19 Gastrointestinal Tract Polyps - Libre Pathology

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Gastrointestinal tract polyps

From Libre Pathology
Gastrointestinal tract polyps, also gastrointestinal polyps or GI

polyps, are the bread & butter of a GI pathologists workload. Some of
'em are benign... some pre-malignant... some malignant... some weird.
Most GI polyps are from the intestine, i.e. intestinal polyps.
Overview - there are four basic types:[1]
Hyperplastic - harmless, most common - 90% of all colonic

polyps.[2]
Hamartomatous - weriod stuff, syndromic things.
Inflammatory - think inflammatory bowel disease, AKA
pseudopolyps.
Adenomatous - premalignant, several types (see below).
Mnemonic: HHI-A.
Diagnostic variability for colorectal polyps is substantial among

community pathologists.[3] Endoscopic image of a gastrointestinal polyp.
Contents
1 Basic approach
2 A set of decision trees for GI polyps
3 Tabular comparison of colonic polyps
3.1 Overview in two tables
3.1.1 Common colonic polyps
3.1.2 Less common
3.2 Common problems
3.2.1 Submucosal invasion
3.2.2 Pseudoinvasion
3.2.3 Early invasion
3.2.4 Adenomatous vs. hyperplastic
4 Normal
4.1 Normal colorectal mucosa
4.1.1 General
4.1.2 Microscopic
4.1.2.1 Images
4.1.3 Sign out
4.1.3.1 Normal
4.1.3.1.1 Block letters
4.1.3.1.2 Polypoid fragments
4.1.3.1.3 Mucosa and submucosa
4.1.3.2 Lymphoid nodule present
4.1.3.2.1 Submucosa present
4.1.3.3 Suspected missed lesion
4.1.3.4 Micro - suspected IBD
4.1.3.5 Rare PMNs - no cryptitis
4.2 Fecal material
5 Hyperplastic polyp
https://librepathology.org/w/index.php?title=Gastrointestinal_tract_polyps&printable=yes 1/20
6 Inflammatory pseudopolyp
7 Adenomatous polyps
7.1 Overview
7.1.1 Management of (adenomatous colonic)
polyps
7.2 Pseudoinvasion in colorectal adenomatous polyps
7.3 High-risk features in (colorectal) adenomatous
polyps with carcinoma
7.4 Traditional adenoma
7.5 Traditional serrated adenoma
7.6 Sessile serrated adenoma
8 Malignant polyps
8.1 Colorectal adenocarcinoma
8.1.1 General
8.1.1.1 Clinical
8.1.2 Microscopic
8.1.2.1 Image
8.1.3 Sign out
8.1.3.1 Micro
8.1.3.1.1 Suspicious
9 Hamartomatous polyps
9.1 Overview
9.2 Juvenile polyp
9.3 Peutz-Jeghers polyp
9.4 Cowden disease
9.4.1 General
9.4.2 Microscopic
10 Weird stuff
10.1 Cronkhite-Canada syndrome
10.2 Ganglioneuroma
10.2.1 General
10.2.2 Microscopic
10.2.2.1 Images
10.3 Inflammatory myoglandular polyp
10.3.1 General
10.3.2 Microscopic
10.4 Leiomyoma
10.5 Colonic polyp with reactive subepithelial cells
10.5.1 Microscopic
10.5.2 Sign out
11 See also
12 References
13 External links
Basic approach
1. Sessile (flat) or polypoid (spherical, possibly has a stalk)?
2. Nuclear features of adenoma & loss of goblets (hyperchromatic nuclei, nuclei round vs. flat, loss of nuclear
stratification)?
3. Inflammation?
4. Serrated architecture?
A set of decision trees for GI polyps

Decision tree - GI polyps
GI
polyp
Polypoid Sessile
(Lollipop-like) (flat)
Nuclear changes No nuc. change Serrated Not serrated
Polypoid
adenoma Serrated Not serrated SSA versus HP Normal versus VA
(below)
See misc.
HP
polyps (below)
Notes:
Polypoid:
Stalk visible (lollipop handle visible) or epithelial surface on three sides (or more).
Sessile (flat):
"Line of muscularis mucosa" visible +/- test tube-like intestinal crypts.
Nuclear changes:
Nuclear enlargement (elongation), crowding/pseudostratification, hyperchromasia (more blue) - especially at
the surface, i.e. adjacent to the lumen (as opposed to the base of the crypt).
Decision tree - polypoid adenoma
Polypoid
adenoma
Serrated Non-serrated
TSA Tubular arch. Tubulovillous arch. Villous arch.
TA TVA VA
Notes:[4]
TA, tubular component >75%.

