What is the correct action?

This is the scar following the piecemeal removal of a sigmoid polyp some 6 months ago.  It was a 15mm tubular adenoma harbouring high-grade dysplasia.  Samples from the EMR scar has showed 'distorted glands' only. 
WHAT WOULD BE THE CORRECT FOLLOW UP?

a) organise an immediate follow-up

WTF ! This not a normal scar! You absolutely need to organise more samples, and perhaps a CT !!!

b) organise a follow-up in 6 months time

Would have been a mistake !

c) organise a follow-up in 12 months time

Would have been a big mistake!!!

d) organise a follow-up in 3 years time

May have cost the patient his life!!!

explanation

The first EMR was piecemeal and histology could of course not confirm that the resection had been complete. Indeed the 'index histology' reads oddly mentioning "frequent mitotic figures" and "back to back glands". To a gastroenterologist these words does not sound particularly alarming. 

However, the pathologist was trying to say "this looks like cancer but I can't actually make that diagnosis" !!!  Indeed this doesn't look like a normal EMR scar! The whole area is indurated as if there is an infiltrative process below the mucosa. Histology was reassuring mentioning some distorted crypts only. 

Sadly, the endoscopist was content with the reassuring repeat histology and did not reflect on the worrying endoscopic appearances. He did NOT organise a second round of post-EMR samples and the patient returned 2 years later with an advanced cancer. 

The take home messages from this sad story? 

1. Always make an endoscopic diagnosis! 
   This does NOT look like a normal scar and therefore you don't histology at face value.  If the histology does not tally with your endoscopic diagnosis, then you stick with your endoscopic diagnosis and act accordingly. In the above case, the patient should at least have had more samples urgently obtained with or without staging CT's.
2. Give the pathologists your endoscopic diagnosis!
   In the above case, if I had seen the scar, I would have written; "At least intramucosal cancer removed 6 month ago and now the EMR site appears indurated and infiltrated presumably by a malignant process. Eight Jumbo samples taken for confirmation" 
   
   As you know Western pathologists are not 'allowed' to make a diagnosis of intramucosal cancer in the colorectum.  it's not a recognised diagnosis in the colorectum according to the Vienna classification.  Naturally,  a UK pathologists would NEVER make that diagnosis.  But as I'm not a pathologists, I don't feel that I have to adhere to the Vienna classification (which I think should be updated) !