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Hyperplastic polyp (view source)

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#redirect [[Intestinal_polyp#Hyperplastic_polyp]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Hyperplastic_polyp_--_alt_-_intermed_mag.jpg
| Width      =
| Caption    = Hyperplastic polyp. [[H&E stain]].
| Micro      = serrated architecture at the surface without glandular abnormalities
| Subtypes  = microvesicular serrated polyps (MVSPs), goblet cell serrated polyps (GCSPs)
| LMDDx      = [[sessile serrated adenoma]], [[normal colon]], [[hyperplastic polyp with perineuromatous stroma]], other [[gastrointestinal polyps]]
| Stains    =
| IHC        = [[Chromogranin A]] +ve (increased scattered Chromogranin A-positive cells in relation to normal mucosa)
| EM        =
| Molecular  =
| IF        =
| Gross      = usually rectum or sigmoid, typically < 5mm
| Grossing  =
| Site      = [[cecum]], [[colon]], [[rectum]]
| Assdx      =
| Syndromes  = [[serrated polyposis syndrome]]
| Clinicalhx =
| Signs      =
| Symptoms  = asymptomatic
| Prevalence = very common
| Bloodwork  =
| Rads      =
| Endoscopy  = pedunculated or sessile
| Prognosis  = good
| Other      =
| ClinDDx    = [[normal colon]], [[sessile serrated adenoma]]
}}
{{ Infobox external links
| Name          = {{PAGENAME}}
| EHVSC          = 10190
| EHVSC_mult    =
| pathprotocols  =
| wikipedia      =
| pathoutlines  =
}}
:''The [[stomach]] lesion is dealt with in [[hyperplastic polyp of the stomach]]''.
The '''hyperplastic [[GI polyps|polyp]]''' of the [[colon]] and rectum is a very common. It is commonly abbreviated '''HP'''.
 
==General==
*Most common type of polyp:
**Approximately 90% of all colonic polyps.<ref name=Ref_PBoD858>{{Ref PBoD|858}}</ref>
*May be part of [[serrated polyposis syndrome]] (previously known as [[hyperplastic polyposis syndrome]]).<ref name=pmid21045813>{{Cite journal  | last1 = Huang | first1 = CS. | last2 = Farraye | first2 = FA. | last3 = Yang | first3 = S. | last4 = O'Brien | first4 = MJ. | title = The clinical significance of serrated polyps. | journal = Am J Gastroenterol | volume = 106 | issue = 2 | pages = 229-40; quiz 241 | month = Feb | year = 2011 | doi = 10.1038/ajg.2010.429 | PMID = 21045813 }}</ref>
 
==Gross==
Features:<ref name=pmid22710576>{{Cite journal  | last1 = Rex | first1 = DK. | last2 = Ahnen | first2 = DJ. | last3 = Baron | first3 = JA. | last4 = Batts | first4 = KP. | last5 = Burke | first5 = CA. | last6 = Burt | first6 = RW. | last7 = Goldblum | first7 = JR. | last8 = Guillem | first8 = JG. | last9 = Kahi | first9 = CJ. | title = Serrated lesions of the colorectum: review and recommendations from an expert panel. | journal = Am J Gastroenterol | volume = 107 | issue = 9 | pages = 1315-29; quiz 1314, 1330 | month = Sep | year = 2012 | doi = 10.1038/ajg.2012.161 | PMID = 22710576 }}</ref>
*Flat lesion, usually <= 5mm.
*Typically in the distal large bowel (rectum, sigmoid colon).
 
==Microscopic==
Features:<ref name=Ref_PBoD858/>
*Irregular crypt architecture - tortuosity.
*Serrated epithelial cells (at the surface of the gland) - only colorectal polyps - '''key feature'''.
**''Serrated'' appearance = ''saw-tooth'' appearance, epithelium has jagged edge.
 
Notes:
*Significant negatives:
**No nuclear atypia; glands ''d''arker staining ''d''eep... ''l''ighter staining ''l''uminal.
**In the colon goblet cells should be present (as is usual).
*Inflammation -- [[cryptitis]] or even crypt abscesses -- is considered to arise due to trauma.{{fact}}
**It is usually ''not'' reported.
 
DDx:
*[[Sessile serrated adenoma]].
*[[Normal colon]].
*[[Colorectal xanthomatous polyp|Xanthomatous polyp]] with hyperplastic features.<ref name=pmid14961968>{{Cite journal  | last1 = Nakasono | first1 = M. | last2 = Hirokawa | first2 = M. | last3 = Muguruma | first3 = N. | last4 = Okahisa | first4 = T. | last5 = Okamura | first5 = S. | last6 = Ito | first6 = S. | last7 = Miyamoto | first7 = H. | last8 = Wada | first8 = S. | last9 = Fukuda | first9 = T. | title = Colorectal xanthomas with polypoid lesion: report of 25 cases. | journal = APMIS | volume = 112 | issue = 1 | pages = 3-10 | month = Jan | year = 2004 | doi =  | PMID = 14961968 }}</ref>
*[[Hyperplastic polyp with perineuromatous stroma]].
 
