【CASE1】

Routine observation: The lesion exhibited a mildly reddish depression without granular irregularity, but mucosal extension was preserved. Disruption of branch-like blood vessels was visualized (arrows)

Iodine staining: Note the multiple unstained areas. The lesion was seen as an 8-mm area that was unstained with iodine and located exactly at the reddish mucosa

NBI: The lesion was visualized as a brownish area

Magnifying NBI: Type V vascular pattern is revealed

Pathological fi ndings: Squamous cell carcinoma, 0-IIc, T1a-EP, ly0, v0, HM0, VM0

Diagnostic Points:

The lesion was easily recognized by observations with NBI and iodine staining.

Mucosal redness with disrupted blood vessels is a fi nding that should never be overlooked by routine observation.

【CASE2】

Routine observation: A 6-mm area with mild redness was observed (arrows). There was no mucosal irregularity. In terms of invasion depth, T1a-EP cancer was suspected

Iodine staining: There was an area unstained with iodine that corresponded to the site of a reddish depression seen by routine observation. The site was positive for the pink color sign

NBI: The lesion was visualized as a brownish area (arrows) that corresponded to the site of a reddish depression seen by routine observation

Magnifying NBI: Type V1 vascular pattern was revealed

Pathological fi ndings: Squamous cell carcinoma, 0-IIb, T1a-EP, ly0, v0, HM0, VM0

Diagnostic Points:

Metachronous multiple lesions were detected during the follow-up after endoscopic resection of a superfi cial-type esophageal cancer. It is important to pay close attention to the presence of metachronous multiple lesions. The fi nding of a positive pink color sign can help diagnose a small lesion.

【CASE3】

Routine observation: An area unstained with iodine extended longitudinally from the lower esophagus (arrows). Reexamination after administration of a proton pump inhibitor (PPI) revealed a mildly reddish area 6 mm in diameter at the same region

Iodine staining: An area unstained with iodine (arrows) was observed at exactly the same site of a reddish depression observed by routine observation. The site was positive for the pink color sign

NBI: The lesion was visualized as a brownish area corresponding to the site of the reddish depression detected by routine observation

Magnifying NBI: Note that blood vessels are thin and extended owing to infl ammation (arrows); a V3 vascular pattern was observed in part. Invasion depth TIb-MM to SM1 was suspected

Pathological findings: Squamous cell carcinoma, 0-IIc, T1b-SM (127 μm), ly0, v0, HM0, VM0

Diagnostic Points:

Background infl ammation was severe, and the margin was unclear. After PPI administration,inflammation subsided and the margin became clearer. A positive pink color sign would help diagnose the margin of the lesion.