Neoplasia · NEET PG Preparation Pathology
A 62-year-old male undergoes surgical resection of a colonic polyp. Histopathological examination reveals a pedunculated lesion with malignant glands…
Practice question from Neoplasia (NEET PG Preparation Pathology), with the correct answer and a step-by-step solution.
hard · MCQ · Q-AF98A9
A 62-year-old male undergoes surgical resection of a colonic polyp. Histopathological examination reveals a pedunculated lesion with malignant glands invading through the muscularis mucosae into the submucosa of the stalk, but the resection margin is clear and there is no lymphovascular invasion. What is the most appropriate next step in management and staging term for this lesion?
- A.Total colectomy because any invasion beyond the muscularis mucosae is invasive carcinoma
- B.No further surgery required, as it is classified as a pT1 malignant polyp completely excisedCorrect answer
- C.Adjuvant systemic chemotherapy only, as submucosal invasion equates to node-positive disease
- D.Immediate re-excision of the colon segment due to high risk of distant metastasis
Solution
Invasion of tumor cells through the muscularis mucosae into the submucosa defines an invasive carcinoma (pT1). When a malignant polyp is completely excised with clear margins and favorable histological features (no lymphovascular invasion, grade 1 or 2 differentiation), endoscopic polypectomy is considered therapeutic and no further bowel resection is required.
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