Abstract

Background: pT1 malignant colorectal polyps are clinically important early lesions. This study investigated the presence of a villous component in the adenomatous background and its associations with clinical, endoscopic, and histopathological features. Materials and Methods: A cross-sectional study was conducted on 93 pT1 malignant colorectal polyps arising in conventional adenomas between January 2015 and June 2024. Associations between villous component and clinicopathological variables were analyzed using appropriate statistical tests, with p < 0.05 considered significant. Results: A villous component was identified in 73.1% of cases. Its presence was significantly associated with rectal location (p = 0.033), larger polyp size (p = 0.022), grade 2 adenocarcinoma (p = 0.001), and low-risk Haggitt/Kikuchi categories (p = 0.010). On multivariable logistic regression, CAP grade 2 adenocarcinoma (OR = 3.88; p = 0.043) and high-risk Haggitt/Kikuchi category (OR = 0.11; p = 0.011) remained independently associated with the presence of a villous component. Conclusion: A villous component is a common finding in pT1 malignant colorectal polyps and is independently associated with key histopathological parameters. These findings suggest that this feature may provide additional information for clinical risk stratification.