===Images===
<gallery>
Image: Hyperplastic polyp -- low mag.jpg | HP - low mag. (WC)
Image: Hyperplastic polyp -- intermed mag.jpg | HP - intermed. mag. (WC)
Image: Hyperplastic polyp -- alt - intermed mag.jpg | HP - intermed. mag. (WC)
Image: Hyperplastic polyp -- high mag.jpg | HP - high mag. (WC)
</gallery>
www:
*[http://www.flickr.com/photos/jthetzel/4317282727/ Microvesicular HP (flickr.com/jhetzel)].
*[http://www.flickr.com/photos/jian-hua_qiao_md/3984355417/ HP of colon (flickr.com/jian-hua_qiao_md)].
 
===Subclassification===
*Usually '''not subclassified''' as there is no demonstrated prognostic significance;<ref name=pmid21045813/> the subtyping is an academic exercise.
 
HPs may be subclassified into two groups:<ref name=pmid21045813/>
#Microvesicular serrated polyps (MVSPs).
#Goblet cell serrated polyps (GCSPs).
 
Features of the HP subtypes:<ref name=pmid21045813/>
{| class="wikitable sortable"
| '''Subtype'''
| '''Histology'''
| '''Mutations'''
| '''Clinical relevance'''
|-
| Microvesicular
| microvesicles at the surface, serration<br> at the surface to the mid portion of glands
| BRAF V600E, CIMP
| possible [[sessile serrated adenoma]] precursor
|-
| Goblet cell
| superficial goblet cells, serration at <br>the surface
| [[KRAS mutation|KRAS]]
| unknown; probably benign
|}
Notes:
*CIMP = CpG island methylation phenotype.
 
==IHC==
*[[Chromogranin A]] increased scattered Chromogranin A-positive cells (in relation to normal colorectal mucosa).
**[[Sessile serrated adenoma]] is completely negative for [[Chromogranin A]].
 
==Sign out==
<pre>
POLYP, RECTUM, POLYPECTOMY:
- HYPERPLASTIC POLYP.
</pre>
 
<pre>
POLYP, SIGMOID COLON, POLYPECTOMY:
- HYPERPLASTIC POLYP.
</pre>
 
<pre>
POLYP, DESCENDING COLON, POLYPECTOMY:
- HYPERPLASTIC POLYP.
</pre>
 
<pre>
POLYP, TRANSVERSE COLON, POLYPECTOMY:
- HYPERPLASTIC POLYP.
</pre>
 
<pre>
COLONIC POLYP, 35 CM, POLYPECTOMY:
- HYPERPLASTIC POLYP.
</pre>
 
<pre>
POLYP, LARGE BOWEL AT 10 CM, EXCISION:
- HYPERPLASTIC POLYP.
</pre>
 
====Numerous hyperplastic polyps====
<pre>
COLONIC POLYP(S), POLYPECTOMY:
- HYPERPLASTIC POLYP, SEE COMMENT. 
 
COMMENT:
Eight pieces of tissue were received.  On microscopy eight pieces of tissue
are identified and all eight (individually) have the diagnostic features of a
hyperplastic polyp.  If these fragments all represent individual polyps and more
polyps of this type are present in the individual, it raises the possibility of
a serrated polyposis syndrome.
</pre>
 
====Superficial changes only====
<pre>
TRANSVERSE COLON (POLYP), BIOPSY:
- COLORECTAL-TYPE MUCOSA WITH SURFACE HYPERPLASTIC CHANGE.
- NEGATIVE FOR DYSPLASIA.
</pre>
 
===Micro===
====Goblet cell type====
The sections show colonic-type mucosa with superficial serrations rich in goblet cells.  There are no serrations in the crypt base and there is no crypt base dilation.  No dysplasia is present.
 
====Generic====
The sections show colonic-type mucosa with superficial serrations.  There are no serrations in the crypt base and there is no crypt base dilation.  No dysplasia is present.
 
=====Alternate=====
The sections show two tissue fragments of colorectal-type mucosa.  One fragment has no
pathologic change. The second fragment has the changes of a hyperplastic polyp
(superficial serrations, no serrations in the crypt base, no crypt base dilation).
 
====Minimal crypt base dilation====
The sections show colonic-type mucosa with superficial serrations. Rare serrations are seen
focally near the crypt base. Rare mild crypt base dilation is seen. No hockey stick-shaped
glands are identified. No crypt branching is seen. No dysplasia is present.
 
==See also==
*[[Gastrointestinal tract polyps]].
*[[Gastrointestinal pathology]].
*[[Hyperplastic polyp with perineuromatous stroma]].
 
==References==
{{Reflist|2}}
 
==External links==
*[http://www.cap.org/apps/microsites/MyBiopsy/hyperplastic_colon_polyps.html Hyperplastic polyps (cap.org)]/
 
[[Category:Diagnosis]]
[[Category:Gastrointestinal pathology]]
Michael
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