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Fig 1.

The adenoma–carcinoma sequence and de novo theory.

The two main theories regarding the carcinogenic pathway of CRC. In the adenoma–carcinoma sequence, the lesions initially present as protruded and eventually become ulcerated. On the other hand, depressed lesions develop via the de novo pathway. Kudo et al. referred to these two pathways as the "mountain route" and "direct route", respectively.

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Fig 2.

Patient selection flow chart.

Of the 153 T2 colorectal cancer patients, 55 were included. 30 had the depressed-type and 25 the protruded-type.

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Fig 3.

Typical endoscopic images of each morphological type.

(a) Endoscopic image of a typical depressed-type colorectal cancer. A clear depressed area is seen after indigo carmine staining. (b) Endoscopic image of a typical protruded-type colorectal cancer.

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Fig 4.

Typical immunostaining images for each marker.

(a) CDX2, (b) FRMD6, (c) KER, (d) HTR2B, and (e) ZEB1.

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Table 1.

Immunostaining results and consensus molecular subtype (CMS) classification according to morphological type (depressed/protruded).

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Table 1 Expand

Table 2.

Clinicopathological characteristics according to each consensus molecular subtype (CMS).

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Table 2 Expand

Table 3.

Clinicopathological characteristics of patients according to morphological type (depressed/protruded).

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Table 3 Expand