VA, villous component >50%.
Decision tree - miscellaneous polyps
Misc. polyps
Inflam. No inflam.
Benign Inflam. p. Hamart. Benign
PJP Juvenile Other
Notes:
Juvenile polyps may have marked inflammation.
Hamartomatous polyps - basic DDx:
Juvenile polyp/Retention polyp -- DIES (dilated glands, incr. LP, eroded surface, stalk).
Peutz-Jeghers polyp (PJP) - frond-like with all mucosa components .
"Other" includes diagnoses which require history or tissue surround the polyp. These include the polyps seen in:
Cowden syndrome.
Cronkhite-Canada syndrome.
Tabular comparison of colonic polyps

Overview in two tables
Common colonic polyps
Prevalence
Type Key feature(s) Details Other DDx Image
/ prognosis
missed lesion,
small colonic
Normal nuclei, moderate spirochetes,
test tubes in a rack- common /
mucosa / no abundant inflammation cryptosporidiosis,
like morphology benign
pathology goblet is normal microscopic
cells colitis, CMV
colitis Normal rectum (WC)
abundant
may be
goblet
syndromic,
cells, usu.
Hyperplastic serrated at the common / e.g. sessile serrated
left colon;
polyp surface benign hyperplastic adenoma
no
polyposis
features of
syndrome HP (WC)
SSA
decreased
tubular
nuclear goblet
adenoma, traditional
hyperchromasia & cells, usu.
Traditional common / tubulovillous serrated adenoma,
pseudostratification polypoid -
adenoma premalignant adenoma, reactive changes
/ crowding at the on a stalk,
villous (inflammation)
luminal aspect usu. left
adenoma
colon
TA (WC)
Less common
Prevalence
Type Key feature(s) Details Other DDx Image
/ prognosis
boot-shaped
Sessile crypts,
AKA sessile
serrated basal crypt dilation horizontal uncommon / hyperplastic
serrated
adenoma & serration crypts, pre-malignant polyp
polyp
(SSA) branching
crypts SSA (WC)
nuclear
hyperchromasia & called traditional
Traditional
pseudostratification "traditional" serrated
serrated decreased very rare /
/ crowding at the to adenoma
adenoma goblet cells premalignant
surface, serrated, differentiate (esp. villous
(TSA)
villous-like from SSA adenoma)
architecture TSA (WC)
eroded
surface (due
Juvenile may be part
dilated glands, to trauma), uncommon /
polyp of juvenile inflammatory
increased lamina stalk benign if in
(retention polyposis pseudopolyp
propria (polypoid), isolation
polyp) syndrome
inflammation
- common Gastric JP (WC)
loss of uncommon /
inflammation, only seen in
Inflammatory mucosa seen in IBD, juvenile
erosion/ulceration IBD; Dx
pseudopolyp adjacent to increased risk polyp
adjacent to polyp implies IBD
pseudopolyp of malignancy
IP (WC)
PJP not pre-

malignant
very rare / normal,
Peutz- tree-like lesion in
branching smooth syndromic; classically in
Jeghers polyp growth itself; see
muscle assoc. with the small
(PJP) pattern Peutz-
cancer bowel
Jeghers
syndrome
PJP (WC)
Common problems
Submucosal invasion
This may be difficult to assess histomorphologically; these one should show a friend.
Pseudoinvasion
See pseudoinvasion in colorectal adenomatous polyps.
Early invasion
See high risk features in (colorectal) adenomatous polyps with carcinoma.
Adenomatous vs. hyperplastic
Adenomatous polyps & hyperplastic polyps - a comparison (adapted from Li and Burgart[5]):
Traditional adenoma
Hyperplastic polyp Sessile serrated Traditional serrated -tubular adenoma
Attribute
(HP) adenoma (SSA) adenoma (TSA) -tubulovillous adenoma
-villous adenoma
Classic location rectum/left colon right colon rectum/left colon rectum/left colon
Morphology polypoid flat (sessile) polypoid polypoid
Cytologic atypia
-Cigar nuclei
-
absent absent present present
Hyperchromasia
-Nuclear
crowding
Location of
- - basal luminal
worst atypia
Cytoplasm eosinophilic prominent eosinophilia eosinophilic basophilic
Goblet cells abundant common less common less common
Luminal
present common present absent
Serration
SSA
architecture
-Basal crypt
serration
-Basal crypt
absent present absent absent
dilation
-Horizonatal
crypts
-Branched
crypts
serrated luminal surf. & abnorm. crypt arch. &
Key feature(s) nuclear atypia & serrated nuclear atypia (luminal)
goblets sessile
Image(s)
HP (WC) SSA (WC) TSA (WC) TA (WC)
Normal colonic mucosa:
Nuclei - round and basally located.

