Difference between revisions of "Hyperplastic polyp"

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Hyperplastic_polyp1.jpg
| Image      = Hyperplastic_polyp_--_alt_-_intermed_mag.jpg
| Width      =
| Width      =
| Caption    = Hyperplastic polyp. [[H&E stain]].
| Caption    = Hyperplastic polyp. [[H&E stain]].
| Micro      = serrated architecture without glandular abnormalities
| Micro      = serrated architecture at the surface without glandular abnormalities
| Subtypes  = microvesicular serrated polyps (MVSPs), goblet cell serrated polyps (GCSPs).
| Subtypes  = microvesicular serrated polyps (MVSPs), goblet cell serrated polyps (GCSPs)  
| LMDDx      = [[sessile serrated adenoma]]
| LMDDx      = [[sessile serrated adenoma]], [[normal colon]], [[hyperplastic polyp with perineuromatous stroma]], other [[gastrointestinal polyps]]
| Stains    =
| Stains    =
| IHC        =
| IHC        = [[Chromogranin A]] +ve (increased scattered Chromogranin A-positive cells in relation to normal mucosa)
| EM        =
| EM        =
| Molecular  =
| Molecular  =
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| Gross      = usually rectum or sigmoid, typically < 5mm
| Gross      = usually rectum or sigmoid, typically < 5mm
| Grossing  =
| Grossing  =
| Site      = [[colon]], [[rectum]]
| Site      = [[cecum]], [[colon]], [[rectum]]  
| Assdx      =
| Assdx      =
| Syndromes  = [[hyperplastic polyposis syndrome]]
| Syndromes  = [[serrated polyposis syndrome]]
| Clinicalhx =
| Signs      =
| Signs      =
| Symptoms  = asymptomatic
| Symptoms  = asymptomatic
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| Prognosis  = good
| Prognosis  = good
| Other      =
| Other      =
| ClinDDx    = normal colon, sessile serrated adenoma
| 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 [[stomach]] lesion is dealt with in [[hyperplastic polyp of the stomach]]''.
The '''hyperplastic polyp''' of the [[colon]] and rectum is very common. It is commonly abbreviated '''HP'''.
The '''hyperplastic [[GI polyps|polyp]]''' of the [[colon]] and rectum is a very common. It is commonly abbreviated '''HP'''.


==General==
==General==
*Most common type of polyp:
*Most common type of polyp:
**Approximately 90% of all colonic polyps.<ref name=Ref_PBoD858>{{Ref PBoD|858}}</ref>
**Approximately 90% of all colonic polyps.<ref name=Ref_PBoD858>{{Ref PBoD|858}}</ref>
*May be part of [[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>
*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==
==Gross==
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**No nuclear atypia; glands ''d''arker staining ''d''eep... ''l''ighter staining ''l''uminal.  
**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).
**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}}
*Inflammation -- [[cryptitis]] or even crypt abscesses -- is considered to arise due to trauma.{{fact}}
**It is usually ''not'' reported.
**It is usually ''not'' reported.


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*[[Sessile serrated adenoma]].
*[[Sessile serrated adenoma]].
*[[Normal colon]].
*[[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===
===Images===
<gallery>
<gallery>
Image:Hyperplastic_polyp1.jpg | HP - high mag. (WC/Nephron)
Image: Hyperplastic polyp -- low mag.jpg | HP - low mag. (WC)
Image:Hyperplastic_polyp2.jpg | HP - lower mag. (WC/Nephron)
Image: Hyperplastic polyp -- intermed mag.jpg | HP - intermed. mag. (WC)
Image:Hyperplastic_polyp_of_the_colon,_HE.jpg | HP (WC/Patho)
Image: Hyperplastic polyp -- alt - intermed mag.jpg | HP - intermed. mag. (WC)
Image: Hyperplastic polyp -- high mag.jpg | HP - high mag. (WC)  
</gallery>
</gallery>
www:
www:
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| Goblet cell
| Goblet cell
| superficial goblet cells, serration at <br>the surface
| superficial goblet cells, serration at <br>the surface
| KRAS
| [[KRAS mutation|KRAS]]
| unknown; probably benign
| unknown; probably benign
|}
|}
Notes:
Notes:
*CIMP = CpG island methylation phenotype.
*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==
==Sign out==
<pre>
<pre>
COLONIC POLYP, 35 CM, BIOPSY:  
POLYP, RECTUM, POLYPECTOMY:
- HYPERPLASTIC POLYP.
</pre>
 
<pre>
POLYP, SIGMOID COLON, POLYPECTOMY:
- HYPERPLASTIC POLYP.
</pre>
 
<pre>
POLYP, DESCENDING COLON, POLYPECTOMY:
- HYPERPLASTIC POLYP.
- HYPERPLASTIC POLYP.
</pre>
</pre>


<pre>
<pre>
COLONIC POLYP, SIGMOID COLON, BIOPSY:  
POLYP, TRANSVERSE COLON, POLYPECTOMY:
- HYPERPLASTIC POLYP.
- HYPERPLASTIC POLYP.
</pre>
</pre>


<pre>
<pre>
POLYP, RECTUM, BIOPSY:  
COLONIC POLYP, 35 CM, POLYPECTOMY:
- HYPERPLASTIC POLYP.
</pre>
 
<pre>
POLYP, LARGE BOWEL AT 10 CM, EXCISION:  
- HYPERPLASTIC POLYP.
- HYPERPLASTIC POLYP.
</pre>
</pre>
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====Numerous hyperplastic polyps====
====Numerous hyperplastic polyps====
<pre>
<pre>
COLONIC POLYP(S), BIOPSY:  
COLONIC POLYP(S), POLYPECTOMY:  
- HYPERPLASTIC POLYP, SEE COMMENT.   
- HYPERPLASTIC POLYP, SEE COMMENT.   


