Pit pattern and three-dimensional configuration of isolated crypts from the patients with colorectal neoplasm

This study examined the usefulness of magnifying videoscopic pit-pattern diagnosis in the differential diagnosis of colonic neoplasms. The relationship between pit patterns and the three-dimensional configuration of the neoplastic gland was evaluated for its contribution toward an understanding of pit patterns.

A total of 3005 colorectal lesions were examined endoscopically and histopathologically. Pit patterns were classified into six types. All materials used for crypt isolation were derived from segments of 21 colorectal lesions and one normal colonic mucosa. For the crypt isolation, the HCl-digestion method was used.

The magnifying videoscopic diagnosis was comparable with the histological diagnosis in the 3005 colorectal lesions. Isolated crypts with the type-I pit pattern resembled a test-tube; the type-II pit pattern was also tubular, but had observed fissures at the bottom; the type-III l pit pattern was a reversed triangle or tongue-like in shape; and the type-III s pit pattern was columnar and either tapered off or meandered. Isolated crypts with the type-IV b pit pattern appeared as long reversed triangles with protuberances, and the type-IV v pit pattern was flat with slender tubules or finger-like processes. The isolated crypts with the type-V pit pattern were complicated and indistinct in shape.

Evaluation of the three-dimensional configuration revealed that when the pit patterns, of each isolated crypt differed, their three-dimensional configurations also differed. Recognition of the differences in the three-dimensional configuration should contribute toward both an understanding of pit-pattern diagnosis and the further development of the endoscopic diagnosis of various colorectal lesions.