American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of histological feature would be considered adverse when evaluating the treatment options for a pedunculated or sessile polyp?

1. Poorly differentiated histology

2. Presence of hyperplastic tissue

3. Absence of dysplasia

4. Low-grade dysplasia

The correct answer is: Poorly differentiated histology

In evaluating treatment options for a pedunculated or sessile polyp, the presence of poorly differentiated histology signifies a more aggressive tumor behavior and a higher likelihood of malignant potential. Poor differentiation suggests that the cells have lost their normal organization and function, which is often associated with a higher grade of cancer. This characteristic implies that the tumor is less responsive to standard treatment approaches and may require more intensive intervention, such as surgical resection or closer monitoring. In contrast, the other options indicate less aggressive behavior or a lower risk of malignancy. Hyperplastic tissue is typically considered benign and does not usually warrant aggressive treatment. The absence of dysplasia would indicate that there are no precancerous changes in the cells, suggesting a lower risk of progression to cancer. Similarly, the presence of low-grade dysplasia indicates some abnormalities but generally does not imply a significant risk for developing invasive cancer compared to poorly differentiated histology. Thus, when selecting treatment options, poorly differentiated histology is a critical factor that raises concerns about the potential for malignancy, making it an adverse histological feature.