{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T09:56:56Z","timestamp":1776419816036,"version":"3.51.2"},"reference-count":44,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2026,1,13]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>The classification and clinical implications of colorectal intramucosal adenocarcinoma remain controversial. Given the increasing frequency of diagnosis through colorectal cancer screening programmes, a reassessment of terminology and its impacts is necessary. This paper critically examines the diagnostic criteria, biological behaviour and clinical consequences of labelling these lesions as colorectal intramucosal carcinoma. While intramucosal adenocarcinoma exhibits cytological and architectural atypia beyond high-grade dysplasia, it remains confined to the mucosa and has minimal metastatic potential, with rare documented exceptions. Conversely, the use of carcinoma terminology has been associated with potential overtreatment, including unnecessary surgical resection, increased patient anxiety and financial burdens such as insurance complications. We explore geographic variations in classification and analyse the impact of terminology shifts. We propose a standardised framework that restricts the term intramucosal adenocarcinoma to intramucosal lesions exhibiting tumour budding or poorly differentiated clusters, signet ring cells, desmoplasia, vascular invasion, mucinous differentiation or features of neuroendocrine carcinoma, while reclassifying adenomas with cribriform architecture and complex glands as high-grade dysplasia. This nomenclature shift aims to reduce overtreatment, align with current oncologic understanding and ensure optimal patient care and communication.<\/jats:p>","DOI":"10.1136\/jcp-2025-210255","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T18:20:32Z","timestamp":1771438832000},"page":"291-298","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Quo Vadis colorectal intramucosal adenocarcinoma?"],"prefix":"10.1136","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4230-9308","authenticated-orcid":false,"given":"Vikram","family":"Deshpande","sequence":"first","affiliation":[{"name":"Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2222-4104","authenticated-orcid":false,"given":"Adrian C","family":"Bateman","sequence":"additional","affiliation":[{"name":"Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0345-5620","authenticated-orcid":false,"given":"Munita","family":"Bal","sequence":"additional","affiliation":[{"name":"Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Runjan","family":"Chetty","sequence":"additional","affiliation":[{"name":"Diagnexia Pty, Ltd, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8424-1765","authenticated-orcid":false,"given":"Maurice B","family":"Loughrey","sequence":"additional","affiliation":[{"name":"Department of Cellular Pathology, Royal Victoria Hospital, Belfast, UK"},{"name":"Centre for Public Health, Queen's University, Belfast, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinru","family":"Shia","sequence":"additional","affiliation":[{"name":"Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Vieth","sequence":"additional","affiliation":[{"name":"Institute for Pathology, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Klinikum Bayreuth GmbH, Bayreuth, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7020-9948","authenticated-orcid":false,"given":"Monika","family":"Vyas","sequence":"additional","affiliation":[{"name":"Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8370-6508","authenticated-orcid":false,"given":"Yoh","family":"Zen","sequence":"additional","affiliation":[{"name":"Liver Institute, King\u2019s College Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"2026041702051377000_79.5.291.1","unstructured":"Amin M , Edge S , Greene F . 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