Question

All of the following statements regarding malignant potential of colorectal polyps are true EXCEPT

• A. Polyps of familial polyposis coli could undergo malignant change
• B. Pseudopolyps of ulcerative colitis have a high risk of malignancy
• C. Villous adenoma is associated with high risk of malignancy
• D. Juvenile polyps have little or no risk

Hint:

Pseudopolyps in ulcerative colitis are inflammatory, not neoplastic; the cancer risk in UC comes from the surrounding flat mucosa, not the pseudopolyps.

Answer 1

The Correct Option is B

The question asks which one claim about polyp cancer risk is wrong. The trick is telling apart polyps that are truly neoplastic from polyps that only look worrying but are not premalignant on their own.

1. Familial polyposis coli: This condition produces innumerable adenomatous (neoplastic) polyps, and left alone almost all patients develop colorectal cancer, so this claim about malignant change is correct.
2. Pseudopolyps of ulcerative colitis: These form from repeated cycles of ulceration and mucosal healing in colitis. They are made of regenerating, inflamed tissue, not neoplastic cells, so they do not carry a high cancer risk by themselves; the real risk in ulcerative colitis comes from dysplasia in the flat mucosa around them. This claim is therefore incorrect.
3. Villous adenoma: Among the adenoma subtypes, the villous pattern has the greatest chance of already containing cancer at the time it is found, so this claim is correct.
4. Juvenile polyps: A single sporadic juvenile polyp is a hamartoma, not a true neoplasm, and carries almost no cancer risk on its own, so this claim is correct too.

Since three of the four statements are accurate and only the pseudopolyp claim is wrong, that is the exception the question is asking for.

Let's summarize:

• Neoplastic polyps (FAP adenomas, villous adenoma) carry real cancer risk.
• Pseudopolyps and sporadic juvenile polyps are non-neoplastic and carry little to no independent cancer risk.

The correct answer is that pseudopolyps of ulcerative colitis have a high risk of malignancy, which is false.