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polyps of this type are present in the individual, it raises the possibility of  
polyps of this type are present in the individual, it raises the possibility of  
a serrated polyposis syndrome.
a serrated polyposis syndrome.
</pre>
====Superficial changes only====
<pre>
TRANSVERSE COLON (POLYP), BIOPSY:
- COLORECTAL-TYPE MUCOSA WITH SURFACE HYPERPLASTIC CHANGE.
- NEGATIVE FOR DYSPLASIA.
</pre>
</pre>


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====Generic====
====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.
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==
==See also==
*[[Gastrointestinal tract polyps]].
*[[Gastrointestinal tract polyps]].
*[[Gastrointestinal pathology]].
*[[Gastrointestinal pathology]].
*[[Hyperplastic polyp with perineuromatous stroma]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
==External links==
*[http://www.cap.org/apps/microsites/MyBiopsy/hyperplastic_colon_polyps.html Hyperplastic polyps (cap.org)]/


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Gastrointestinal pathology]]
[[Category:Gastrointestinal pathology]]

Latest revision as of 21:48, 19 September 2018

Hyperplastic polyp
Diagnosis in short

Hyperplastic polyp. H&E stain.
LM serrated architecture at the surface without glandular abnormalities
Subtypes microvesicular serrated polyps (MVSPs), goblet cell serrated polyps (GCSPs)
LM DDx sessile serrated adenoma, normal colon, hyperplastic polyp with perineuromatous stroma, other gastrointestinal polyps
IHC Chromogranin A +ve (increased scattered Chromogranin A-positive cells in relation to normal mucosa)
Gross usually rectum or sigmoid, typically < 5mm
Site cecum, colon, rectum
Syndromes serrated polyposis syndrome
Symptoms asymptomatic
Prevalence very common
Endoscopy pedunculated or sessile
Prognosis good
Clin. DDx normal colon, sessile serrated adenoma
Hyperplastic polyp
External resources
EHVSC 10190
The stomach lesion is dealt with in hyperplastic polyp of the stomach.

The hyperplastic polyp of the colon and rectum is a very common. It is commonly abbreviated HP.

General

Gross

Features:[3]

  • Flat lesion, usually <= 5mm.
  • Typically in the distal large bowel (rectum, sigmoid colon).

Microscopic

Features:[1]

  • 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 darker staining deep... lighter staining luminal.
    • In the colon goblet cells should be present (as is usual).
  • Inflammation -- cryptitis or even crypt abscesses -- is considered to arise due to trauma.[citation needed]
    • It is usually not reported.

DDx:

Images

  • HP - low mag. (WC)

  • HP - intermed. mag. (WC)

  • HP - intermed. mag. (WC)

  • HP - high mag. (WC)

www:

Subclassification

  • Usually not subclassified as there is no demonstrated prognostic significance;[2] the subtyping is an academic exercise.

HPs may be subclassified into two groups:[2]

  1. Microvesicular serrated polyps (MVSPs).
  2. Goblet cell serrated polyps (GCSPs).

Features of the HP subtypes:[2]

Subtype Histology Mutations Clinical relevance
Microvesicular microvesicles at the surface, serration
at the surface to the mid portion of glands 		BRAF V600E, CIMP possible sessile serrated adenoma precursor
Goblet cell superficial goblet cells, serration at
the surface 		KRAS unknown; probably benign

Notes:

  • CIMP = CpG island methylation phenotype.

IHC

Sign out

POLYP, RECTUM, POLYPECTOMY: 
- HYPERPLASTIC POLYP.

POLYP, SIGMOID COLON, POLYPECTOMY: 
- HYPERPLASTIC POLYP.

POLYP, DESCENDING COLON, POLYPECTOMY:
- HYPERPLASTIC POLYP.

POLYP, TRANSVERSE COLON, POLYPECTOMY:
- HYPERPLASTIC POLYP.

COLONIC POLYP, 35 CM, POLYPECTOMY: 
- HYPERPLASTIC POLYP.

POLYP, LARGE BOWEL AT 10 CM, EXCISION: 
- HYPERPLASTIC POLYP.

Numerous hyperplastic polyps

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.

Superficial changes only

TRANSVERSE COLON (POLYP), BIOPSY:
- COLORECTAL-TYPE MUCOSA WITH SURFACE HYPERPLASTIC CHANGE.
- NEGATIVE FOR DYSPLASIA.

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

References

  1. ↑ 1.0 1.1 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 858. ISBN 0-7216-0187-1.
  2. ↑ 2.0 2.1 2.2 2.3 Huang, CS.; Farraye, FA.; Yang, S.; O'Brien, MJ. (Feb 2011). "The clinical significance of serrated polyps.". Am J Gastroenterol 106 (2): 229-40; quiz 241. doi:10.1038/ajg.2010.429. PMID 21045813.
  3. ↑ Rex, DK.; Ahnen, DJ.; Baron, JA.; Batts, KP.; Burke, CA.; Burt, RW.; Goldblum, JR.; Guillem, JG. et al. (Sep 2012). "Serrated lesions of the colorectum: review and recommendations from an expert panel.". Am J Gastroenterol 107 (9): 1315-29; quiz 1314, 1330. doi:10.1038/ajg.2012.161. PMID 22710576.
  4. ↑ Nakasono, M.; Hirokawa, M.; Muguruma, N.; Okahisa, T.; Okamura, S.; Ito, S.; Miyamoto, H.; Wada, S. et al. (Jan 2004). "Colorectal xanthomas with polypoid lesion: report of 25 cases.". APMIS 112 (1): 3-10. PMID 14961968.

External links

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