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[[Image:Polyp-2.jpeg|thumb|right|Endoscopic image of a gastrointestinal polyp.]] | |||
'''Gastrointestinal tract polyps''', also '''gastrointestinal polyps''' or '''GI polyps''', are the bread & butter of a GI pathologists workload. Some of 'em are benign... some pre-malignant... some malignant... some weird. Most GI polyps are from the intestine, i.e. intestinal polyps. | '''Gastrointestinal tract polyps''', also '''gastrointestinal polyps''' or '''GI polyps''', are the bread & butter of a GI pathologists workload. Some of 'em are benign... some pre-malignant... some malignant... some weird. Most GI polyps are from the intestine, i.e. intestinal polyps. | ||
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{{familytree | D | | | | E | | | | F | | G |D=Nuclear changes|E=No nuc. change|F=Serrated|G=Not serrated}} | {{familytree | D | | | | E | | | | F | | G |D=Nuclear changes|E=No nuc. change|F=Serrated|G=Not serrated}} | ||
{{familytree | |!| | | |,|-|^|-|.| | | |!| | | |!| |}} | {{familytree | |!| | | |,|-|^|-|.| | | |!| | | |!| |}} | ||
{{familytree | H | | I | | J | | K | | L |H=Polypoid adenoma<br>(below)|I=Serrated|J=Not serrated|K=[[sessile serrated adenoma|SSA]] | {{familytree | H | | I | | J | | K | | L |H=Polypoid adenoma<br>(below)|I=Serrated|J=Not serrated|K=[[sessile serrated adenoma|SSA]] versus HP|L=Normal versus VA}} | ||
{{familytree | | | | | |!| | | |!| | | | | | | | | |}} | {{familytree | | | | | |!| | | |!| | | | | | | | | |}} | ||
{{familytree | | | | | M | | N | | | | | | | | |M=[[Hyperplastic polyp|HP]]|N=See misc.<br>polyps (below)}} | {{familytree | | | | | M | | N | | | | | | | | |M=[[Hyperplastic polyp|HP]]|N=See misc.<br>polyps (below)}} | ||
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| common / benign | | common / benign | ||
| moderate inflammation is normal | | moderate inflammation is normal | ||
| [[colonic spirochetes]], [[cryptosporidiosis]], [[microscopic colitis]], [[CMV colitis]] | | missed lesion, [[colonic spirochetes]], [[cryptosporidiosis]], [[microscopic colitis]], [[CMV colitis]] | ||
| [[Image:Rectum - intermed mag.jpg|thumb|center|150px| Normal rectum (WC)]] | | [[Image:Rectum - intermed mag.jpg|thumb|center|150px| Normal rectum (WC)]] | ||
|- | |- | ||
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===Sign out=== | ===Sign out=== | ||
====Normal==== | ====Normal==== | ||
<pre> | |||
Cecum, Biopsy: | |||
- Colorectal-type mucosa within normal limits. | |||
</pre> | |||
<pre> | |||
Right Colon, Biopsy: | |||
- Colonic mucosa within normal limits. | |||
</pre> | |||
<pre> | |||
Transverse Colon, Biopsy: | |||
- Colonic mucosa within normal limits. | |||
</pre> | |||
<pre> | |||
Left Colon, Biopsy: | |||
- Colonic mucosa within normal limits. | |||
</pre> | |||
<pre> | |||
Rectum, Biopsy: | |||
- Colorectal mucosa within normal limits. | |||
</pre> | |||
=====Block letters===== | |||
<pre> | <pre> | ||
SIGMOID COLON, BIOPSY: | SIGMOID COLON, BIOPSY: | ||
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COMMENT: | COMMENT: | ||
The clinical history is noted. This biopsy does not show neoplastic tissue; however, the | The clinical history is noted. This biopsy does not show neoplastic tissue; | ||
biopsy may not be representative of the lesion seen. | however, the biopsy may not be representative of the lesion seen. | ||
Levels were cut and these did not yield additional information. There are no changes to | Levels were cut and these did not yield additional information. There are | ||
