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<p class="ql-align-justify">An adenomatous polyp formed of tubular and villous glands lined by pseudostratified columnar epithelium exhibiting diffuse moderate to marked anaplasia with active mitosis and reduced mucigenic activity. Focally, glands appear to be irregular with focal cribriform pattern and crowdness and extension to invade lamina propria above the level of muscularis mucosa (intramucosal neoplasia).</p>
<p class="ql-align-justify">Rectal bleeding underwent a colonoscopy that revealed a large pedunculated polyp 10 cm from the anal verge, which was removed via hot snare endoscopic mucosal resection.</p>
<p class="ql-align-justify">Fragments of collective size 3 x 2.8 x 1 cm, with the largest piece measuring 1.8 x 1.5 x 1 cm.</p>
<p><strong><em><u>Rectum, endoscopic biopsy:</u></em></strong></p><ul><li class="ql-align-justify"><strong>Tubulovillous adenomatous polyp with focal intramucosal malignant change.</strong></li><li class="ql-align-justify"><strong>Depth of invasion can't be assessed based on such superficial material. </strong></li></ul><p class="ql-align-justify"><br></p><p class="ql-align-justify"><strong><u>COMMENT:</u></strong></p><h5 class="ql-align-justify">These glands could represent intramucosal carcinoma or part of an underlying invasive adenocarcinoma. Since treatment of these two lesions are different (conservative mucosal resection for the former and segmental resection with lymphadenectomy for the latter), a deeper rebiopsy from the lesion is needed to resolve this issue.</h5>
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