- Human pathology

Home > E. Pathology by systems > Digestive system > Colon and rectum > colorectal adenoma with adenocarcinoma

colorectal adenoma with adenocarcinoma

Tuesday 6 January 2015

colorectal polyps with invasive adenocarcinoma ; Cancerised Adenoma; Malignant colorectal polyps

See also : colorectal adenoma

Invasion in pediculated polyp

- See : Haggitt classification system

- Haggitt

  • Haggitt defined the submucosal invasion in all sessile polyps as level 4 and therefore associated with bad outcome, independently of the affection or not of the resection margins.
  • Despite Haggitt’s classification has been widely used to evaluate the resection quality of endoscopic polypectomies, this is less useful in non-pedunculated, flat or depressed lesions.

Invasion in sessile polyp

- Kikuchi

  • The most accepted classification for them is Kikuchi’s one, quantifying the grade of vertical and horizontal submucosal invasion: submucosa is divided into superior third (Sm1), medium third (Sm2) and lower third (Sm3).
  • Superior third is subdivided into 3 subtypes depending on horizontal spread in relation with the tumoral size.
  • Referring to the outcome, Sm1 is equivalent to Haggitt’s level 1, Sm 2 to levels 2 and 3, and Sm3 may correspond with a level 4. Sm1a or Sm1b lesions without invasion never develop metastases.




Open references


- Malignant colorectal polyps. 2010. doi : 10.3748/wjg.v16.i25 3103

- Endoscopic resection as unique treatment for early colorectal cancer. Revista EspaƱola de Enfermedades Digestivas. Rev. esp. enferm. dig. v.102 n.7 Madrid jul. 2010.