Diagnosis and Management of Pedunculated Polyps with Tubular Glands

Introduction to Tubular Adenomas

A pedunculated polyp with tubular glands is not inherently malignant, as tubular adenomas are benign neoplastic polyps with malignant potential, but they only become malignant when invasive carcinoma penetrates through the muscularis mucosa into the submucosa, according to the American Gastroenterological Association 1, 2
The term "malignant polyp" specifically refers to polypoid lesions that appear endoscopically as adenomas but histologically reveal an invasive carcinoma component, as defined by the American Gastroenterological Association 1, 3

Polyps ≥10 mm have significantly higher risk of advanced neoplasia, as reported by the American College of Gastroenterology 4
Pedunculated polyps are generally easier to assess for complete excision, according to the American Society for Gastrointestinal Endoscopy 1

If a pedunculated polyp contains invasive carcinoma, it would be considered high-risk for residual or recurrent cancer if it has any of the following features: poor tumor differentiation, lymphovascular invasion, tumor within 1 mm of the resection margin, or tumor budding, as identified by the American Gastroenterological Association 5, 6

Complete endoscopic removal is the standard approach for a pedunculated polyp with tubular glands, and the polyp should be removed en bloc to allow proper histopathologic assessment, as recommended by the American College of Gastroenterology 1, 6
Proper pathologic sectioning is essential, and the polyp should be bisected through the center of the stalk to visualize the mucosa/submucosa junction and assess margins, according to the American Gastroenterological Association 1, 3
If invasive carcinoma is found, assess for favorable vs. unfavorable features, and surgical resection is indicated if unfavorable features are present, as suggested by the National Comprehensive Cancer Network 2

The incidence of high-grade dysplasia increases from 4.4% in 6-10 mm adenomas to 16.2% in adenomas >10 mm, according to the American College of Radiology 7
Adenomas ≥10 mm are 20.3 times more likely to have high-grade dysplasia compared with small adenomas, as reported by the American College of Radiology 7