suggest a chronic colitis. | no changes to suggest a chronic colitis. | ||
Correlation with imaging may be useful. A re-biopsy is suggested. | Correlation with imaging may be useful. A re-biopsy is suggested. | ||
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==Pseudoinvasion in colorectal adenomatous polyps== | ==Pseudoinvasion in colorectal adenomatous polyps== | ||
*[[AKA]] ''pseudoinvasion''. | *[[AKA]] ''pseudoinvasion''. | ||
*[[AKA]] ''epithelial misplacement''. | |||
* | {{Main|Pseudoinvasion in colorectal adenomatous polyps}} | ||
==High-risk features in (colorectal) adenomatous polyps with carcinoma== | ==High-risk features in (colorectal) adenomatous polyps with carcinoma== | ||
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#[[Lymphovascular invasion]]. | #[[Lymphovascular invasion]]. | ||
#High-grade [[tumour budding]]. | #High-grade [[tumour budding]]. | ||
#*Tumour bud = 1-4 cell(s); "high-grade budding" is >=10 tumour buds in a field of 0.385 mm<sup>2</sup>.<ref name=pmid11952856>{{Cite journal | last1 = Ueno | first1 = H. | last2 = Murphy | first2 = J. | last3 = Jass | first3 = JR. | last4 = Mochizuki | first4 = H. | last5 = Talbot | first5 = IC. | title = Tumour 'budding' as an index to estimate the potential of aggressiveness in rectal cancer. | journal = Histopathology | volume = 40 | issue = 2 | pages = 127-32 | month = Feb | year = 2002 | doi = | PMID = 11952856 }}</ref> | #*Tumour bud = 1-4 cell(s); "high-grade budding" is >=10 tumour buds in a field of 0.385 mm<sup>2</sup>.<ref name=pmid11952856>{{Cite journal | last1 = Ueno | first1 = H. | last2 = Murphy | first2 = J. | last3 = Jass | first3 = JR. | last4 = Mochizuki | first4 = H. | last5 = Talbot | first5 = IC. | title = Tumour 'budding' as an index to estimate the potential of aggressiveness in rectal cancer. | journal = Histopathology | volume = 40 | issue = 2 | pages = 127-32 | month = Feb | year = 2002 | doi = | PMID = 11952856 }}</ref>‡ | ||
#**If the microscope has a 22 mm eye piece and... | #**If the microscope has a 22 mm eye piece and... | ||
#***A 20x objective, the field is approximately 0.950 mm<sup>2</sup> -- to match the buds/area -- it would be 24.68 buds/0.950 mm<sup>2</sup>. | #***A 20x objective, the field is approximately 0.950 mm<sup>2</sup> -- to match the buds/area -- it would be 24.68 buds/0.950 mm<sup>2</sup>. | ||
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If none of the above factors is present the risk of [[lymph node]] metastasis is < 1%. The presence of one risk factor increases the risk to ~20%. If multiple risk factors are present the chance of [[lymph node metastases]] is greater than 35%.<ref name=pmid15300569/> | If none of the above factors is present the risk of [[lymph node]] metastasis is < 1%. The presence of one risk factor increases the risk to ~20%. If multiple risk factors are present the chance of [[lymph node metastases]] is greater than 35%.<ref name=pmid15300569/> | ||
Note: | |||
*‡Tumour budding as per international consensus is now assessed in field area of 0.785 mm<sup>2</sup>.<ref name=pmid28548122>{{Cite journal | last1 = Lugli | first1 = A. | last2 = Kirsch | first2 = R. | last3 = Ajioka | first3 = Y. | last4 = Bosman | first4 = F. | last5 = Cathomas | first5 = G. | last6 = Dawson | first6 = H. | last7 = El Zimaity | first7 = H. | last8 = Fléjou | first8 = JF. | last9 = Hansen | first9 = TP. | title = Recommendations for reporting tumor budding in colorectal cancer based on the International Tumor Budding Consensus Conference (ITBCC) 2016. | journal = Mod Pathol | volume = 30 | issue = 9 | pages = 1299-1311 | month = Sep | year = 2017 | doi = 10.1038/modpathol.2017.46 | PMID = 28548122 }}</ref> | |||
