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Diagnostic Dilemma: GI Disease

Diagnostic Dilemma: GI Disease

Test your diagnostic skills with the following diagnostic quiz

This 72-year-old woman undergoes surveillance colonoscopy. She has a history of small colonic adenomas removed from the distal colon and of a sessile hyperplastic polyp in the cecum. Prior biopsies have demonstrated only hyperplastic changes and no evidence of adenomatous or dysplastic features. Her last colonoscopic examination was more than 3 years ago.

Her past medical history is positive only for mild hypertension well controlled on medication. There is no surgical history. Her family history is negative for colorectal cancer. Her physical examination is unremarkable, and laboratory testing has been normal.

During colonoscopy, this flat, subtle sessile polyp is detected in the cecum. Upon initial visualization, it was covered with thick mucus, which was washed away. The polyp is at least 1.5 cm in diameter.

1) This polyp most likely represents:
a) A lipoma
b) A carcinoma
c) A hyperplastic polyp
d) An inverted diverticulum
e) An adenomatous polyp

2) Appropriate diagnostic/therapeutic options include:
a) Biopsy and observation
b) Attempt at snare polypectomy
c) Ablation after biopsy
d) Colectomy
e) Observation without biopsy

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