Abundant goblet cells.
Moderate inflammation.
Paneth cells - present in right colon.
Glands - straight, no branching; "test tube" shape.
Notes: Left colon refers to the sigmoid colon, descending colon and the distal half of the transverse colon; right colon
refers to the cecum, ascending colon and proximal half of the transverse colon.
Normal
Normal colorectal mucosa

General
Endoscopists go after anything that is polypoid... and that may be normal.
Microscopic
Features:
Test tube like glands.

Minimal palisading.
Nuclei <3:1 = height:width.
No nuclear pseudostratification. †
Deep part of crypt is more hyperchromatic than superficial component - important.
The surface should be lighter staining than the deeper aspect, i.e. the deeper glands are dark blue and the
superficial gland are light blue.
Note:
† May be seen in reactive changes.
DDx (colorectal mucosa with minimal changes):
CMV colitis.
Cryptosporidiosis.
Intestinal spirochetosis.
Lymphocytic colitis.
Collagenous colitis.
Images
Rectum - low mag. Rectum - intermed. Rectum - intermed. Rectum - high mag.
(WC) mag. (WC) mag. (WC) (WC)
www:
Normal colorectal mucosa (uwa.edu.au) (http://www.lab.anhb.uwa.edu.au/mb140/CorePages/GIT/images/col10he.jp

g).[6]
Colon (siumed.edu) (http://www.siumed.edu/~dking2/erg/GI027b.htm).
Normal colorectal mucosa (maricopa.edu) (http://www.gwc.maricopa.edu/class/bio202/Digestive/DigestHisto/Colon
A.htm).
Sign out
Normal
Cecum, Biopsy:
- Colorectal-type mucosa within normal limits.
Right Colon, Biopsy:

- Colonic mucosa within normal limits.
Transverse Colon, Biopsy:

Left Colon, Biopsy:

Rectum, Biopsy:
- Colorectal mucosa within normal limits.
Block letters
SIGMOID COLON, BIOPSY:

- COLORECTAL-TYPE MUCOSA WITHIN NORMAL LIMITS.
COLON, 70 CM, BIOPSY:

- COLORECTAL-TYPE MUCOSA WITHIN NORMAL LIMITS.
Polypoid fragments
POLYP, SIGMOID COLON, BIOPSY:

- POLYPOID FRAGMENT OF COLORECTAL-TYPE MUCOSA WITHIN NORMAL LIMITS.
Mucosa and submucosa
POLYP, SIGMOID COLON, BIOPSY:

- COLONIC MUCOSA AND SUBMUCOSA WITHIN NORMAL LIMITS.
Lymphoid nodule present
Lymphoid nodules manifest endoscopically as a small polypoid protuberances. It is worthwhile to report the
presence of lymphoid nodules as they reassure the endoscopist that they probably sampled the abnormality they saw.
POLYP, RECTUM, BIOPSY:

- RECTAL MUCOSA WITHIN NORMAL LIMITS WITH A MORPHOLOGICALLY BENIGN LYMPHOID AGGREGATE.
COLON, RIGHT SIDE, BIOPSY:

- COLONIC MUCOSA WITH MORPHOLOGICALLY BENIGN LYMPHOID AGGREGATES,
NO SIGNIFICANT PATHOLOGY.
Submucosa present
POLYP, ASCENDING COLON, BIOPSY:

- COLONIC MUCOSA AND SUBMUCOSA WITHIN NORMAL LIMITS WITH A MORPHOLOGICALLY BENIGN
LYMPHOID NODULE.
Suspected missed lesion
RECTOSIGMOID, BIOPSY:
- COLORECTAL-TYPE MUCOSA WITH A LYMPHOID AGGREGATE.
- NEGATIVE FOR ACTIVE COLITIS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY -- SEE COMMENT.
COMMENT:
The clinical history is noted. This biopsy does not show neoplastic tissue;
however, the biopsy may not be representative of the lesion seen.
Levels were cut and these did not yield additional information. There are
no changes to suggest a chronic colitis.
Correlation with imaging may be useful. A re-biopsy is suggested.
Micro - suspected IBD
The sections show colorectal-type mucosa. The glands show no significant architectural abnormalities and mature
normally to the surface. Rare apoptotic epithelial cells are seen. There is no cryptitis. Neutrophils are not apparent in the
lamina propria.
Rare PMNs - no cryptitis
The sections show colorectal mucosa with rare lymphoid aggregates. The architecture is within normal limits. The
epithelium matures normally to the surface. Very rare neutrophils are present within the lamina propria. A very small
number of crypts have one or two neutrophils. No definite cryptitis is present.
Fecal material
Main article: Fecal material
Hyperplastic polyp
The stomach lesion is dealt with in hyperplastic polyp of the stomach.
Main article: Hyperplastic polyp
Inflammatory pseudopolyp
Main article: Inflammatory pseudopolyp
Adenomatous polyps
Overview
Several types of adenomatous polyps are recognized:
Traditional adenomas (have three subtypes):

