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A 64−year−old woman was referred to our endoscopic unit for investigation of ab− dominal pain. At colonoscopy we found a sessile polyp, 15 mm in diameter, in the middle part of the rectum (Figure 1). Mag− nified chromoendoscopy using 0.2 % indi− go carmine dye revealed a type IV pit pat− tern according to Kudo s classification, suggesting that the polyp was a good can− didate for endoscopic resection. However, this polyp seemed to be taller than an or− dinary sessile polyp, and a biopsy forceps was used to determine how hard it was. This revealed that the polyp was elastical− ly harder than an ordinary adenomatous polyp. Eventually, excisional biopsy of the polyp was performed by endoscopic mucosal resection rather than by snare polypectomy, and this procedure was un− eventful. Histologically, the tumor was found to consist of adenoma arising from the mucosal layer, which showed transi− tion to carcinoid tumor, mainly in the submucosal layer (Figure 2). Because there was evidence of both lymphatic and venous invasion of tumor cells in the carcinoid component of the tumor, addi− tional surgery was performed as a cura− tive measure. No local residual tumor or lymph node metastasis was found.

A composite adenoma and carcinoid tumor in a single rectal polyp