Difference between revisions of "Traditional serrated adenoma"

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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===
<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:Diagnosis]]
[[Category:Gastrointestinal pathology]]

Latest revision as of 15:49, 5 June 2017

Traditional serrated adenoma
Diagnosis in short
LM 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
LM DDx villous adenoma, hyperplastic polyp, sessile serrated adenoma
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
Molecular BRAF & KRAS
Site colon - usu. left side / gastrointestinal polyps
Prevalence very rare
Prognosis benign (pre-malignant)
Clin. DDx other GI polyps
Treatment polypectomy, q3years surveillance colonoscopy

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

Before the sessile serrated adenomas were recognized, these lesions were known as serrated adenomas.[1]

General

  • Very rare.
  • Pre-malignant.[2]

Gross

Microscopic

Features:[3]

  • 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.[4]‡

Note:

  • ‡ECF considered pathognomonic for TSA - but seen in other entities.[5]

DDx:[6]

Images

  • TSA - low mag. (WC/Nephron)

  • TSA - intermed. mag. (WC/Nephron)

  • TSA - very high mag. (WC/Nephron)

  • TSA - low mag. (WC/Nephron)

  • TSA - intermed. mag. (WC/Nephron)

  • TSA - high mag. (WC/Nephron)

  • TSA - very high mag. (WC/Nephron)

Sign out

Polyp, Sigmoid Colon, Polypectomy:
- Traditional serrated adenoma.
-- NEGATIVE for high-grade dysplasia.

Block letters

POLYP, SIGMOID COLON, POLYPECTOMY:
- TRADITIONAL SERRATED ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.

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

References

  1. ↑ Noffsinger, AE.; Hart, J. (Jul 2010). "Serrated adenoma: a distinct form of non-polypoid colorectal neoplasia?". Gastrointest Endosc Clin N Am 20 (3): 543-63. doi:10.1016/j.giec.2010.03.012. PMID 20656251.
  2. ↑ Rosty, C.; Hewett, DG.; Brown, IS.; Leggett, BA.; Whitehall, VL. (Mar 2013). "Serrated polyps of the large intestine: current understanding of diagnosis, pathogenesis, and clinical management.". J Gastroenterol 48 (3): 287-302. doi:10.1007/s00535-012-0720-y. PMID 23208018.
  3. ↑ Li SC, Burgart L (March 2007). "Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps". Arch. Pathol. Lab. Med. 131 (3): 440-5. PMID 17516746. http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=131&page=440.
  4. ↑ URL: http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/printable.html. Accessed on: 5 June 2017.
  5. ↑ Väyrynen, SA.; Väyrynen, JP.; Klintrup, K.; Mäkelä, J.; Tuomisto, A.; Mäkinen, MJ. (Dec 2016). "Ectopic crypt foci in conventional and serrated colorectal polyps.". J Clin Pathol 69 (12): 1063-1069. doi:10.1136/jclinpath-2015-203593. PMID 27281826.
  6. ↑ URL: http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/differential-diagnosis.html. Accessed on: 28 May 2015.
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