This sessile polyp was found in the caecum, close to the appendiceal orrifice
WHAT IS YOUR DIAGNOSIS?
■ Mixed adenomatous & serrated polyp
I don't see a mixture of crypt patterns!
No, TSA's look like a cross between TVA & VA!
■ Adenomatous polyp
Perhaps the crypts look a little slit-like but it's covered with mucus...
Well, perhaps the crypt openings look a little slit-like but the lesion is partially covered with that mucus typical of an SSL. By the way, couldn't it be a hyperplastic polyp? I think that pathologists have given up even attempting to tell the two apart! My own rule of thumb is that anything which is ≥10mm, I call an SSL and remove.
By the way, SSL's usually lift very well. In this particular case, the lift is a little sub-standard for an SSL, presumably because it's situated very close to the appendix orifice which anchors it down.
A word of caution! I've had several 'post polypectomy syndrome' cases after removing large SSL's. In these cases, the lift was excellent and I asked for the LARGE snare to remove the lesion en-bloc. However, in both cases, I found that the snare was taking quite a long time to cut through. Perhaps because of that fatty reaction in the stroma below which Neil Shepherd talked about in the Podcast.
To avoid any risk of the 'post polypectomy syndrome', you should ask your assistant to close the snare as quickly and hard as possible. Don't worry about bleeding. These lesions are never supplied by any significant vessels. Oh yes! And place clips !!!