Traditional serrated adenoma: Difference between revisions

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~~#redirect~~ [[~~Gastrointestinal_tract_polyps#Traditional_serrated_adenoma~~]]

{{ Infobox diagnosis

| Name = {{PAGENAME}}

| Image = Traditional_serrated_adenoma_very_high_mag.jpg

| Width = Traditional serrated adenoma. [[H&E stain]].

| Caption =

| Micro = ectopic crypt foci (ECF), serrated, eosinophilic cytoplasm, villous-like architecture, "pine cone, fernlike, stellate pit pattern"

| Subtypes = With and without high grade dysplasia, mixed with other types of polyps

| LMDDx = [[villous adenoma]], [[hyperplastic polyp]], [[sessile serrated adenoma]]

| Stains =

| IHC = CK20 in the eosinophilic cells, absent in ECF; Ki67 (MIB1) stains ECF and absent in eosinophilic cells, MUC2+, MUC5CA+, MUC6-; In areas of dysplasia TP53+, nuclear B-catenin+; p16+ in late dysplasia

| EM =

| Molecular = [[BRAF]] & [[KRAS]]

| IF =

| Gross =

| Grossing =

| Site = [[colon]] - usu. left side / [[gastrointestinal polyps]]

| Assdx =

| Syndromes =

| Clinicalhx =

| Signs =

| Symptoms =

| Prevalence = very rare

| Bloodwork =

| Rads =

| Endoscopy =

| Prognosis = benign (pre-malignant)

| Other =

| ClinDDx = other [[GI polyps]]

| Tx = [[polypectomy]], q3years surveillance colonoscopy

}}

'''Traditional serrated adenoma''', abbreviated '''TSA''', are a rare type of [[gastrointestinal polyp]].

Before the [[sessile serrated adenoma]]s were recognized, these lesions were known as '''[[serrated adenoma]]s'''.<ref name=pmid20656251>{{Cite journal | last1 = Noffsinger | first1 = AE. | last2 = Hart | first2 = J. | title = Serrated adenoma: a distinct form of non-polypoid colorectal neoplasia? | journal = Gastrointest Endosc Clin N Am | volume = 20 | issue = 3 | pages = 543-63 | month = Jul | year = 2010 | doi = 10.1016/j.giec.2010.03.012 | PMID = 20656251 }}</ref>

==General==

*Very rare.

*Pre-malignant.<ref name=pmid23208018>{{Cite journal | last1 = Rosty | first1 = C. | last2 = Hewett | first2 = DG. | last3 = Brown | first3 = IS. | last4 = Leggett | first4 = BA. | last5 = Whitehall | first5 = VL. | title = Serrated polyps of the large intestine: current understanding of diagnosis, pathogenesis, and clinical management. | journal = J Gastroenterol | volume = 48 | issue = 3 | pages = 287-302 | month = Mar | year = 2013 | doi = 10.1007/s00535-012-0720-y | PMID = 23208018 }}</ref>

==Gross==

*Polypoid mass.

*Usually in the [[left colon]].

==Microscopic==

Features:<ref name=pmid17516746>{{cite journal |author=Li SC, Burgart L |title=Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps |journal=Arch. Pathol. Lab. Med. |volume=131 |issue=3 |pages=440-5 |year=2007 |month=March |pmid=17516746 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=131&page=440}}</ref>

*Serrated - '''essential'''.

*Eosinophilic cytoplasm - '''key feature'''.

*Nuclear atypia as in [[tubular adenoma]].

**Nuclear hyperchromasia, enlargement and pseudostratification.

*Villous-like architecture.

*Ectopic crypt foci (ECF) - short crypts oriented perpendicular to the main crypt, do not reach muscularis mucosae.<ref>URL: [http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/printable.html http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/printable.html]. Accessed on: 5 June 2017.</ref>‡

Note:

*‡ECF considered pathognomonic for TSA - but seen in other entities.<ref name=pmid27281826>{{Cite journal | last1 = Väyrynen | first1 = SA. | last2 = Väyrynen | first2 = JP. | last3 = Klintrup | first3 = K. | last4 = Mäkelä | first4 = J. | last5 = Tuomisto | first5 = A. | last6 = Mäkinen | first6 = MJ. | title = Ectopic crypt foci in conventional and serrated colorectal polyps. | journal = J Clin Pathol | volume = 69 | issue = 12 | pages = 1063-1069 | month = Dec | year = 2016 | doi = 10.1136/jclinpath-2015-203593 | PMID = 27281826 }}</ref>

DDx:<ref>URL: [http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/differential-diagnosis.html http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/differential-diagnosis.html]. Accessed on: 28 May 2015.</ref>

*[[Villous adenoma]].

