Abstract

We report a 52-year-old man who underwent a screening colonoscopy, which revealed a sessile rectal polyp with neoplastic features on magnified chromo-endoscopy. Based on pit pattern analysis and Endoscopic Ultrasound (EUS) (EUS), Endoscopic Submucosal Dissection (ESD) was performed for a presumptive diagnosis of an early rectal neoplastic lesion (limited to the mucosa and upper third of the submucosa). Histopathological examination however reported it to be a submucosal rectal lipoma with overlying regenerative changes over the mucosa. A second opinion was sought due to the discordance between the histology report and the pit pattern analysis of the lesion. Following a reassessment of the pathological specimen, it was revealed that the initial endoscopic diagnosis of a likely malignant neoplastic change within the mucosal lesion was accurate. In view of the revised histology report of a poorly differentiated adenocarcinoma with lymphatic invasion, he subsequently underwent a formal laparoscopic anterior resection for a T1N0 rectal cancer. Postoperative recovery was uneventful, and the patient remains well, in remission.

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