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Background and Study Aims: Because of the rarity of cap polyposis of the colon and rectum, the endoscopic features of this condition have not been specified to date. The aim of this study is to characterize the endoscopic features of cap polyposis. Patients and Methods: The diagnosis of cap polyposis was established by histologic findings in specimens obtained endoscopically or surgically from four patients. Colonoscopic findings in the four patients were retrospectively reviewed. Results: The endoscopic features were divided into semipedunculated type (three patients) and flat-topped protruding type (one patient). In the semipedunculated type, the polyps were characterized by reddish protrusions of various configurations with eroded surface in the rectosigmoid colon. In the remaining patient, all the lesions were flat protrusions with a reddish central depression. The polyps of both types became smaller in size and fewer in number at the proximal part of the sigmoid colon. Multiple white specks were observed in the intervening mucosa in all four patients. Conclusions: The prominence of the polyps at the distal part of the colon and rectum and multiple white specks in the intervening mucosa seem to be the additional endoscopic features suggestive of cap polyposis.

Background and Study Aims: Brunner's gland hamartomas are uncommon duodenal submucosal tumors. We aim to describe their morphological characteristics, with particular attention to the endosonographic features. Patients and Methods: We reviewed the radiological, endoscopic, endosonographic, and histological findings from six Brunner's gland hamartomas which were completely removed by endoscopic resection. Results: The lesions appeared as broad-based, sessile, or pedunculated submucosal tumors, measuring 0.7 to 2 cm in maximal diameter. Three lesions contained tiny dimple-like depressions on the surface; in one lesion these were only recognized following the use of an endoscopic dye-spraying technique. All the lesions could be safely removed by endoscopic resection after endosonographic confirmation of the layer origin within the submucosa. The internal echo structure of the tumors appeared to be solid echogenic in two, simple cystic in two, and multicystic in the remaining two lesions. In three lesions with an indistinct boundary, some stromal proliferation and solid Brunner's glands were recognized in an area extending from the mucosa to the submucosa. These endosonographic features corresponded to histological findings comprising stromal proliferation and various degrees of solid and cystic glandular Brunner's glands. Conclusions: Brunner's gland hamartoma is characterized endosonographically by a heterogeneous solid and/or cystic mass within the submucosa.

Background and study aims The aim of the present study was to describe the endosonographic findings in gastrointestinal cystic submucosal tumors. Patients and methods The endosonographic and clinicopathological findings in 51 patients with a confirmed diagnosis of cystic submucosal tumors were reviewed. Results Endosonographically, cystic submucosal tumors were classified into simple cystic, multicystic, and solid cystic tumor types. The simple cystic tumor type was frequently identified in cysts, and rarely in Brunner's gland hamartomas or in heterotopic gastric mucosa. The multicystic tumor type was common in lymphangiomas, followed by gastric cystic malformations, hemangiomas, and Brunner's gland hamartomas. The solid cystic tumor type included duplication cysts, heterotopic gastric mucosa, heterotopic pancreas, myogenic tumors with advanced cystic degeneration, and gastric tuberculomas. Based on the endosonographic findings, 14 lesions were safely treated with endoscopic removal, using in particular the unroofing technique (cutting off the upper part of the tumors) in nine lesions. Conclusions Endosonography is a useful diagnostic modality for investigating cystic submucosal tumors.