J Gastrointestin Liver Dis December 2011 Vol. 20 No 4, 347 Colonic Angiodysplasia with Adenomatous Epithelial Foci Alessandro Federico, Pasquale Esposito, Antonietta Gerarda Gravina, Luigi Martorelli, Giuseppe Esposito, Marco Romano Second University of Naples, Department of Clinical and Experimental Medicine - Gastroenterology, Naples, Italy Angiodysplasia is a vascular lesion responsible for about 6% of lower gastrointestinal bleeding. It is generally located in the cecum and ascending colon of elderly patients. At colonoscopy, angiodysplasia appears as a bright red flat area with irregular borders as “coral bank” [1]. However, angiodysplasias with a pedunculated appearance have been reported [2-5]. Histologically, colonic arteriovenous malformations are believed to be degenerative lesions, which are the result of intermittent, low-grade obstructions of the submucosal veins as they penetrate the muscular layers of the colon causing small arteriovenous communications [6]. A 45-year old man was admitted to our Gastroenterology Division because of asthenia and bloody stools for more than 10 days. At admission, he presented anemia (hemoglobin 9.2 g/dl). Other laboratory indings were normal. Colonoscopy showed in the sigmoid several angiodysplasias < 5 mm in diameter (Fig.1); three of them had an overimposed nonpolypoid lat lesions, as indicated by contrast chromoscopy using indigo carmine and magniication endoscopy (Fig. 2). These lesions were removed through endoscopic mucosal resection (EMR), whereas the remaining vascular lesions were treated with argon laser photocoagulation. Histology of the resected specimens showed presence of adenomatous epithelial foci, with mild dysplasia together with a large number of dilated vessels reaching the muscularis mucosae as indicated by positivity for CD34 at immunohistochemistry (Fig. 3). Following endoscopic treatment, there was a prompt improvement of clinical conditions and hemoglobin levels raised to 11.9 g/dl within 30 days. In our young patient, angiodysplasias were located in the sigmoid colon. More interestingly, some of the angiodysplastic lesions showed an overimposed nonpolypoid flat lesion, as indicated by contrast chromoscopy, which, at histology, showed foci of tubular adenoma with dysplasia. This, to our knowledge, has never been described. Whether angiodysplasia may predispose to adenomatous transformation of the glandular epithelium or, conversely, an adenomatous lesion may favour neoangiogenesis thus leading to angiodysplasia formation cannot be established. This case suggests that angiodysplasia can be associated with adenomatous transformation of the overlying epithelium and therefore, in the case of angiodysplastic lesions, the endoscopist should carefully look for nonpolypoid lat lesions by contrast chromoscopy and magniication. Reference 1. Foutch PG. Colonic angiodysplasia. Gastroenterologist 1997; 5: 148-156. 2. Chung YW, Jeon YC, Paik CH, et al. Pedunculated angiodysplasia of the colon treated with endoscopic resection: a case report. Dig Dis Sci 2005; 50: 1550-1552. 3. Sawada T, Kawamura O, Kodama T, et al. Pedunculated angiodysplasia of the colon successfully treated with endoscopy: a new type of angiodysplasia. Gastrointest Endosc 2003; 57: 602-605, 4. KakushimaN, Fujishiro M, Yahagi N, et al. An unusual case of polypoid angiodysplasia.Endoscopy2004; 36: 379. 5. Kim BK, Han HS, Lee SY, Kim CH, Jin CJ. Cecal polypoid arteriovenous malformations removed by endoscopic biopsy. J Korean Med Sci 2009; 24: 342-345. 6. Boley SJ, Sammartano R, Adams A, DiBiase A, Kleinhaus S, Sprayregen S. On the nature and etiology of vascular ectasias of the colon: degenerative lesions of aging. Gastroenterology 1977; 72: 650-660. Fig.1. Angiodysplasias > 5 mm in diameter in the sigmoid tract (colonoscopy); Fig.2. Contrast chromoscopy using indigo carmine and magniication endoscopy showing nonpolypoid lat lesions (arrowhead); Fig 3. Histopathology of the resection specimen; adenomatous epithelial foci, with mild dysplasia together with dilated vessels reaching the muscularis mucosae as indicated by positivity for CD34 at immunohistochemistry (arrowhead).