Normal scar or local recurrence?

Six months ago a SSL+HGD had been removed from transverse colon. This is the EMR scar.
IS THERE A LOCAL RECURRENCE? 

■ No, site looks OK

No it so doesn't !!!

■ Yes, looks like a local recurrence

In fact, it's a malignant local recurrence !

explanation

​You will be surprised to hear that samples taken was reported as 'normal mucosa'!!!    Fortunately, someone didn't believe this and organised an early follow up for further samples.  This confirmed adenocarcinoma with LVI !!!

Bizarre how a lesion can seemingly turn cancerous after resection!  Presumably what happened is that it was cancer all along but this wasn't recognised at the 'index histology'. 

The moral of the story?  Don't take the histological diagnosis as the 'bottom line'.  These guys are experts but at the mercy of accurate targeting of samples and they only have a few tiny scraps to look at.  You on the other hand, can see the whole lesion.  If histology, doesn't seem to correspond with your endoscopic resection, more tissue is needed.  

On the topic of endoscopic assessment, ALWAYS look at lesions in both anteversion and retroversion !