Tubulovillous Adenoma: Post-Polypectomy Concerns and Follow-Up

Sigmoid colon polyp

Hello, Dr.
Ke! A month ago, I had a colonoscopy during which a polyp located 45 cm from the anus in the sigmoid colon was removed.
The pathology report indicated a tubulovillous adenoma measuring 0.6 x 0.6 x 0.4 cm.
The doctor mentioned it is a benign tumor.
My pathology report shows: "Section shows tubulovillous adenoma with hyperchromatic, elongated, and pseudostratified nuclei of colonic crypts and chronic inflammatory infiltrate in the lamina propria."
1.
Could you please help me understand the details of my report, specifically regarding the arrangement of the nuclei and the degree of inflammation? How severe is it?
2.
After the removal of a pedunculated polyp, will the inflammatory area at the base continue to deepen, or will it stop inflaming and possibly heal?
3.
Recently, when I press above the left lower abdomen near the groin, I feel a sharp, needle-like sensation.
Is it normal to feel a foreign body sensation in the area where the polyp was removed, or is this just a normal response to abdominal pressure?
4.
How long should I wait before the next follow-up colonoscopy?
Thank you for your response, I appreciate it!

Danxin Zhe, 40~49 year old female. Ask Date: 2012/10/23

Dr. Ke Fangxu reply Surgery

Tubulovillous adenoma is a type of benign polyp.
Although its differentiation status is relatively active, it is not classified as a malignant tumor.
It is recommended to undergo a colonoscopy once a year.

2.
After the removal of a pedunculated polyp, as long as the resection margins are free of inflammation, there should be no concerns regarding deep inflammation.

3.
Under normal circumstances, polyp removal should not cause any complications; it is typically just a normal response.

4.
If a colonoscopy reveals the presence of polyps, it is advisable to have another colonoscopy the following year.
If polyps are again found, continue to have colonoscopies annually until no polyps are detected.
After that, a colonoscopy can be performed every 2 to 3 years.
Additionally, an annual fecal occult blood test can be conducted, and if any abnormalities are found, a colonoscopy should be performed.

Reply Date: 2012/10/23

More Info

Understanding tubulovillous adenoma and its implications post-polypectomy is crucial for ensuring ongoing health and monitoring for potential complications. Based on your pathology report and the details provided, let’s break down your concerns and provide guidance on follow-up care.

1. Pathology Report Interpretation
Your pathology report indicates that the polyp removed was a tubulovillous adenoma, which is a type of benign tumor. The size of the adenoma (0.6 x 0.6 x 0.4 cm) is relatively small, and the report describes hyperchromatic, elongated, and pseudostratified nuclei within the colonic crypts, along with chronic inflammatory infiltrate in the lamina propria.
- Cellular Arrangement and Inflammation: The hyperchromatic nuclei suggest that the cells are actively dividing, which is typical for adenomatous polyps. The presence of chronic inflammation indicates that there may have been some irritation or response from the body to the polyp, but this is not uncommon. The severity of the inflammation is generally assessed in the context of the overall findings, and in your case, it does not indicate malignancy.

2. Post-Polypectomy Inflammation
After the removal of a stalked polyp, it is common to have some localized inflammation at the site of excision. Typically, if the surgical margins are clear (which they appear to be in your case), the inflammation should resolve over time. The body usually heals itself, and any inflammatory response should diminish as the tissue recovers. If there are no signs of infection or complications, the inflammation should not deepen.

3. Sensations After Surgery
Experiencing a sensation of "needle-like pain" or a feeling of an "object" in the area where the polyp was removed can be a normal part of the healing process. This discomfort may arise from the healing tissue, nerve regeneration, or even residual inflammation. However, if the pain persists, worsens, or is accompanied by other symptoms such as fever, significant swelling, or changes in bowel habits, it would be prudent to consult your physician.

4. Follow-Up Colonoscopy
Regarding follow-up colonoscopy, guidelines typically recommend that individuals with a history of adenomatous polyps undergo surveillance colonoscopy every 3 to 5 years, depending on the number and type of polyps found. Since your adenoma was tubulovillous, which has a higher risk of progression to colorectal cancer compared to other types of adenomas, your doctor may recommend a follow-up colonoscopy sooner, possibly within 3 years. It is essential to discuss this with your healthcare provider, who can tailor the follow-up schedule based on your individual risk factors and findings.

Additional Recommendations
- Diet and Lifestyle: Maintaining a healthy diet rich in fruits, vegetables, and fiber can help reduce the risk of future polyps. Regular physical activity and avoiding smoking and excessive alcohol consumption are also beneficial.

- Monitoring Symptoms: Keep track of any new symptoms, such as changes in bowel habits, abdominal pain, or rectal bleeding, and report these to your doctor promptly.

- Regular Check-Ups: Stay engaged with your healthcare provider for regular check-ups and screenings as recommended.

In summary, while your pathology report indicates a benign condition, ongoing monitoring and lifestyle adjustments are essential for maintaining colorectal health. Always feel free to reach out to your healthcare provider with any concerns or questions regarding your health and follow-up care.

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