A polyp with horns ...

This polyp on a short stalk was removed from the colon
WHAT IS THE LIKELY HISTOLOGY?

a) TA

At the edge, the crypts are clearly sli-like but how about the centre?

b) TVA

Doesn't look like gyrate crypts!

c) VA

Doesn't look like a sea anenome!

d) TSA

TSA's do have crypts but this lesion doesn't in the centre!

e) Early cancer

Was my own firm diagnosis!

explanation

The head of the lesion is clearly of concern.  There are 'horns' on it!   Of course, the devil has horns but as it was arising from a stumpy stalk. I went ahead and removed it. Somewhat surprising our pathologists called the lesion TA+HGD! 

Admittedly, there was disagreement between our histopathologists and 2 out of 5 believed that it was an invasive cancer. Endoscopically, the lesion is clearly malignant and at the very least it's an intramucosal cancer (IMca).  Of course, our UK histopathologists are unable to make the diagnosis of Intramucosal cancer in the colorectum because this is not a diagnosis recognised by the 'Vienna classification'.  Elsewhere in the GI tract, intramucosal cancer is  a diagnosis which our pathologists are 'free' to make.  It makes no sense whatsoever to me !