Endoscopic submucosal dissection of multiple flat adenomas in the radiated rectum

Figure 4 Resected specimens. A: A complete one-piece resection of 52 mm × 30 mm in size with tumor-free margins was achieved; B: Complete one-piece resection with tumor-free margins 18 mm × 18 mm; C: Microscopy of the resected specimens revealed increased vessel wall thickness in the submucosal layer and the serous coat of the large intestine around the tumors, indicating chronic radiation proctitis; D: A well-differentiated adenocarcinoma, 35 mm × 18 mm, invading beyond the muscularis propriae (pT3). None of the 10 lymph nodes retrieved were involved (pN0). Moreover, adenomatous change, which endoscopic observation failed to detect, was found.