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Cancer - Principles & Practice of Oncology
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F7_6.CAP
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1999-06-07
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751b
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FIGURE 32.7-6. Levels of invasion in a pedunculated adenoma (A) and a
sessile adenoma (B). The stippled areas represent zones of carcinoma.
Any invasion below the muscularis mucosae in a sessile lesion
represents level 4 invasion (submucosa). In contrast, invasive
carcinoma in a pedunculated adenoma must traverse a considerable
distance before it reaches the submucosa of the underlying bowel wall.
However, any cancer that penetrates the muscularis mucosae is at risk
for dissemination. (Haggitt RC, Glotzbach RE, Soffer EE, et al.
Prognostic factors in colorectal carcinomas arising in adenomas:
implications for lesions removed by endoscopic polypectomy.
Gastroenterology 1985;89:328)