1. Tubular adenoma - most common, lowest malignant potential.

2. Tubulovillous adenoma.
3. Villous adenoma - highest malignant potential.
Sessile serrated adenomas:
New kid on the block.
Traditional serrated adenomas - nuclear features of 'traditional adenoma' + serrated architecture.
Notes:
They are all considered pre-malignant, i.e. if you leave 'em in place they often develop into cancer.
If multiple... think about familial adenomatous polyposis (FAP), attenuated FAP, MUTYH polyposis syndrome,
serrated polyposis syndrome.
Management of (adenomatous colonic) polyps
Follow-up interval for polyps (colonoscopy interval):[7]
Normal follow-up (includes presence of hyperplastic polyps): ~10 years.

1-2 low risk (adenomatous) polyps: 5-10 years.
3-10 low risk polyps or a high risk polyp: 3 years.
>10 low risk polyps: <3 years.
Inadequately removed polyps: <6 months.
Classified as high risk polyp (any of the following):[7]
Tubulovillous.
Villous.
High grade dysplasia.
Size >= 1 cm.
Mnemonic: GAS = grade (high), architecture (tubulovillous, villous), size (>1 cm).
Note:
High risk polyp, as defined above, is also called advanced adenoma;[8] however, it should be noted that there are
different definitions for advanced adenoma (e.g. Winawer & Zauber[9] include early invasive tumours). Thus, it is
best to avoid the term.
Pseudoinvasion in colorectal adenomatous polyps

AKA pseudoinvasion.
AKA epithelial misplacement.
Main article: Pseudoinvasion in colorectal adenomatous polyps
High-risk features in (colorectal) adenomatous polyps with carcinoma

Predictors of poor outcome with early submucosal invasion:[10]
1. High tumour grade.

2. Lymphovascular invasion.
3. High-grade tumour budding.
Tumour bud = 1-4 cell(s); "high-grade budding" is >=10 tumour buds in a field of 0.385 mm2.[11]‡
If the microscope has a 22 mm eye piece and...
A 20x objective, the field is approximately 0.950 mm2 -- to match the buds/area -- it would be
24.68 buds/0.950 mm2.
A 40x objective, the field is approximately 0.238 mm2 -- to match the buds/area -- it would be
6.17 buds/0.238 mm2.
4. Extensive submucosal invasion.
>= 4 mm width or >= 2 mm depth.
If none of the above factors is present the risk of lymph node metastasis is < 1%. The presence of one risk factor increases
the risk to ~20%. If multiple risk factors are present the chance of lymph node metastases is greater than 35%.[10]
Note:
‡Tumour budding as per international consensus is now assessed in field area of 0.785 mm2.[12]
Traditional adenoma
Includes tubular adenoma, tubulovillous adenoma, and villous adenoma.
Main article: Traditional adenoma
Traditional serrated adenoma

Main article: Traditional serrated adenoma
Sessile serrated adenoma

Main article: Sessile serrated adenoma
Malignant polyps
Colorectal adenocarcinoma
Main article: Colorectal adenocarcinoma
General
Diagnosis may be a challenging on a small biopsy.
Clinical
Invasion can be predicted based on endoscopic findings:
Kudo pit pattern.[13]

Non-lifting sign.[14]
Presence predicts deeper invasion.[15]
Microscopic
One of the two following:
1. Dysplasia and evidence of invasion - features:[16]

Nuclear changes seen in adenomatous polyps - malignant-appearing cells.
Enlarged nuclei.
Chromatin hyperchromatic or vesicular.
Round-shape or cigar-shaped and pseudostratified.

Architectural changes - usually those of high-grade dysplasia:
Cribriforming - most common.
Papillary tufting.
Budding.
Sheeting.
Deep involvement - one of the two following - key feature:
1. Malignant-appearing cells in the submucosa.
Pseudoinvasion must be excluded.
2. Desmoplastic stromal response.
Spindle cells with:
Large nuclei (nucleus ~ size of a plasma cell).
Eosinophilic cytoplasm.
2. Signet ring cells.
DDx:
Pseudoinvasion - surrounded by lamina propria, desmoplasia lacking, hemosiderin-laden macrophages.

