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Small Flat Umbilicated Tumors of the Colon

Radiographic and Pathologic Findings

Mary E. Cunnane1, Stephen E. Rubesin1, Emma E. Furth2, Marc S. Levine1 and Igor Laufer1

1 Department of Radiology, University of Pennsylvania Medical Center, MRI Bldg. 1, 3400 Spruce St., Philadelphia, PA 19104.
2 Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, PA 19104.



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  		Fig. 1. —55-year-old man with heme-positive stool. Spot radiograph of sigmoid colon from double-contrast barium enema examination shows flat lesion (large straight arrow) as 1.0-cm, barium-etched ring shadow with barium-filled central linear umbilication (small straight arrow). Forceps biopsy revealed hyperplastic polyp. Note 2.0-cm polyp (curved arrow) on 2.5-cm stalk. Excisional biopsy of pedunculated polyp revealed tubular adenoma.

 


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  		Fig. 2. —84-year-old woman with palpable mass in right lower quadrant. Spot radiograph of hepatic flexure from double-contrast barium enema examination shows 1.2-cm flat lesion as barium-etched ring shadow (white arrow) with central, linear, barium-filled umbilication (black arrow). Right hemicolectomy was performed for 7.0-cm cecal adenocarcinoma (not shown). Small flat umbilicated tumor proved to be hyperplastic polyp of 0.9 cm in diameter.

 


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  		Fig. 3. —60-year-old man without symptoms who was undergoing screening examination. Spot radiograph of sigmoid colon from double-contrast barium enema examination reveals 1.2-cm flat umbilicated tumor. One edge of tumor (white arrow) is etched by barium. Note punctate central barium collection (black arrow). Excisional biopsy revealed 0.8-cm adenocarcinoma invading superficial submucosa. Eight days later, sigmoid colon was removed, and no residual tumor was identified.

 

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