This lesion, situated in a very spastic sigmoid, has been referred for resection.
WHAT IS THE LIKELY DIAGNOSIS?
a) lesion is not neoplastic
Yes, hard to believe but true!
b) lesion is adenomatous
Lesion is 'battered' but crypts don't look typically adenomatous
c) lesion is malignant
No way, lesion isn't angry red, chunky or devoid of crypts!
I couldn't stop myself! After yesterday's case of a rectal 'prolapse polyp, part of the 'Mucosal Prolapse Syndrome', I had to show an example of a sigmoid mucosal 'traction polyp' (my nomenclature). The mucosa at the apex of this sigmoid fold is traumatised and inflamed but not actually adenomatous! Histologically these lesions also appear somewhat bashed up. This is where pathologists may see 'pseudo-invasion' which is actually movement of crypts due to trauma and inflammation.
The sigmoid colon is the most 'powerful' part of the colon developing the force needed to go to the toilet. Presumably this is the reason that diverticular disease first develop in the sigmoid. The force can also create these pseudo-polyps from patches of inflammation which I presume gets tugged along with each peristaltic wave. The end result is that this is the most difficult part of the colon to make head an tail of polyps.
These are common lesions and if you are a 'therapeutic endoscopist', you will be refer these lesions. In these cases, I don't go overboard by placing a snare far down the 'pseudo-stalk'. If you did, you will find that it's taking a long time to cut through all that healthy sigmoid mucosal fold and you run the risk of a perforation (early or late).
Instead, I just catch the tip of the fold and ask my assistant to close the snare as quickly as possible. Of course, you don't need to worry about a type of chunky central vessel which you may find in an adenomatous polyp. Analysis of a small piece of mucosal apex confirmed a normal mucosa. Hopefully this was enough for everyone to relax ...