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A 15-mm flat elevated lesion with central depression in the sigmoid colon was assessed using narrow-band imaging, crystal violet staining, and ultra-magnification endoscopy to estimate depth and malignancy features. Endoscopic ultrasonography showed third-layer disruption, supporting T1b (SM) cancer. Endoscopic submucosal dissection was performed, and pathology identified moderately differentiated tubular adenocarcinoma with an invasive micropapillary carcinoma component and deep submucosal invasion, followed by additional surgery and no recurrence for three years.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/a-case-of-human-epidermal-growth-factor-receptor-2-positive-colon-cancer-with-invasive-micropapillary-carcinoma-component/368769/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/a-case-of-human-epidermal-growth-factor-receptor-2-positive-colon-cancer-with-invasive-micropapillary-carcinoma-component/368769.png","ImageObject",300,407,{"name":92,"@type":93},"Dipper","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-27","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"How was the suspected colon lesion evaluated before treatment?","Question",{"text":113,"@type":114},"Colonoscopy identified a 15-mm flat elevated lesion with central depression in the sigmoid colon. Narrow-band imaging, crystal violet staining, and ultra-magnification imaging were used to characterize pit pattern and depressed-area morphology, and endoscopic ultrasonography assessed layer disruption to support T1b (SM) diagnosis.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What treatment was performed for this T1b (SM) suspected cancer?",{"text":118,"@type":114},"Because the lesion size was intermediate and the patient requested it, endoscopic submucosal dissection (ESD) was performed as initial treatment.",{"name":120,"@type":111,"acceptedAnswer":121},"What did pathology and follow-up show regarding invasive micropapillary carcinoma (IMPC)?",{"text":122,"@type":114},"Pathology revealed moderately differentiated tubular adenocarcinoma with an invasive micropapillary carcinoma component and deep submucosal invasion. Additional surgery confirmed no residual tumor or lymph-node metastasis, and careful follow-up found no recurrence for three years.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},368769,1790220174,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},1374404997633,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","DEN Open  \nCASE REPORT   \nA Case of Human Epidermal Growth Factor Receptor 2-Positive Colon Cancer With Invasive Micropapillary Carcinoma Component  \nMasashi Kono1  Yoriaki Komeda1   Hiroshi Kashida1  Satoru Hagiwara1  Akihiro Yoshida1  Shunsuke Omoto1   Mamoru Takenaka1   Naoko Tsuji1  George Tribonias2  Masatoshi Kudo1  \n1 Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan  2 Department of Gastroenterology, Red Cross Hospital, Athens, Greece  \nCorrespondence: Yoriaki Komeda ([y-komme@mvb.biglobe.ne.jp](y-komme@mvb.biglobe.ne.jp))  \nReceived: 26 February 2025  Revised: 25 July 2025  Accepted: 30 July 2025  \nFunding: The authors received no specific funding for this work.  \nKeywords: colon cancer | endoscopic submucosal dissection | endoscopic ultrasonography | IMPC | invasive micropapillary carcinoma  \nABSTRACT  \nA female patient in her 60s tested positive for the fecal occult blood test while undergoing health screening. Colonoscopy revealed a 15-mm-sized flat elevated lesion with a central depression in the sigmoid colon. Narrow-band imaging magnification revealed a Japan Narrow-Band Imaging Expert Team classification of type 2B, whereas crystal violet staining showed a mild to severely irregular type VI pit pattern. Ultra-magnification imaging revealed an EC3a morphology in the depressed area. Endoscopic ultrasonography revealed partial disruption of the third layer, leading to the diagnosis of T1b (SM) colon cancer. Owing to the intermediate lesion size and since the patient had requested it, an endoscopic submucosal dissection was performed as an initial treatment. Pathological analysis revealed a moderately differentiated tubular adenocarcinoma with an invasive micropapillary carcinoma (IMPC) component, with deep submucosal invasion. Additional surgery was performed, and no recurrence was observed in the following three years. IMPC is known for its high rate of lymph-node metastasis and poor prognosis, as reported for breast, bladder, and lung cancers. IMPC is rare; this report presents a literature review and case details. This case represents the first reported instance of identification of a cancerous IMPC component by magnifying endoscopy at the T1b (SM) depth. Thus, even for intermediate lesions, IMPC should be considered as a differential diagnosis when endoscopic imaging suggests malignancy.  \n1  Introduction  \nInvasive micropapillary carcinoma (IMPC) was first described in 1993 by Siriaunkgul et al. [1] as a biologically aggressive subtype of invasive ductal carcinoma of the breast. It is characterized by  \na high frequency of lymphovascular invasion and lymph node metastasis [2] .  \nReports of IMPC in organs such as the urinary tract, lungs, and salivary glands have since emerged, and all provide evidence  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2025 The Author(s) . DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.  \nDEN Open, 2026; 6:e70184  \n[https://doi.org/10.1002/deo2.70184](https://doi.org/10.1002/deo2.70184)  \n1 of 5  \nFIGURE 1  (a) Endoscopic images of white light imaging (WLI),(b) narrow band imaging (NBI) (normal),(c) NBI (magnification), and (d) crystal violet staining (magnification) .  \nof associated poor prognosis due to frequent lymphatic spread. Herein, we report an unusual case of early-stage colorectal carcinoma with an IMPC component.  \n2  Case Report  \nA female patient in her 60s was referred for further evaluation after a positive fecal occult blood test. Colonoscopy identified a 15 mm, red, flat, elevated lesion in the sigmoid colon, surrounded by white plaques, but there were no obvious signs of pulling or distortion of the folds (Figure 1a) . Magnified narrow-band imaging revealed a Japan Narrow-Band Imaging Exper","cbCaimTVIAU4X5LB","https://ap.wps.com/l/cbCaimTVIAU4X5LB","pdf",15577807,"English","# Abstract\n# Introduction\n# Case Report\n# Discussion","[{\"question\":\"How was the suspected colon lesion evaluated before treatment?\",\"answer\":\"Colonoscopy identified a 15-mm flat elevated lesion with central depression in the sigmoid colon. Narrow-band imaging, crystal violet staining, and ultra-magnification imaging were used to characterize pit pattern and depressed-area morphology, and endoscopic ultrasonography assessed layer disruption to support T1b (SM) diagnosis.\"},{\"question\":\"What treatment was performed for this T1b (SM) suspected cancer?\",\"answer\":\"Because the lesion size was intermediate and the patient requested it, endoscopic submucosal dissection (ESD) was performed as initial treatment.\"},{\"question\":\"What did pathology and follow-up show regarding invasive micropapillary carcinoma (IMPC)?\",\"answer\":\"Pathology revealed moderately differentiated tubular adenocarcinoma with an invasive micropapillary carcinoma component and deep submucosal invasion. Additional surgery confirmed no residual tumor or lymph-node metastasis, and careful follow-up found no recurrence for three years.\"}]","A Case of Human Epidermal Growth Factor Receptor 2-Positive Colon Cancer With Invasive Micropapillary Carcinoma Component | PDF",1790178443,13]