Reactive changes.
Note:
Desmoplastic response is not predictive of submucosal invasion in pedunculated polyps.[17]
Image
Colorectal carcinoma.
(WC/Nephron)
Sign out
RECTOSIGMOID TUMOUR, BIOPSY:

- INVASIVE ADENOCARCINOMA, MODERATELY DIFFERENTIATED.
RECTUM, BIOPSY:
- INVASIVE ADENOCARCINOMA, MODERATELY DIFFERENTIATED.
RECTUM, BIOPSY:
- HIGHLY SUSPICIOUS FOR INVASIVE ADENOCARCINOMA, SEE MICROSCOPIC.
- TUBULOVILLOUS ADENOMA WITH HIGH-GRADE DYSPLASIA.
Micro
The sections shows colorectal-type mucosa with a tubule-forming epithelium that has cellular pseudostratification and
enlarged hyperchromatic nuclei, from the crypt base to the luminal aspect (dysplasia).
There is cribriforming of glands and epithelial budding. Plump spindle cells with eosinophilic cytoplasm surround the
abnormal epithelium (desmoplastic stroma). No definite submucosa is identified; the diagnosis is based on the stromal
desmoplasia.
Suspicious
The sections shows multiple fragments of colorectal-type mucosa with a tubule-forming and villous-forming epithelium
that has cellular pseudostratification and enlarged hyperchromatic nuclei, from the crypt base to the luminal aspect
(dysplasia).
Cribriforming of glands is identified at multiple foci. Goblet cells are rare in the dysplastic epithelium.
One fragment of tissue, measuring approximately 2 millimetres, has increased numbers of plump stromal cells
(desmoplastic response); this is suspicious for invasive adenocarcinoma.
Hamartomatous polyps
Overview
There are three well known hamartomatous polyp syndromes:[18]
Peutz-Jeghers syndrome.
Juvenile polyposis syndrome.
Cowden's disease.
There are two obscure hamartomatous polyp syndromes:[18]
Bannayan-Riley-Ruvalcaba syndrome (BRBS).

Devon polyposis syndrome (DPS).
Notes:
BRBS is due to a PTEN mutation[19] (the same gene associated with Cowden's disease).
DPS is reported in only one family that lives in Devon, UK.[20]
Juvenile polyp
Main article: Juvenile polyp
Peutz-Jeghers polyp
Main article: Peutz-Jeghers polyp
Cowden disease
Main article: Cowden syndrome
AKA Cowden syndrome.
General
Etiology:
PTEN gene mutation.
Clinical features:[21]
Hamartomatous polyps.
Facial trichilemmomas (hair follicle root sheath epithelium tumour).
Oral papillomas.
Acral keratoses (peripheral keratoses).
Note:
Lame mnemonic PATH:[22] Papilloma (oral), Acral keratosis, Trichilemmoma, Hamartomatous polyps.
Microscopic
Features:
Hamartomatous polyp - features non-specific. (???)
Weird stuff
Cronkhite-Canada syndrome
Abbreviated CCS.
Main article: Cronkhite-Canada syndrome
Ganglioneuroma
Main article: Ganglioneuroma
General
May be part of MEN 2B.
Microscopic
Features - see ganglioneuroma:
Ganglion cells - key feature.

Large cells with a round nucleus and a prominent nucleolus.
DDx:
Hyperplastic polyp with perineuromatous stroma.
Images
Ganglioneuroma - Ganglioneuroma - high Ganglioneuroma - very

intermed. mag. mag. (WC/Nephron) high mag.
(WC/Nephron) (WC/Nephron)
Inflammatory myoglandular polyp

General
Controversial - probably not a distinct pathologic entity.[23]

Rare, benign, non-neoplastic.[24]
Large bowel, usually rectosigmoid.
Microscopic
Features:[25]
1. Granulation tissue within the lamina propria.

2. Lamina propria smooth muscle.
3. Irregular gland architecture:
Cystic dilatation.
Tortuosity.
DDx:[23]
Mucosal prolapse syndrome.

