Clinical Images  |   February 2020
Rectal Tubulovillous Adenoma
Author Notes
  • From the Gastroenterology Fellowship at Advocate Lutheran General Hospital in Park Ridge, Illinois. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Ryan T. Hoff, DO, Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL 60068. Email:
Article Information
Gastroenterology / Imaging / Clinical Images
Clinical Images   |   February 2020
Rectal Tubulovillous Adenoma
The Journal of the American Osteopathic Association, February 2020, Vol. 120, 121. doi:
The Journal of the American Osteopathic Association, February 2020, Vol. 120, 121. doi:
A 45-year-old woman presented to the clinic with hematochezia. She described 2 years of intermittent, painless, small-volume rectal bleeding after bowel movements, without weight loss or constipation. She had no family history of colon cancer. A colonoscopy revealed a large rectal polyp (image A) with gyrus-like pits, which were well visualized with narrow-band imaging (image B). Endoscopic ultrasonography demonstrated no submucosal invasion. A polypectomy was performed piecemeal via endoscopic mucosal resection using an injectable liquid compound (SIC-8000) for submucosal lift. Histologic analysis confirmed a tubulovillous adenoma, 4.8 cm in the greatest dimension. The hematochezia resolved following polypectomy. 
Colon polyps account for nearly 13% of rectal bleeding in outpatients.1 A tubulogyrus surface pattern of polyps suggests adenomatous histology.2 When found, adenomas should be resected because of the risk of malignant transformation. SIC-8000 is a Food and Drug Administration-approved agent for submucosal injection during endoscopic mucosal resection and is a safe and potentially more effective alternative to saline.3 
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Rastogi A, Keighley J, Singh V, et al. High accuracy of narrow band imaging without magnification for the real-time characterization of polyp histology and its comparison with high-definition white light colonoscopy: a prospective study. Am J Gastroenterol. 2009;104(10):2422-2430. doi: 10.1038/ajg.2009.403 [CrossRef] [PubMed]
Repici A, Wallace M, Sharma P, et al. A novel submucosal injection solution for endoscopic resection of large colorectal lesions: a randomized, double-blind trial. Gastrointest Endosc. . 2018;88(3):527-535.e5. doi: 10.1016/j.gie.2018.04.2363 [CrossRef] [PubMed]