Small colon polyps: the primary physician's dilemma

This case report and literature review is presented to alert primary care physicians performing flexible sigmoidoscopy and limited colonoscopy to the malignant potential of even diminutive polyps. The term "polyp" refers to any circumscribed mass of tissue that arises from mucosa and protrudes into the lumen of the gastrointestinal tract. The significance of this lesion in the rectum and colon is its propensity for malignant change. Although small polyps in the region of the rectum tend to be hyperplastic and those more proximal tend to be adenomas with a significant malignant potential, there is no way to distinguish them visually; hence, all need to be biopsied. The following case report shows the necessity of identifying neoplastic lesions within diminutive polyps (less than 1 cm). Standard biopsy technique usually removes these lesions; nevertheless, when histology confirms the presence of adenoma or carcinoma, the patient requires additional evaluation of the entire large intestine and more frequent follow-up examinations.