Polypoid prolaping mucosal fold in diverticular disease.
Inflammatory cloacogenic polyp.
Inflammatory cap polyp.
Image:
IMP (biomedcentral.com) (http://www.biomedcentral.com/1471-230X/10/10/figure/F3).[24]
Leiomyoma
Main article: Colonic leiomyoma
Main article: Leiomyoma
May present as a polyp in the colon.[26]
Colonic polyp with reactive subepithelial cells

Microscopic
Features:
Surface epithelium with a reduced quantity of cytoplasm and less goblets (regenerative appearance).
Mildly atypical subepithelial cells with pale moderate-to-abundant cytoplasm and nuclear enlargement +/-nuclear
hyperchromasia.
Sign out
POLYP, ASCENDING COLON, POLYPECTOMY:

- POLYPOID FRAGMENT OF COLONIC-TYPE MUCOSA WITH REACTIVE SUBEPITHELIAL
CELLS, SEE COMMENT.
- NEGATIVE FOR DYSPLASIA.
COMMENT:
A pankeratin and CK7 immunostains are non-concerning. A CD68 immunostain
highlights lamina propria macrophages.
See also
Gastrointestinal pathology.
Stomach.
Small bowel.
Colon.
Polypectomy.
References
6. URL:
1. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso http://www.lab.anhb.uwa.edu.au/mb140/CorePages/GIT/git.h
Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Accessed on: 18 October 2012.
Robbins and Cotran pathologic basis of disease (7th ed.). 7. Levine JS, Ahnen DJ (December 2006). "Clinical practice.
St. Louis, Mo: Elsevier Saunders. pp. 856. ISBN 0-7216- Adenomatous polyps of the colon" (http://content.nejm.org/
0187-1. cgi/reprint/355/24/2551.pdf). N. Engl. J. Med. 355 (24):
2. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso 2551–7. doi:10.1056/NEJMcp063038 (http://dx.doi.org/10.
Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). 1056%2FNEJMcp063038). PMID 17167138 (http://www.n
Robbins and Cotran pathologic basis of disease (7th ed.). cbi.nlm.nih.gov/pubmed/17167138).
St. Louis, Mo: Elsevier Saunders. pp. 858. ISBN 0-7216- http://content.nejm.org/cgi/reprint/355/24/2551.pdf.
0187-1. 8. Laiyemo, AO.; Murphy, G.; Albert, PS.; Sansbury, LB.;
3. Rex, DK.; Alikhan, M.; Cummings, O.; Ulbright, TM. (Oct Wang, Z.; Cross, AJ.; Marcus, PM.; Caan, B. et al. (Mar
1999). "Accuracy of pathologic interpretation of colorectal 2008). "Postpolypectomy colonoscopy surveillance
polyps by general pathologists in community practice.". guidelines: predictive accuracy for advanced adenoma at 4
Gastrointest Endosc 50 (4): 468-74. PMID 10502165 (htt years.". Ann Intern Med 148 (6): 419-26. PMID 18347350
p://www.ncbi.nlm.nih.gov/pubmed/10502165). (http://www.ncbi.nlm.nih.gov/pubmed/18347350).
4. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso 9. Winawer, SJ.; Zauber, AG. (Jan 2002). "The advanced
Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). adenoma as the primary target of screening.". Gastrointest
Robbins and Cotran pathologic basis of disease (7th ed.). Endosc Clin N Am 12 (1): 1-9, v. PMID 11916153 (http://w
St. Louis, Mo: Elsevier Saunders. pp. 860. ISBN 0-7216- ww.ncbi.nlm.nih.gov/pubmed/11916153).
0187-1. 10. Ueno, H.; Mochizuki, H.; Hashiguchi, Y.; Shimazaki, H.;
5. Li SC, Burgart L (March 2007). "Histopathology of serrated Aida, S.; Hase, K.; Matsukuma, S.; Kanai, T. et al. (Aug
adenoma, its variants, and differentiation from conventional 2004). "Risk factors for an adverse outcome in early
adenomatous and hyperplastic polyps" (http://journals.allen invasive colorectal carcinoma.". Gastroenterology 127 (2):
press.com/jrnlserv/?request=get-abstract&issn=0003-9985 385-94. PMID 15300569 (http://www.ncbi.nlm.nih.gov/pub
&volume=131&page=440). Arch. Pathol. Lab. Med. 131 med/15300569).
(3): 440-5. PMID 17516746 (http://www.ncbi.nlm.nih.gov/ 11. Ueno, H.; Murphy, J.; Jass, JR.; Mochizuki, H.; Talbot, IC.
pubmed/17516746). (Feb 2002). "Tumour 'budding' as an index to estimate the
http://journals.allenpress.com/jrnlserv/?request=get- potential of aggressiveness in rectal cancer.".
abstract&issn=0003-9985&volume=131&page=440.
Histopathology 40 (2): 127-32. PMID 11952856 (http://ww 18. Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth
w.ncbi.nlm.nih.gov/pubmed/11952856). A. (2005). Gastrointestinal and Liver Pathology: A Volume
12. Lugli, A.; Kirsch, R.; Ajioka, Y.; Bosman, F.; Cathomas, in the Foundations in Diagnostic Pathology Series (1st ed.).
G.; Dawson, H.; El Zimaity, H.; Fléjou, JF. et al. (Sep Churchill Livingstone. pp. 345. ISBN 978-0443066573.
