Pathologic issues in the treatment of endoscopically removed malignant colorectal polyps

Endoscopically removed malignant colorectal polyps are early stage cancers for which treatment depends on histopathologic findings. For accurate pathologic evaluation, the polyps should be received in 1 piece because margins cannot be accurately assessed in fragmented polyps. Polyps with grade I or II cancer, no lymphovascular invasion, and a negative resection margin can be successfully treated with endoscopic polypectomy, whereas those with grade III cancer, lymphovascular invasion, or a positive or close margin require definitive surgical resection after endoscopic polypectomy. Potentially new significant parameters for patient management are depth of invasion and tumor budding. The pathology report must be clear and concise, indicating all relevant important parameters. The pathologist must differentiate invasive adenocarcinoma from intramucosal adenocarcinoma and pseudo-invasion.