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<p class="ql-align-justify">Tubulovillous adenomatous polyp featuring a complex architectural mixture of elongated villous fronds and branching tubular glands. The epithelium exhibits high-grade dysplasia with pseudostratified, hyperchromatic nuclei and a complete loss of goblet cell polarity. Within this precursor lesion, focal intramucosal adenocarcinoma is identified, characterized by back-to-back, glandular proliferations infiltrating the lamina propria. Neoplastic cells exhibit marked nuclear pleomorphism, vesicular chromatin, and prominent nucleoli.</p><p class="ql-align-justify">There is no evidence of submucosal invasion or a desmoplastic stromal response in the current material.</p>
<p>Sessile sigmoid polyp.</p>
<p>Soft tissue fragments collectively measured 1 cm, totally embedded.</p>
<p><strong><em><u>Sigmoid colon, sessile polyp; excision:</u></em></strong></p><ul><li><strong>Intramucosal adenocarcinoma (Carcinoma in situ / pTis).</strong></li><li><strong>Arising within a tubulovillous adenoma with high-grade dysplasia.</strong></li><li><strong>Recommended for complete excision of the polyp to assess for concomitant invasive component. </strong></li></ul><p><br></p><h5><strong>COMMENT</strong></h5><h5 class="ql-align-justify">Because the colonic mucosa lacks lymphatic channels above the level of the muscularis mucosae, there is a negligible risk of regional lymph node metastasis. Complete endoscopic resection with clear margins is recommended to assess for more invasive component and it is generally considered curative.</h5>
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