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Colorectal carcinoma (CRC) is the third most commonly diagnosed type of cancer in Europe and the USA [1]. Main risk factors include advanced age, family history, male sex, lifestyle factors natural exposures to dietary/environmental factors, genome differences, obesity, type 2 diabetes, and the colonic microbiome [2]. CRC usually originates in mucosal foci of mutated cells with proliferative, biochemical and molecular aberrations, referred to as colorectal adenomas (CRA)[3].Less frequently, CRC develops from dysplastic crypts in flat mucosa in patients with ulcerative colitis[4], from epithelial cells covering gut-associated lymphoid tissue [5],or from mucosa without any recognizable preceding dysplastic alteration (de novo carcinoma)[6, 7].

Microtubular Colorectal Adenoma an Aggressive Histologic Phenotype with Propensity to Evolve into Invasive Carcinoma