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+A 60-year-old man who underwent colonoscopy was found to have a 2 cm sessile polyp that was located 10 cm from the anal verge and successfully removed.
+The polyp was a tubulovillous adenoma with focal high-grade dysplasia.
+A flexible sigmoidoscopy performed three months later, as well as a repeat colonoscopy one year after the initial colonoscopy, were both negative for recurrence.
+A colonoscopy performed three years after the initial colonoscopy revealed a sessile polyp, 3 cm in size, at 10 cm from the anal verge.
+Biopsies were taken and reported to be fragments of a villous adenoma with low-grade dysplasia.
+Due to the previous high-grade dysplasia, relatively rapid recurrence and concern that a cancer may have been missed by sampling error, a pelvic magnetic resonance imaging (MRI) scan and an endoscopic ultrasound (EUS) were performed before definitive excision.
+The MRI revealed an invasive rectal mass involving the muscularis propria but without breach of the adventitia, consistent with a T2 rectal carcinoma (Figure 1).
+No pelvic lymphadenopathy was detected.
+The EUS revealed a rectal mass involving the mucosa and submucosa, with no involvement of the muscularis propria (Figure 2).
+The results of the MRI and EUS, as well as the surgical versus endoscopic resection treatment options, were discussed with the patient, who opted for a surgical resection.
+The patient underwent a low anterior resection and end-to-end anastomosis with loop ileostomy.
+Pathology review of the resected rectosigmoid revealed a villous adenoma with low-grade dyplasia.
+There was no evidence of muscularis propria invasion, and a total of five pericolic and two mesorectal lymph nodes were excised and deemed benign.
+The patient underwent ileostomy reversal five months later.
+He remains asymptomatic with no recurrence of tumours.