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Difference between revisions of "Gastrointestinal tract polyps"
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Gastrointestinal tract polyps (view source)
Revision as of 02:17, 10 August 2012
, 02:17, 10 August 2012nl update
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=Hyperplastic polyp= | =Hyperplastic polyp= | ||
:''The [[stomach]] lesion is dealt with in [[hyperplastic polyp of the stomach]]''. | |||
===General=== | ===General=== | ||
*Most common type of polyp: | *Most common type of polyp: | ||
| Line 346: | Line 347: | ||
==Traditional adenoma== | ==Traditional adenoma== | ||
:''Includes '''tubular adenoma''', '''tubulovillous adenoma''', and '''villous adenoma'''.'' | |||
===General=== | ===General=== | ||
*Most common group of ''adenomas'' in GI tract | *Most common group of ''adenomas'' in GI tract. | ||
===Microscopic=== | ===Microscopic=== | ||
#Nuclear changes at the surface (of the mucosa) - '''key feature'''. | #Nuclear changes at the surface (of the mucosa) - '''key feature'''. | ||
| Line 396: | Line 398: | ||
===Grading=== | ===Grading=== | ||
Adenomas are usually graded adenomas with a two-tier system: | |||
{| class="wikitable sortable" | |||
!Feature | |||
!Low grade dysplasia (LGD) | |||
!High grade dysplasia (HGD) | |||
!Importance | |||
|- | |||
|Architecture | |||
|tubular, minimal focal gland fusion acceptable | |||
|any of the following: (gland) cribriforming, glandular budding, intraluminal papillary tufting, sheeting (of epithelium), lamina propria invasion † | |||
|'''key feature''' | |||
|- | |||
|Cytology | |||
|usu. no features of HGD | |||
|any of the following: loss of nuclear stratification, enlarged nuclei, loss of cell polarity, prominent nucleoli, open (clear) chromatin | |||
|supportive feature, not sufficient alone for HGD | |||
|} | |||
Low power colour can be suggestive of HGD: | |||
{| class="wikitable sortable" | |||
!Feature | |||
!Low grade | |||
!High grade | |||
|- | |||
| Colour | |||
| light blue | |||
| dark blue | |||
|} | |||
Note: | Note: | ||
*In the colon, unlike other areas of the GI tract, invasive carcinoma is defined by neoplastic cells through the muscularis mucosae. In all other places, e.g. small bowel, invasive carcinoma is defined by neoplastic cells through the basement membrane. | *† In the colon, unlike other areas of the GI tract, invasive carcinoma is defined by neoplastic cells through the muscularis mucosae. In all other places, e.g. small bowel, invasive carcinoma is defined by neoplastic cells through the basement membrane. | ||
Image: | Image: | ||
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DDx: | DDx: | ||
*Villous adenoma. | *[[Villous adenoma]]. | ||
Images: | Images: | ||
| Line 449: | Line 472: | ||
==Sessile serrated adenoma== | ==Sessile serrated adenoma== | ||
*Often abbreviated ''SSA''. | *Often abbreviated ''SSA''. | ||
*[[AKA]] sessile serrated polyp. | *[[AKA]] ''sessile serrated polyp'', abbreviated ''SSP''. | ||
*[[AKA]] ''sessile serrated lesion''. | |||
===General=== | ===General=== | ||
*Colonic lesion. | *Colonic lesion. | ||
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Epidemiology: | Epidemiology: | ||
*Thought to lead to colorectal cancer through a different pathway that most tumours in the left colon/rectum. | *Thought to lead to colorectal cancer through a different pathway that most tumours in the left colon/rectum. | ||
*''Microvesicular [[hyperplastic polyp]]s'' are hypothesized to be the the precursor of SSAs.<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> | |||
===Microscopic=== | ===Microscopic=== | ||
| Line 487: | Line 512: | ||
Notes: | Notes: | ||
*BRBS is due to a PTEN mutation | *BRBS is due to a PTEN mutation<ref name=omim153480>{{OMIM|153480}}</ref> (the same gene associated with Cowden's disease). | ||
*DPS is reported in only one family that lives in Devon, UK.<ref name=pmid1644320>{{Cite journal | last1 = Allibone | first1 = RO. | last2 = Nanson | first2 = JK. | last3 = Anthony | first3 = PP. | title = Multiple and recurrent inflammatory fibroid polyps in a Devon family ('Devon polyposis syndrome'): an update. | journal = Gut | volume = 33 | issue = 7 | pages = 1004-5 | month = Jul | year = 1992 | doi = | PMID = 1644320 }}</ref> | *DPS is reported in only one family that lives in Devon, UK.<ref name=pmid1644320>{{Cite journal | last1 = Allibone | first1 = RO. | last2 = Nanson | first2 = JK. | last3 = Anthony | first3 = PP. | title = Multiple and recurrent inflammatory fibroid polyps in a Devon family ('Devon polyposis syndrome'): an update. | journal = Gut | volume = 33 | issue = 7 | pages = 1004-5 | month = Jul | year = 1992 | doi = | PMID = 1644320 }}</ref> | ||