Expert: Neha Dahiya MD - 7/7/2009

Question
Clinical reports below. My doctor recommends a laparascopic right hemi-colectomy to remove the polyp completely, along with 12-18" of ascending colon. Trying to decide whether this is a reasonable approach. Any thoughts? Thanks!


Operative findings 6/08: 1 cm polyp in the proximal ascending colon just distal to the ileocecal valve. Multiple biopsies obtained, including snare excision of the majority of the polyp as well as biopsies with forceps. Due to the nature of the polyp, complete removal not possible.   

Pathology Lab Report 6/08: Diagnosis, Ascending Colon Polyp:  Tubulovillous adenoma. Microscopic Description: Sections show tubular and elongated glands with adenomatous change without high-grade dysplasia.   

Operative findings 6/09: At the site of the previous tubulovillous adenoma, there was an additional polyp, approx 1 cm x 1 cm. It was somewhat sessile and the majority of the polyp was excised using cold snare and forceps, but some polyp appeared to be remaining.

Pathology Lab Report 6/09: Diagnosis, Ascending Colon Polyp:  fragments of tubular adenoma, no high grade dysplasia identified.
Microscopic Description: Sections show multiple fragments of a polyp having adenomatous change in the epithelium consisting of nuclear basophilic hyper chromasia and stratification with mild dysplasia.  High grade epithelial dysplasia is absent.


Answer
Hello Steve:

As far as the pathology reports state, this polyp is benign without any kind of features suggesting of cancer.

Polyps in the colon carry an overall < 1% risk of cancer. Of all the polyps of colon the type you have is - Adenoma (tubulovillous type) Here the risk of progression to cancer is related to both the size and the appearance of cells of the adenoma. Adenomas that are greater than 1 cm, contain a substantial (>25%) villous (finger like projections)component, or have high-grade dysplasia (abnormality in maturation of cells) are commonly referred to as advanced neoplasms and carry an increased cancer risk.

Yours is about a cm in size with mild dysplasia.

The decision to have the section of colon removed should be in consultation with the surgeon. I am not an expert on the treatment aspect of the disease. You can ask another surgeon on this forum regarding the surgery.