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Colon Cancer

Colon Polyp - Pathology Question

03/04/2011

Question:

I am a 38 year old White male who just received a colonoscopy. My father died of metastatic colon cancer last year at the age of 68, after a 2 year struggle. My scope found 2 sessile polyps, a 6mm one in the distal sigmoid colon, and a 1 cm one in the hepatic flexure. I was told on the phone that both were benign, and to return for another colonoscopy in 5 years.

I asked for a copy of the pathology report. The smaller polyp seems to be no problem, but the larger one was described as a "benign mucosal polyp, favor hyperplastic polyp, but see microscopic description." I am a bit perplexed by some of the terminology used to describe the larger one in the microscopic examination, and was hoping you might be able to help me. The report said:

"The bisected polyp presents frilly archtecture and excess mucin production. The crypts are slight elongated. The mucin production does not begin until after modest delay rather than in the depths of the crypts, which do not become particularly serrated until the upper part of the mucosa. The do not bend, flatten, flare, bulge or grow laterally along the muscularis mucosae to a significant degree. These histologic changes are more consistent with a classic hyperplastic polyp than a sessile serrated one, despite the relatively large size of the lesion. Nevertheless, some right-sided hyperplastic-looking polyps can exhibit biologic behavior more typical of adenomatous ones, and a somewhat abbreviated surveillance interval may be indicated. The material does not present the typical hypereosinophilic epithelium of a traditional serrated adenoma."

1. Based upon what I`ve written and my family history, do you suggest I seek a 2nd opinion on the sample from the hepatic flexure? Even though I was told it was benign, the description is less than definitive, and is even less reassuring when coupled with the fact that my dad`s last "clean" colonoscopy in 2005 was followed by the discovery of a softball-sized neoplasm in his cecum less than 3 years later...

2. What specific measures, if any, could add clarity to the diagnosis of the polyp in question?

3. Finally, do you think a 3 or 5 year surveillance period is more appropriate in my case?

Thank you very much for your consideration.

Sincerely,

Answer:

1. The polyps are benign but it sounds like the pathologist wasn't convinced that whether the larger polyp was hyperplastic or what is called a sessile serrated adenoma, which is considered precancerous. I would recommend that you seek a second opinion about it.

2. When you seek a second opinion, the slides could be sent to a second pathologist to review.

3. With your family history and polyp diagnosis, a three year follow up interval may be more appropriate but I would defer to the physicians who are more familiar with your case.

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Response by:

Gregory S Cooper, MD Gregory S Cooper, MD
Professor of Medicine
School of Medicine
Case Western Reserve University