Clinicopathological features and expression of regulatory mechanism of the Wnt signaling pathway in colorectal sessile serrated adenomas/polyps with different syndrome types

Figure 1 Classification of the tongue coating. A: Patients with large intestine damp-heat (Da-Chang-Shi-Re) syndrome showed a thick yellow coating; B: Patients with spleen-stomach weakness (Pi-Wei-Xu-Ruo) syndrome showed a thin white coating.

Figure 2 Endoscopic features. A: Adenoma in a patient with large intestine damp-heat (Da-Chang-Shi-Re) syndrome. Close observation revealed a dilated branched vessel and an open II pit; B: Polyp in a patient with spleen-stomach weakness (Pi-Wei-Xu-Ruo) syndrome. The surface was smooth, with a small amount of attached hyaline mucus. The color was similar to that of the background mucosa.

Figure 3 Hematoxylin and eosin staining in each group. A and B: Patient with large intestine damp-heat (Da-Chang-Shi-Re) syndrome. A: The crypt epithelium was serrated, and interstitial oedema was observed (× 100); B: Goblet cells were absent in the crypts of the adenoma, and the nuclei were pencil-rod-shaped (× 200). C and D: Patient with spleen-stomach weakness (Pi-Wei-Xu-Ruo) syndrome. C: The epithelium was serrated, and the crypts are evenly distributed and undifferentiated, comprising several goblet cells (× 100); D: The upper part of the crypt was serrated, and the base was not expanded (× 200).

Figure 4 Protein expression of β-catenin, adenomatous polyposis coli, and mutated in colorectal cancer in each group (× 200). A, B, and C: Patient with large intestine damp-heat (Da-Chang-Shi-Re) syndrome; D, E, and F: Patient with spleen-stomach weakness (Pi-Wei-Xu-Ruo) syndrome.

Figure 5 Correlation analysis between the related protein expression and the sessile serrated adenomas/polyps size. A, B, and C: Patient with large intestine damp-heat (Da-Chang-Shi-Re) syndrome; D, E, and F: Patient with spleen-stomach weakness (Pi-Wei-Xu-Ruo) syndrome. APC: Adenomatous polyposis coli; DCSR: Large intestine damp-heat (Da-Chang-Shi-Re); MCC: Mutated in colorectal cancer; PWXR: Spleen-stomach weakness (Pi-Wei-Xu-Ruo).

Figure 6 Abnormal Wnt signaling pathway activation in sessile serrated adenomas/polyps. APC: Adenomatous polyposis coli; LEF: Lymphoid enhancing factor; MMC: Mutated in colorectal cancer; SSA/P: Sessile serrated adenoma/polyp; TCF: T cell transcription factor.