A tubulovillous adenoma is a non-cancerous growth in the colon. It develops from the glands in the mucosa on the inside surface of the colon. These adenomas can develop anywhere along the length of the colon from the cecum to the rectum. All tubulovillous adenomas are associated with an increased risk for developing a type of colon cancer called adenocarcinoma over time.
The colon is a part of the gastrointestinal tract which also includes the mouth, esophagus, stomach, small bowel, and anus. The colon is a long hollow tube that starts at the small bowel and ends at the anal canal. The colon is divided into sections which include the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. The functions of the colon are to absorb water from the food that we eat and to move waste out of the body.
The colon is made up of six layers of tissue:
The diagnosis of tubulovillous adenoma is usually made after the adenoma is removed during a medical procedure called a colonoscopy. The adenoma may be removed in one piece or in multiple pieces. The tissue sample is then sent to a pathologist for examination.
When examined under the microscope, tubulovillous adenomas are made up of cells that show an abnormal pattern of growth. Pathologists call this abnormal pattern of growth dysplasia. Dysplasia in the colon is important because it is considered a precancerous condition that can turn into cancer over time.
In the colon, pathologists divide dysplasia into two categories: low-grade dysplasia and high-grade dysplasia. All tubulovillous adenomas show at least low-grade dysplasia. Your pathologist will carefully examine your tissue sample to look for any high-grade dysplasia because the risk for developing cancer is greater with high-grade dysplasia.
In the colon, a margin is any tissue that was cut by the surgeon in order to remove the tubulovillous adenoma from your body. Many tubulovillous adenomas grow on a piece of tissue called a stalk and the adenoma is removed by cutting the stalk. In these cases, the margin is the part of the stalk that is cut.
Dysplasia at the cut edge of the tissue means that the abnormal tissue may not have been completely removed from the body.
Tubulovillous adenomas are often removed and sent to pathology as multiple pieces (fragments) of tissue. In some of these cases, it will not be possible for your pathologist to determine which piece is the real margin and the changes seen at the margin will not be described in your report.