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Difference between revisions of "Traditional adenoma"
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| Micro = nuclear changes - esp. at the surface (hyperchromatic elongated nuclei or round cleared nuclei), nuclear crowding/pseudostratification, +/- loss of nuclear polarity, loss/decrease of goblet cells, cytoplasmic hyperchromasia | | Micro = nuclear changes - esp. at the surface (hyperchromatic elongated nuclei or round cleared nuclei), nuclear crowding/pseudostratification, +/- loss of nuclear polarity, loss/decrease of goblet cells, cytoplasmic hyperchromasia | ||
| Subtypes = [[tubular adenoma]], [[villous adenoma]], [[tubulovillous adenoma]] | | Subtypes = [[tubular adenoma]], [[villous adenoma]], [[tubulovillous adenoma]] | ||
| LMDDx = [[sessile serrated adenoma]] with dysplasia, [[gastrointestinal polyps]] | | LMDDx = [[sessile serrated adenoma]] with dysplasia, reactive changes in other [[gastrointestinal polyps]], invasive adenocarcinoma, adenoma-like adenocarcinoma | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = | ||
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| Other = | | Other = | ||
| ClinDDx = invasive [[colorectal adenocarcinoma]], [[Normal_colorectal_mucosa|benign colorectal mucosa]], [[hyperplastic polyp]], other [[gastrointestinal tract polyps]] | | ClinDDx = invasive [[colorectal adenocarcinoma]], [[Normal_colorectal_mucosa|benign colorectal mucosa]], [[hyperplastic polyp]], other [[gastrointestinal tract polyps]] | ||
| Tx = usually endoscopic resection | | Tx = usually endoscopic resection ([[polypectomy]]) | ||
}} | }} | ||
{{ Infobox external links | {{ Infobox external links | ||
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#*Size and shape ''or'' size change: | #*Size and shape ''or'' size change: | ||
#**Cigar-shaped (elongated) nucleus (usu. length:width > 3:1) with nuclear hyperchromasia (more blue). | #**Cigar-shaped (elongated) nucleus (usu. length:width > 3:1) with nuclear hyperchromasia (more blue). | ||
#**Large round nuclei +/- vesicular appearance (clearing) -- nuclei have white space. | #**Large round nuclei +/- [[vesicular nuclei|vesicular]] appearance (clearing) -- nuclei have white space. | ||
#*Nuclear crowding/pseudostratification - '''important'''. | #*Nuclear crowding/pseudostratification - '''important'''. | ||
#*+/-Loss of nuclear polarity (nuclei no longer on basement membrane). | #*+/-Loss of nuclear polarity (nuclei no longer on basement membrane). | ||
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***The base is more mature (more globlet cells, no nuclear changes -- less blue). | ***The base is more mature (more globlet cells, no nuclear changes -- less blue). | ||
*[[Ampullary adenoma]]s often have less prominent pseudostratification and fine chromatin. | *[[Ampullary adenoma]]s often have less prominent pseudostratification and fine chromatin. | ||
DDx: | |||
*Reactive changes due to inflammation. | |||
*Invasive adenocarcinoma. | |||
**Adenoma-like adenocarcinoma.<ref name=pmid25913616>{{Cite journal | last1 = Gonzalez | first1 = RS. | last2 = Cates | first2 = JM. | last3 = Washington | first3 = MK. | last4 = Beauchamp | first4 = RD. | last5 = Coffey | first5 = RJ. | last6 = Shi | first6 = C. | title = Adenoma-like adenocarcinoma: a subtype of colorectal carcinoma with good prognosis, deceptive appearance on biopsy and frequent KRAS mutation. | journal = Histopathology | volume = 68 | issue = 2 | pages = 183-90 | month = Jan | year = 2016 | doi = 10.1111/his.12725 | PMID = 25913616 }}</ref> | |||
===Images=== | ===Images=== | ||
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Image:Tubular_adenoma_2_intermed_mag.jpg| Tubular adenoma - intermed. mag. (WC/Nephron). | Image:Tubular_adenoma_2_intermed_mag.jpg| Tubular adenoma - intermed. mag. (WC/Nephron). | ||
Image:Tubulovillous_adenoma.jpg| Tubulovillous adenoma (WC/Nephron). | Image:Tubulovillous_adenoma.jpg| Tubulovillous adenoma (WC/Nephron). | ||
Image: Tubular adenoma - ase -- low mag.jpg | TA - low mag. (WC/Nephron) | |||
