Progression to invasive cancer from sessile serrated adenoma/polyp

A 86-year-old female had a positive fecal immunochemical test, and a subsequent colonoscopy revealed a whitish, flat elevated lesion (Paris class IIa) 10 mm in diameter in the ascending colon (Figure 1, A). Biopsy was performed and histology confirmed sessile serrated adenoma/polyp (SSA/P). At 2 years, the lesion changed into a flat elevated lesion with depression (Paris class IIa+IIc) 12 mm in diameter (Figure 1, B). However, she refused endoscopic resection because of older age. At 4 years, the lesion increased to 15 mm in diameter, and the right side of the lesion was reddish (Figure 1, C).

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