Cancer in a polyp of the large intestine - an interdisciplinary decision problem

Abstract

Large intestine polyps are commonly found during colonoscopies. Pedunculated colon polyps can be totally removed using an endoscopic invasive technique. A problem arises when the pendulated polyp contains cancerous infiltration. The aim of the article was a presentation of the clinical decision process concerned with the presence of cancer invasion tissue within colorectal polyps. Review of literature source and presentation of histological sample photography. A correct interpretation of the pathomorphological protocol is crucial for the therapeutic decision, which should be consistent with the actual recommendations of gastroenterological societies. Local treatment is considered as complete when the adenocarcinoma is well or moderately differentiated without any microinvasion of blood and lymphatic vessels and the resection margin is more than 1 mm from the cancer tissue infiltration. In the contemporary clinical practice patients with a colon polyp require rational clinical decisions, which are based on the actual recommendations.

Keywords: colonoscopy; malignant colorectal polyp.

Figure 1

Pedunculated colon polyp, assessed with the Haggitt classification as level 3. A, D – H + E staining; the subsequent magnifications show infiltration of the polyp stalk by cancerous tissue (numbers 1); A, at the stalk level, there is regular intestinal epithelium (numbers 2), and the margin of the polyp resected with the endoscopic loop is tagged with the number 4. B, C – Immunohistochemical staining against desmin; to demonstrate smooth muscle tissue of the muscularis mucosae (numbers 3), the arrows indicate destruction of the muscularis mucosae from the cancer infiltration. The magnification bar: A – 5000 µm, B – 1000 µm, C – 2000 µm, and D – 1000 µm is labelled in each photo, respectively