*[[Hyperplastic polyp]].

*[[Sessile serrated adenoma]].

===Images===

Image:Traditional_serrated_adenoma_low_mag.jpg | TSA - low mag. (WC/Nephron)

Image:Traditional_serrated_adenoma_intermed_mag.jpg | TSA - intermed. mag. (WC/Nephron)

Image:Traditional_serrated_adenoma_very_high_mag.jpg | TSA - very high mag. (WC/Nephron)

</gallery>

Image: Traditional serrated adenoma -- low mag.jpg | TSA - low mag. (WC/Nephron)

Image: Traditional serrated adenoma -- intermed mag.jpg | TSA - intermed. mag. (WC/Nephron)

Image: Traditional serrated adenoma -- high mag.jpg | TSA - high mag. (WC/Nephron)

Image: Traditional serrated adenoma -- very high mag.jpg | TSA - very high mag. (WC/Nephron)

</gallery>

==Sign out==

<pre>

Polyp, Sigmoid Colon, Polypectomy:

- Traditional serrated adenoma.

-- NEGATIVE for high-grade dysplasia.

</pre>

===Block letters===

<pre>

POLYP, SIGMOID COLON, POLYPECTOMY:

- TRADITIONAL SERRATED ADENOMA.

-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.

</pre>

===Micro===

====Nonvilliform TSA====

This polyp has cytologic dysplasia and serrations at the surface; however, it does not have a villiform architecture. The surface epithelium has eosinophilic cytoplasm. Overall, the morphology is most in keeping with a traditional serrated adenoma.

==See also==

*[[Gastrointestinal polyps]].

*[[Gastrointestinal pathology]].

==References==

[[Category:Diagnosis]]

[[Category:Gastrointestinal pathology]]