2017). "Recommendations for reporting tumor budding in 19. Online 'Mendelian Inheritance in Man' (OMIM) 153480 (htt
colorectal cancer based on the International Tumor Budding p://www.ncbi.nlm.nih.gov/omim/153480)
Consensus Conference (ITBCC) 2016.". Mod Pathol 30 (9): 20. Allibone, RO.; Nanson, JK.; Anthony, PP. (Jul 1992).
1299-1311. doi:10.1038/modpathol.2017.46 (http://dx.doi.o "Multiple and recurrent inflammatory fibroid polyps in a
rg/10.1038%2Fmodpathol.2017.46). PMID 28548122 (htt Devon family ('Devon polyposis syndrome'): an update.".
p://www.ncbi.nlm.nih.gov/pubmed/28548122). Gut 33 (7): 1004-5. PMID 1644320 (http://www.ncbi.nlm.n
13. Onishi, T.; Tamura, S.; Kuratani, Y.; Onishi, S.; Yasuda, N. ih.gov/pubmed/1644320).
(2008). "Evaluation of the depth score of type V pit patterns 21. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso
in crypt orifices of colorectal neoplastic lesions.". J Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005).
Gastroenterol 43 (4): 291-7. doi:10.1007/s00535-008-2161- Robbins and Cotran pathologic basis of disease (7th ed.).
1 (http://dx.doi.org/10.1007%2Fs00535-008-2161-1). St. Louis, Mo: Elsevier Saunders. pp. 858-9. ISBN 0-7216-
PMID 18458845 (http://www.ncbi.nlm.nih.gov/pubmed/18 0187-1.
458845). 22. URL:
14. Uno, Y.; Munakata, A.. "The non-lifting sign of invasive http://www.pathologyexpert.com/boards/onlinefiles/syndrom
colon cancer.". Gastrointest Endosc 40 (4): 485-9. Accessed on: 6 December 2011.
PMID 7926542 (http://www.ncbi.nlm.nih.gov/pubmed/792 23. Bhathal, PS.; Chetty, R.; Slavin, JL. (Aug 1993).
6542). "Myoglandular polyps.". Am J Surg Pathol 17 (8): 852-3.
15. Ishiguro, A.; Uno, Y.; Ishiguro, Y.; Munakata, A.; Morita, PMID 8338196 (http://www.ncbi.nlm.nih.gov/pubmed/833
T. (Sep 1999). "Correlation of lifting versus non-lifting and 8196).
microscopic depth of invasion in early colorectal cancer.". 24. Meniconi, RL.; Caronna, R.; Benedetti, M.; Fanello, G.;
Gastrointest Endosc 50 (3): 329-33. Ciardi, A.; Schiratti, M.; Papini, F.; Farelli, F. et al. (2010).
doi:10.1053/ge.1999.v50.98591 (http://dx.doi.org/10.105 "Inflammatory myoglandular polyp of the cecum: case
3%2Fge.1999.v50.98591). PMID 10462651 (http://www.nc report and review of literature." (https://www.ncbi.nlm.nih.
bi.nlm.nih.gov/pubmed/10462651). gov/pmc/articles/PMC2828397/). BMC Gastroenterol 10:
16. Kimura, R.; Fujimori, T.; Ichikawa, K.; Ajioka, Y.; Ueno, 10. doi:10.1186/1471-230X-10-10 (http://dx.doi.org/10.118
H.; Ohkura, Y.; Kashida, H.; Togashi, K. et al. (Aug 2012). 6%2F1471-230X-10-10). PMC 2828397 (http://www.pubm
"Desmoplastic reaction in biopsy specimens of early edcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=282
colorectal cancer: a Japanese prospective multicenter 8397). PMID 20102635 (http://www.ncbi.nlm.nih.gov/pub
study.". Pathol Int 62 (8): 525-31. doi:10.1111/j.1440- med/20102635).
1827.2012.02840.x (http://dx.doi.org/10.1111%2Fj.1440-18 //www.ncbi.nlm.nih.gov/pmc/articles/PMC2828397/.
27.2012.02840.x). PMID 22827760 (http://www.ncbi.nlm.n 25. Nakamura, S.; Kino, I.; Akagi, T. (Aug 1992).
ih.gov/pubmed/22827760). "Inflammatory myoglandular polyps of the colon and
17. Hirose, M.; Fukui, H.; Igarashi, Y.; Fujimori, Y.; Katake, Y.; rectum. A clinicopathological study of 32 pedunculated
Sekikawa, A.; Ichikawa, K.; Tomita, S. et al. (Dec 2010). polyps, distinct from other types of polyps.". Am J Surg
"Detection of desmoplastic reaction in biopsy specimens is Pathol 16 (8): 772-9. PMID 1309176 (http://www.ncbi.nlm.
useful for predicting the depth of invasion of early nih.gov/pubmed/1309176).
colorectal cancer: a Japanese collaborative study.". J 26. Kemp, CD.; Arnold, CA.; Torbenson, MS.; Stein, EM.
Gastroenterol 45 (12): 1212-8. doi:10.1007/s00535-010- (2011). "An unusual polyp: a pedunculated leiomyoma of
0288-3 (http://dx.doi.org/10.1007%2Fs00535-010-0288-3). the sigmoid colon.". Endoscopy 43 Suppl 2 UCTN: E306-
PMID 20665053 (http://www.ncbi.nlm.nih.gov/pubmed/20 7. doi:10.1055/s-0030-1256640 (http://dx.doi.org/10.1055%
665053). 2Fs-0030-1256640). PMID 21915840 (http://www.ncbi.nl
m.nih.gov/pubmed/21915840).
External links
Serrated polyps quiz (unibas.ch) (http://kathrin.unibas.ch/polyp/index.html) - nice quiz... though it is annoying that
one has to click on the images to enlarge 'em.
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12019/4/ Gastrointestinal tract polyps - Libre Pathology