==Traditional adenoma== | ==Traditional adenoma== | ||
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==Cronkhite-Canada syndrome== | ==Cronkhite-Canada syndrome== | ||
*Abbreviated ''CCS''. | *Abbreviated ''CCS''. | ||
{{Main|Cronkhite-Canada syndrome}} | |||
==Ganglioneuroma== | ==Ganglioneuroma== | ||
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*Ganglion cells - '''key feature'''. | *Ganglion cells - '''key feature'''. | ||
**Large cells with a round nucleus and a prominent nucleolus. | **Large cells with a round nucleus and a prominent nucleolus. | ||
DDx: | |||
*[[Hyperplastic polyp with perineuromatous stroma]]. | |||
====Images==== | ====Images==== | ||
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Image:Ganglioneuroma_-_very_high_mag.jpg | Ganglioneuroma - very high mag. (WC/Nephron) | Image:Ganglioneuroma_-_very_high_mag.jpg | Ganglioneuroma - very high mag. (WC/Nephron) | ||
</gallery> | </gallery> | ||
==Inflammatory myoglandular polyp== | ==Inflammatory myoglandular polyp== | ||
===General=== | ===General=== | ||
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*Polypoid prolaping mucosal fold in [[diverticular disease]]. | *Polypoid prolaping mucosal fold in [[diverticular disease]]. | ||
*[[Inflammatory cloacogenic polyp]]. | *[[Inflammatory cloacogenic polyp]]. | ||
*Inflammatory cap polyp. | *[[Inflammatory cap polyp]]. | ||
Image: | Image: | ||
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{{Main|Leiomyoma}} | {{Main|Leiomyoma}} | ||
*May present as a polyp in the colon.<ref name=pmid21915840>{{Cite journal | last1 = Kemp | first1 = CD. | last2 = Arnold | first2 = CA. | last3 = Torbenson | first3 = MS. | last4 = Stein | first4 = EM. | title = An unusual polyp: a pedunculated leiomyoma of the sigmoid colon. | journal = Endoscopy | volume = 43 Suppl 2 UCTN | issue = | pages = E306-7 | month = | year = 2011 | doi = 10.1055/s-0030-1256640 | PMID = 21915840 }}</ref> | *May present as a polyp in the colon.<ref name=pmid21915840>{{Cite journal | last1 = Kemp | first1 = CD. | last2 = Arnold | first2 = CA. | last3 = Torbenson | first3 = MS. | last4 = Stein | first4 = EM. | title = An unusual polyp: a pedunculated leiomyoma of the sigmoid colon. | journal = Endoscopy | volume = 43 Suppl 2 UCTN | issue = | pages = E306-7 | month = | year = 2011 | doi = 10.1055/s-0030-1256640 | PMID = 21915840 }}</ref> | ||
==Colonic polyp with reactive subepithelial cells== | |||
===Microscopic=== | |||
Features: | |||
*Surface epithelium with a reduced quantity of cytoplasm and less goblets (regenerative appearance). | |||
*Mildly atypical subepithelial cells with pale moderate-to-abundant cytoplasm and nuclear enlargement +/-nuclear hyperchromasia. | |||
===Sign out=== | |||
<pre> | |||
POLYP, ASCENDING COLON, POLYPECTOMY: | |||
- POLYPOID FRAGMENT OF COLONIC-TYPE MUCOSA WITH REACTIVE SUBEPITHELIAL | |||
CELLS, SEE COMMENT. | |||
- NEGATIVE FOR DYSPLASIA. | |||
COMMENT: | |||
A pankeratin and CK7 immunostains are non-concerning. A CD68 immunostain | |||
highlights lamina propria macrophages. | |||
</pre> | |||
=See also= | =See also= | ||
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*[[Small bowel]]. | *[[Small bowel]]. | ||
*[[Colon]]. | *[[Colon]]. | ||
*[[Polypectomy]]. | |||
=References= | =References= |
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