| Theme | Management of large colorectal polyp --Indication and technique of endoscopic treatment | |
|---|---|---|
| Title | Pathologists' point of view | |
| Publish Date | 2000/11 | |
| Author | Tetsuo Nemoto | Department of Pathology, Tokyo Medical and Dental University |
| Author | Touichiro Takizawa | Department of Pathology, Tokyo Medical and Dental University |
| Author | Morio Koike | Department of Pathology, Tokyo Medical and Dental University |
| [ Summary ] | Endoscopic mucosal resection (EMR) of large elevated lesions (over 2cm) of the colo-rectum are difficult to perform by using a single ("en bloc"), which is applicable for treatment of adenoma and/or well differentiated intramucosal carcinomas. However, EMR for similar large lesions with submucosal infiltration and/or lymphatic metastasis may be contradictory. Colectomy must be chosen as the proper approach for such cases. Histopathological features of the tumor, moderately/poorly differentiated components, mucinous components, significant stromal reaction and lymphatics and/or venous permeation, suggest the presence of submucosal infiltration and/or distant metastasis. These features are easily appreciated in routine biopsy samples taken from the tumor surface. Thus, the findings obtained from routine biopsy samples must be carefully evaluated and used for selection of the treatment of large elevated lesions of the colo-rectum. Biopsies from the proper tumor site, based on careful endoscopical observation, are essentially needed for this purpose. Methods for handling EMR specimens and the indications for additional surgical procedures of the tumor were also commented on. |
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