Preventing an Unfortunate Polypectomy Attempt in a Large Broad-Based, Smooth, and Soft Polypoid Elevation of the Colonic Wall

Question: A 65-year-old black man with a medical history significant for hypertension and hemorrhoids was referred by his primary care doctor for colorectal cancer screening. The patient denies constipation and notes a small amount of blood on the toilet paper. Also the patient denies any abdominal pain or weight loss. The patient has no family history of colon cancer. Medication list significant for lisinopril 40 mg once a day and ibuprofen 800 mg tablet as needed. Physical examination and laboratory data are unremarkable. Colonoscopy revealed a large polypoid mass with short, thick stalk in the proximal transverse colon, approximately 70–75 cm from anal verge (Figure A). The polypoid mass appeared smooth, with a shiny pink mucosa; the mucosa overlying the mass lesion and stalk was similar to that surrounding normal colonic mucosa. On gentle insufflation, the lesion does not recede into the wall of the colon. The polypoid structure was palpated with forceps (Figure B); it was soft and easily compressible to palpation, which also resulted in a small indentation (Figure C). No diverticulum was seen during our evaluation. The rest of the examination was normal except for internal hemorrhoids.

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