Gastrointestinal tract polyps

Gastrointestinal tract polyps, also gastrointestinal polyps or GI

Overview - there are four basic types:[1]

Hyperplastic - harmless, most common - 90% of all colonic

Diagnostic variability for colorectal polyps is substantial among

A set of decision trees for GI polyps

Decision tree - GI polyps

Nuclear changes No nuc. change Serrated Not serrated

Decision tree - polypoid adenoma

TSA Tubular arch. Tubulovillous arch. Villous arch.

TA, tubular component >75%.

Decision tree - miscellaneous polyps

Benign Inflam. p. Hamart. Benign

PJP Juvenile Other

Juvenile polyps may have marked inflammation.

Hamartomatous polyps - basic DDx:

Tabular comparison of colonic polyps

PJP not pre-

See pseudoinvasion in colorectal adenomatous polyps.

See high risk features in (colorectal) adenomatous polyps with carcinoma.

Adenomatous vs. hyperplastic

HP (WC) SSA (WC) TSA (WC) TA (WC)

Normal colonic mucosa:

Nuclei - round and basally located.

Normal colorectal mucosa

Endoscopists go after anything that is polypoid... and that may be normal.

Test tube like glands.

† May be seen in reactive changes.

DDx (colorectal mucosa with minimal changes):

Normal colorectal mucosa (uwa.edu.au) (http://www.lab.anhb.uwa.edu.au/mb140/CorePages/GIT/images/col10he.jp

Right Colon, Biopsy:

Transverse Colon, Biopsy:

Left Colon, Biopsy:

SIGMOID COLON, BIOPSY:

COLON, 70 CM, BIOPSY:

POLYP, SIGMOID COLON, BIOPSY:

Mucosa and submucosa

POLYP, SIGMOID COLON, BIOPSY:

Lymphoid nodule present

POLYP, RECTUM, BIOPSY:

COLON, RIGHT SIDE, BIOPSY:

POLYP, ASCENDING COLON, BIOPSY:

Suspected missed lesion

Correlation with imaging may be useful. A re-biopsy is suggested.

Micro - suspected IBD

Rare PMNs - no cryptitis

Main article: Hyperplastic polyp

Traditional adenomas (have three subtypes):

1. Tubular adenoma - most common, lowest malignant potential.

Management of (adenomatous colonic) polyps

Follow-up interval for polyps (colonoscopy interval):[7]

Normal follow-up (includes presence of hyperplastic polyps): ~10 years.

Classified as high risk polyp (any of the following):[7]

Pseudoinvasion in colorectal adenomatous polyps

Main article: Pseudoinvasion in colorectal adenomatous polyps

High-risk features in (colorectal) adenomatous polyps with carcinoma

1. High tumour grade.

Main article: Traditional adenoma

Traditional serrated adenoma

Sessile serrated adenoma

Diagnosis may be a challenging on a small biopsy.

Invasion can be predicted based on endoscopic findings:

Kudo pit pattern.[13]