Colonic adenocarcinoma arising in tubulovillous adenoma
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Clinical history
68-year-old man with iron deficiency anaemia. Colonoscopy showed a 35 mm sigmoid polypoid lesion.
Specimen
Endoscopic polypectomy · Stain: H&E
Microscopic description
Tubulovillous architecture with high-grade dysplasia and a focus of invasive glands penetrating the muscularis mucosae into the submucosa, with a desmoplastic response.
Diagnostic question
How would you report the invasive component and which parameters determine further management?
Reveal differential diagnosis
High-grade dysplasia without invasion
Pseudoinvasion (epithelial misplacement)
Reveal final diagnosis
Moderately differentiated adenocarcinoma arising in a tubulovillous adenoma
Learning points
Distinguish true invasion from epithelial misplacement
Report depth of submucosal invasion, differentiation, lymphovascular invasion and margin distance
Correlate with endoscopic appearance
Self-assessment
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