Hyperplastic polyp

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, gastrointestinal polyps
Gross	usually rectum or sigmoid, typically < 5mm
Site	cecum, colon, rectum
Syndromes	hyperplastic polyposis syndrome
Symptoms	asymptomatic
Prevalence	very common
Endoscopy	pedunculated or sessile
Prognosis	good
Clin. DDx	normal colon, sessile serrated adenoma

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

• Most common type of polyp:
  • Approximately 90% of all colonic polyps.
• May be part of hyperplastic polyposis syndrome.

Gross

Features:

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

Microscopic

Features:

• 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:

• Sessile serrated adenoma.
• Normal colon.

Images

• 

  HP - high mag. (WC/Nephron)

• 

  HP - lower mag. (WC/Nephron)

• 

  HP (WC/Patho)

www:

• Microvesicular HP (flickr.com/jhetzel).
• HP of colon (flickr.com/jian-hua_qiao_md).

Subclassification

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

HPs may be subclassified into two groups:

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

Features of the HP subtypes:

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.

Sign out

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

COLONIC POLYP, SIGMOID COLON, BIOPSY: 
- HYPERPLASTIC POLYP.

POLYP, RECTUM, BIOPSY: 
- HYPERPLASTIC POLYP.

Numerous hyperplastic polyps

COLONIC POLYP(S), BIOPSY: 
- 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.

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.

See also

• Gastrointestinal tract polyps.
• Gastrointestinal pathology.