78 year old male, had right hemicolectomy for colon cancer many years ago followed by reop for starch peritonitis.
Repeat routine follow-up type colonoscopy (most recent previous was 3-5 years ago) showed flat small (less than 1 cm) apparent healed ulcer (white patch with slight surrouding erythema) in sigmoid colon and very narrow anastomosis with inflammation on colon side (not biopsied). No obstructive symptoms.
Flat ulcer from sigmoid biopsied and Path shows tubular adenoma with focal nuclear atypia. This didn't look like any polyp I have seen in thousands of colonoscopies and it is definitely not something I could remove with a polypectomy or hot biopsy.
What would you do?