with advanced pathology, including villous adenoma and high-grade dysplasia (odds ratio [OR], 2.078; 95% confidence interval [CI], 1.191-3.627; P=0.010), multiple adenomas (i.e., > or =2 adenomas; OR, 1.692; 95% CI, 1.143-2.507; P=0.009), and a protruding morphology (OR, 1.493; 95% CI, 1.027-2.170; P=0.036). There were no significant differences in polyp size or clinical parameters between patients with and without CSM.
CONCLUSIONS
CSM-related adenoma was mainly found in the distal colon, and was associated with advanced pathology and multiple adenomas. CSM could be a potential predictive marker of the carcinogenetic progression of distally located colorectal adenomas.

Keyword

Chicken skin mucosa; Colorectal adenoma; Carcinogenesis; Colonoscopy

MeSH Terms

Adenoma*
Adenoma, Villous
Carcinogenesis
Chickens*
Chungcheongnam-do
Colon*
Colonoscopy
Cross-Sectional Studies
Health Promotion
Humans
Macrophages
Mass Screening
Mucous Membrane*
Multivariate Analysis
Pathology
Polyps
Prevalence
Skin*

Figure

• 

  Fig. 1 Endoscopic features of chicken skin mucosa. (A) Endoscopic features of a chicken skin mucosa (CSM), including tiny yellow speckles adjacent to a tubular adenoma. (B) Endoscopic features of a CSM, including dense yellow speckles adjacent to a colonic adenocarcinoma. (C) Endoscopic features of a CSM, including yellow speckles adjacent to early colonic adenocarcinoma.

• 

  Fig. 2 Histologic appearances of chicken skin mucosa. (A) Histological appearance of tubular adenoma and the surrounding mucosa (H&E, ×40). (B) Histological appearance of chicken skin mucosa (CSM) surrounding a tubular adenoma, including foamy macrophages (arrow) located in the lamina propria (H&E, ×400). (C) Histological appearance of colonic adenocarcinoma and the surrounding mucosa (H&E, ×40). (D) Histological appearance of CSM surrounding a colonic adenocarcinoma, including densely deposited foamy macrophages (arrow) located in the lamina propria (H&E, ×400).

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