@@ Line 1: / Line 1: @@
-#redirect [[Gastrointestinal_tract_polyps#Traditional_serrated_adenoma]]
+{{ Infobox diagnosis
+| Name       = {{PAGENAME}}
+| Image      = Traditional_serrated_adenoma_very_high_mag.jpg
+| Width      = Traditional serrated adenoma. [[H&E stain]].
+| Caption    =
+| Micro      = ectopic crypt foci (ECF), serrated, eosinophilic cytoplasm, villous-like architecture, "pine cone, fernlike, stellate pit pattern"
+| Subtypes   = With and without high grade dysplasia, mixed with other types of polyps
+| LMDDx      = [[villous adenoma]], [[hyperplastic polyp]], [[sessile serrated adenoma]]
+| Stains     =
+| IHC        = CK20 in the eosinophilic cells, absent in ECF; Ki67 (MIB1) stains ECF and absent in eosinophilic cells, MUC2+, MUC5CA+, MUC6-; In areas of dysplasia TP53+, nuclear B-catenin+; p16+ in late dysplasia
+| EM         =
+| Molecular  = [[BRAF]] & [[KRAS]]
+| IF         =
+| Gross      =
+| Grossing   =
+| Site       = [[colon]] - usu. left side / [[gastrointestinal polyps]]
+| Assdx      =
+| Syndromes  =
+| Clinicalhx =
+| Signs      =
+| Symptoms   =
+| Prevalence = very rare
+| Bloodwork  =
+| Rads       =
+| Endoscopy  =
+| Prognosis  = benign (pre-malignant)
+| Other      =
+| ClinDDx    = other [[GI polyps]]
+| Tx         = [[polypectomy]], q3years surveillance colonoscopy
+}}
+'''Traditional serrated adenoma''', abbreviated '''TSA''', are a rare type of [[gastrointestinal polyp]].
+Before the [[sessile serrated adenoma]]s were recognized, these lesions were known as '''[[serrated adenoma]]s'''.<ref name=pmid20656251>{{Cite journal  | last1 = Noffsinger | first1 = AE. | last2 = Hart | first2 = J. | title = Serrated adenoma: a distinct form of non-polypoid colorectal neoplasia? | journal = Gastrointest Endosc Clin N Am | volume = 20 | issue = 3 | pages = 543-63 | month = Jul | year = 2010 | doi = 10.1016/j.giec.2010.03.012 | PMID = 20656251 }}</ref>
+==General==
+*Very rare.
+*Pre-malignant.<ref name=pmid23208018>{{Cite journal  | last1 = Rosty | first1 = C. | last2 = Hewett | first2 = DG. | last3 = Brown | first3 = IS. | last4 = Leggett | first4 = BA. | last5 = Whitehall | first5 = VL. | title = Serrated polyps of the large intestine: current understanding of diagnosis, pathogenesis, and clinical management. | journal = J Gastroenterol | volume = 48 | issue = 3 | pages = 287-302 | month = Mar | year = 2013 | doi = 10.1007/s00535-012-0720-y | PMID = 23208018 }}</ref>
+==Gross==
+*Polypoid mass.
+*Usually in the [[left colon]].
+==Microscopic==
+Features:<ref name=pmid17516746>{{cite journal |author=Li SC, Burgart L |title=Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps |journal=Arch. Pathol. Lab. Med. |volume=131 |issue=3 |pages=440-5 |year=2007 |month=March |pmid=17516746 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=131&page=440}}</ref>
+*Serrated - '''essential'''.
+*Eosinophilic cytoplasm - '''key feature'''.
+*Nuclear atypia as in [[tubular adenoma]].
+**Nuclear hyperchromasia, enlargement and pseudostratification.
+*Villous-like architecture.
+*Ectopic crypt foci (ECF) - short crypts oriented perpendicular to the main crypt, do not reach muscularis mucosae.<ref>URL: [http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/printable.html http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/printable.html]. Accessed on: 5 June 2017.</ref>‡
+Note:
+*‡ECF considered pathognomonic for TSA - but seen in other entities.<ref name=pmid27281826>{{Cite journal  | last1 = Väyrynen | first1 = SA. | last2 = Väyrynen | first2 = JP. | last3 = Klintrup | first3 = K. | last4 = Mäkelä | first4 = J. | last5 = Tuomisto | first5 = A. | last6 = Mäkinen | first6 = MJ. | title = Ectopic crypt foci in conventional and serrated colorectal polyps. | journal = J Clin Pathol | volume = 69 | issue = 12 | pages = 1063-1069 | month = Dec | year = 2016 | doi = 10.1136/jclinpath-2015-203593 | PMID = 27281826 }}</ref>
+DDx:<ref>URL: [http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/differential-diagnosis.html http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/differential-diagnosis.html]. Accessed on: 28 May 2015.</ref>
+*[[Villous adenoma]].
+*[[Hyperplastic polyp]].
+*[[Sessile serrated adenoma]].
+===Images===
+<gallery>
+Image:Traditional_serrated_adenoma_low_mag.jpg | TSA - low mag. (WC/Nephron)
+Image:Traditional_serrated_adenoma_intermed_mag.jpg | TSA - intermed. mag. (WC/Nephron)
+Image:Traditional_serrated_adenoma_very_high_mag.jpg | TSA - very high mag. (WC/Nephron)
+</gallery>
+<gallery>
+Image: Traditional serrated adenoma -- low mag.jpg | TSA - low mag. (WC/Nephron)
+Image: Traditional serrated adenoma -- intermed mag.jpg | TSA - intermed. mag. (WC/Nephron)
+Image: Traditional serrated adenoma -- high mag.jpg | TSA - high mag. (WC/Nephron)
+Image: Traditional serrated adenoma -- very high mag.jpg | TSA - very high mag. (WC/Nephron)
+</gallery>
+==Sign out==
+<pre>
+Polyp, Sigmoid Colon, Polypectomy:
+- Traditional serrated adenoma.
+-- NEGATIVE for high-grade dysplasia.
+</pre>
+===Block letters===
+<pre>
+POLYP, SIGMOID COLON, POLYPECTOMY:
+- TRADITIONAL SERRATED ADENOMA.
+-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
+</pre>
+===Micro===
+====Nonvilliform TSA====
+This polyp has cytologic dysplasia and serrations at the surface; however, it does not have a villiform architecture.  The surface epithelium has eosinophilic cytoplasm. Overall, the morphology is most in keeping with a traditional serrated adenoma.
+==See also==
+*[[Gastrointestinal polyps]].
+*[[Gastrointestinal pathology]].
+==References==
+{{Reflist|2}}
 [[Category:Diagnosis]]
+[[Category:Gastrointestinal pathology]]

Traditional serrated adenoma: Difference between revisions

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