A 50-year-old woman is found to have a 3 cm sessile villous adenoma of the rectum at 10 cm from the anal verge. Biopsy shows no malignancy. Which is the most appropriate curative treatment?

• A Endoscopic mucosal resection
• B Radiation therapy
• C Low anterior resection
• D Transanal endoscopic microsurgery (TEM) ✓

Explanation

Villous adenomas greater than 2 cm have high malignant potential and are difficult to remove endoscopically. TEM allows full-thickness excision with clear margins and is the standard for large benign rectal villous adenomas. Endoscopic resection is insufficient, and radical surgery is overtreatment for a benign lesion.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.