Image: Tubular adenoma - ase -- intermed mag.jpg | TA - intermed. mag. (WC/Nephron) | |||
</gallery> | </gallery> | ||
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==Sign out== | ==Sign out== | ||
===Tubular adenoma - negative for high-grade=== | ===Tubular adenoma - negative for high-grade=== | ||
<pre> | |||
A. Colonic Polyp, Transverse Colon, Polypectomy: | |||
- Tubular adenoma. | |||
- NEGATIVE for high grade dysplasia. | |||
B. Colonic Polyp, Transverse Colon, Polypectomy: | |||
-Tubular adenoma. | |||
-NEGATIVE for high grade dysplasia. | |||
</pre> | |||
<pre> | |||
Polyp, Rectum, Polypectomy: | |||
- Tubular adenoma. | |||
-- NEGATIVE for high-grade dysplasia. | |||
</pre> | |||
====Block letters==== | |||
<pre> | <pre> | ||
POLYP, RECTUM, POLYPECTOMY: | POLYP, RECTUM, POLYPECTOMY: | ||
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===Tubulovillous adenoma - negative for high-grade=== | ===Tubulovillous adenoma - negative for high-grade=== | ||
<pre> | |||
Polyp, Sigmoid Colon at 30 cm, Biopsy: | |||
- Fragments of tubulovillous adenoma. | |||
-- NEGATIVE for high-grade dysplasia. | |||
Comment: | |||
This biopsy may not be representative of the lesion as a whole. | |||
Clinical correlation is required. | |||
</pre> | |||
====Block letters==== | |||
<pre> | <pre> | ||
COLONIC POLYP, SIGMOID COLON, BIOPSY: | COLONIC POLYP, SIGMOID COLON, BIOPSY: | ||
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<pre> | <pre> | ||
POLYP, TRANSVERSE COLON, BIOPSY: | POLYP, TRANSVERSE COLON, BIOPSY: | ||
- TUBULAR ADENOMA WITH FOCAL HIGH-GRADE DYSPLASIA. | - TUBULAR ADENOMA WITH FOCAL HIGH-GRADE DYSPLASIA, MARGINS CLEAR, SEE COMMENT. | ||
COMMENT: | |||
The case was partially reviewed internally by Dr. Pathology and there is agreement high-grade dysplasia is focally present. | |||
</pre> | </pre> | ||
Note: | |||
*"Focal" is something that should prompt review; the management decision often turns on high grade versus low grade. | |||
===Tubular adenoma with high-grade dysplasia=== | ===Tubular adenoma with high-grade dysplasia=== | ||
<pre> | <pre> | ||
POLYP, SIGMOID COLON, BIOPSY: | POLYP, SIGMOID COLON, BIOPSY: | ||
- TUBULAR ADENOMA WITH HIGH-GRADE DYSPLASIA. | - TUBULAR ADENOMA WITH HIGH-GRADE DYSPLASIA, MARGINS CLEAR. | ||
</pre> | </pre> | ||
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A small number of rare finger-like epithelial projections (villi) are noted; however these appear to comprise less than 20% of the sampled tissue. It is possible that the villous component is higher or lower due to sampling. | A small number of rare finger-like epithelial projections (villi) are noted; however these appear to comprise less than 20% of the sampled tissue. It is possible that the villous component is higher or lower due to sampling. | ||
=====Abbreviated version===== | =====Abbreviated version 1===== | ||
The sections shows colorectal-type mucosa with a tubule-forming epithelium that has | The sections shows colorectal-type mucosa with a tubule-forming epithelium that has | ||
cellular pseudostratification and enlarged hyperchromatic nuclei, from the crypt base to | cellular pseudostratification and enlarged hyperchromatic nuclei, from the crypt base to | ||
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A small number of finger-like epithelial projections (villi) are noted; however, these | A small number of finger-like epithelial projections (villi) are noted; however, these | ||
appear to comprise less than 20% of the sampled tissue. | appear to comprise less than 20% of the sampled tissue. | ||
=====Abbreviated version 2===== | |||
A number of finger-like epithelial projections (villi) are noted; however, these appear to comprise less than 25% of the adenomatous tissue seen in section. | |||
=====More abbreviated===== | =====More abbreviated===== | ||
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*[[Gastrointestinal polyps]]. | *[[Gastrointestinal polyps]]. | ||
*[[Gastrointestinal pathology]]. | *[[Gastrointestinal pathology]]. | ||
*"[[Intramucosal colorectal carcinoma]]". | |||
==References== | ==References== | ||