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Special Feature
September 1, 2007

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations:John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California (Drs Kavanagh, Ahmad, and Bilchik); and Simi Valley Hospital, Simi Valley, California (Dr Amadpour).



Arch Surg. 2007;142(9):901. doi:10.1001/archsurg.142.9.901

An otherwise healthy 57-year-old woman underwent routine follow-up colonoscopy after colonoscopic polypectomy 6 years previously. She was found to have a healthy colon, but her rectum showed a circumferential dense collection of polyps (Figure 1). Multiple biopsy specimens of the polyps were obtained. Pathologic examination demonstrated multiple serrated adenomas. The patient reported no family history of colon cancer, and she had no biologic children. On rectal examination, she had multiple palpable polyps extending to the dentate line.

Figure 1.
Dense polyps seen during colonoscopy.

Dense polyps seen during colonoscopy.

She underwent rigid sigmoidoscopy followed by low anterior resection with coloanal J pouch reconstruction. Final pathologic examination demonstrated the carpet of polyps; some polyps were larger than 1 cm, but all were negative for carcinoma (Figure 2).

Figure 2.
Gross pathologic examination reveals distal rectal polyps with transition zone.

Gross pathologic examination reveals distal rectal polyps with transition zone.

What Is the Diagnosis?

A. Familial adenomatous polyposis

B. Hereditary nonpolyposis colorectal cancer syndrome

C. Serrated adenomatous polyposis

D. Hereditary mixed polyposis syndrome