Gastrointestinal pathology: colorectal adenoma: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Gastrointestinal pathology: colorectal adenoma

Sample item

A 55-year-old man has rectal bleeding, and colonoscopy shows a 2.5 cm sessile polyp. Which histological features of an adenoma carry the greatest risk of containing invasive carcinoma?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Villous architecture, size above 2 cm and high-grade dysplasia

The malignant potential of an adenoma rises with villous architecture, larger size and higher grade of dysplasia. A villous adenoma greater than 2 cm has a substantial chance of harbouring carcinoma. Complete removal and histological assessment of the stalk or base is needed.

Option by option

  • A. Tubular architecture, size below 1 cm and low-grade dysplasia

    Small tubular adenomas with low-grade dysplasia carry the lowest risk.

  • B. Villous architecture, size above 2 cm and high-grade dysplasia (correct)

    Correct. These three features are the strongest predictors of invasive carcinoma.

  • C. Cystically dilated glands in lamina propria with inflamed stroma

    Cystic glands with inflamed stroma describe a juvenile hamartomatous polyp.

  • D. Serrated crypts with no cytological atypia in the rectosigmoid

    Small hyperplastic-type serrated polyps in the rectosigmoid are essentially benign.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Villous architecture, size above 2 cm and high-grade dysplasia. The malignant potential of an adenoma rises with villous architecture, larger size and higher grade of dysplasia.

Why is "Tubular architecture, size below 1 cm and low-grade dysplasia" not the answer?

Small tubular adenomas with low-grade dysplasia carry the lowest risk.

Why is "Cystically dilated glands in lamina propria with inflamed stroma" not the answer?

Cystic glands with inflamed stroma describe a juvenile hamartomatous polyp.

Why is "Serrated crypts with no cytological atypia in the rectosigmoid" not the answer?

Small hyperplastic-type serrated polyps in the rectosigmoid are essentially benign.

What concept does this question test?

It tests Gastrointestinal pathology: colorectal adenoma in Pathology. A villous adenoma greater than 2 cm has a substantial chance of harbouring carcinoma. Complete removal and histological assessment of the stalk or base is needed.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal pathology: colorectal adenoma?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.