An evil little polyp?
This is a video clip of a small lesion removed from the sigmoid colon.
WHAT IS THE MOST LIKELY HISTOLOGY?
But it's a IIc lesion with IIIs crypts in the centre?!?
c) Invasive cancer
But there ARE small round crypts in the centre and it DOES lift!!!
You may call this a "flat elevated lesion with a central depression (IIa+IIc lesion) or simply a depressed lesion (IIc lesion). Frankly it doesn't matter because both a part of the same 'family' of evil little b.....ds.
They are always TA's and the small, round crypts (Kudo type IIIs crypt pattern) tells you that the lesion harbours HGD. This is because as dysplasia progresses from low to high grade, crypts get smaller and more withered. Of course they eventually disappear altogether as the lesion develops into a cancer which no longer follows any 'instructions' to form organised crypts.
However, the crypt pattern is still discernible in the centre AND the lesion lifts well. Both of these tells you that the lesion is likely to still be benign.
Ultimately, the pathologists called it a TA+HGD. However, there was mucinous differentiation in the centre of the lesion. Could these little shits be the early stage of mucinous colonic cancers? Quite likely! Imagine how easily they are missed when hiding behind a fold or below a shallow puddle !!!