A woman, aged 52, was referred for evaluation because of a positive fecal occult blood test. At colonoscopy, she had a neoplasm in the ascending colon close to the hepatic flexure. There was ulceration at the center of the neoplasm but the elevated margins had an unusual appearance with multiple shallow depressions that mimicked octopus suckers (arrows, Figure 1). The appearance raised the possibility of unusual lesions surrounded by normal mucosa. Biopsies from the ulcerated region revealed a poorly-differentiated adenocarcinoma. A subsequent upper gastrointestinal endoscopy and computed tomography scan of the abdomen were normal. A right hemicolectomy was performed and pathological evaluation confirmed the presence of a poorly-differentiated adenocarcinoma with spread to the serosa and adjacent lymph nodes. Histological evaluation of the octopus suckers showed that the central area was exposed carcinoma that had invaded towards the lumen from the submucosa. Furthermore, staining with podoplanin/D2-40 confirmed that the exposed cancer was surrounded by lymphendothelial cells (arrows, Figure 2).
The appearance of octopus suckers is rare but has been previously described with colon cancer, T-cell lymphoma and gastrointestinal metastases. These octopus suckers are often single lesions but can be multiple as in the patient described above. Our histological study has shown that the central area of the sucker is exposed carcinoma spreading from the submucosa. The nature of the reticular pattern on the margin of the sucker remains unclear but may be related to the formation of new blood vessels or to exposure of normal blood vessels in the mucosa and submucosa. Another possibility is that changes are highlighted by spread of cancer along lymph channels causing a degree of superficial lymphatic obstruction. Although it seems likely that octopus suckers reflect the presence of poorly-differentiated neoplasms, reports in larger numbers of patients will be necessary for confirmation. Another unusual endoscopic appearance of gastrointestinal neoplasms is that of onion-like whorls although pathological reasons for this appearance remain unclear.