Abort or Attack?
I was asked to remove this sigmoid lesion. Previous samples have revealed a TA+HGD. The dark colouration is due to a previous ink tattoo, placed rather too close to the lesion itself for my liking.
SHOULD I ABORT OR ATTACK?
When this question was first published on our FB group, >95% correctly answered; Abort !
The complete absence of a crypt pattern means that this lesion should not be endoscopically resectable. The Japanese would say that there is evidence of 'massive invasion' (invasion beyond 2mm below the muscularis mucosa). Of course, I confirmed my impression with a 'test-lift', which of course failed.
Subsequently, surgery confirmed that the lesion was T3 (invading through the muscle propria layer) but luckily no nodes were involved.
The take-home message? If a 'test lift' had been done a the first examination, we could have saved a lot of time. A test-lift will not scupper a future endoscopic resection!