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Difference between revisions of "Gastrointestinal tract polyps"
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Gastrointestinal tract polyps (view source)
Revision as of 08:29, 3 February 2011
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Mnemonic: ''HHI-A''. | Mnemonic: ''HHI-A''. | ||
=Basic approach= | |||
# Sessile (flat) or polypoid (spherical, possibly has a stalk)? | # Sessile (flat) or polypoid (spherical, possibly has a stalk)? | ||
# Nuclear features of adenoma & loss of goblets (hyperchromatic nuclei, nuclei round vs. flat, loss of nuclear stratification)? | # Nuclear features of adenoma & loss of goblets (hyperchromatic nuclei, nuclei round vs. flat, loss of nuclear stratification)? | ||
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# Serrated architecture? | # Serrated architecture? | ||
= | =A set of decision trees for GI polyps= | ||
'''Decision tree - GI polyps''' | '''Decision tree - GI polyps''' | ||
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*Peutz-Jeghers polyp (PJP) - frond-like with all mucosa components . | *Peutz-Jeghers polyp (PJP) - frond-like with all mucosa components . | ||
=Tabular comparison of colonic polyps= | |||
Adenomatous polyps & hyperplastic polyps - a comparison (adapted from Li and Burgart<ref>{{cite journal |author=Li SC, Burgart L |title=Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps |journal=Arch. Pathol. Lab. Med. |volume=131 |issue=3 |pages=440-5 |year=2007 |month=March |pmid=17516746 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=131&page=440}}</ref>): | Adenomatous polyps & hyperplastic polyps - a comparison (adapted from Li and Burgart<ref>{{cite journal |author=Li SC, Burgart L |title=Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps |journal=Arch. Pathol. Lab. Med. |volume=131 |issue=3 |pages=440-5 |year=2007 |month=March |pmid=17516746 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=131&page=440}}</ref>): | ||
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Notes: ''Left colon'' refers to the sigmoid colon, descending colon and the distal half of the transverse colon; ''right colon'' refers to the cecum, ascending colon and proximal half of the transverse colon. | Notes: ''Left colon'' refers to the sigmoid colon, descending colon and the distal half of the transverse colon; ''right colon'' refers to the cecum, ascending colon and proximal half of the transverse colon. | ||
=Hyperplastic polyp= | |||
===General=== | ===General=== | ||
*Most common colonic polyp (90% of all colonic polyps<ref name=Ref_PBoD858/>). | *Most common colonic polyp (90% of all colonic polyps<ref name=Ref_PBoD858/>). | ||
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*[http://commons.wikimedia.org/wiki/File:Hyperplastic_polyp2.jpg HP - lower mag. (WC)]. | *[http://commons.wikimedia.org/wiki/File:Hyperplastic_polyp2.jpg HP - lower mag. (WC)]. | ||
=Adenomatous polys= | |||
Several types of adenomatous polyps are recognized. | Several types of adenomatous polyps are recognized. | ||
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They are all considered pre-malignant, i.e. if you leave 'em in place they often develop into cancer. | They are all considered pre-malignant, i.e. if you leave 'em in place they often develop into cancer. | ||
==Management of (intestinal) polyps== | |||
Follow-up interval for polyps (colonoscopy interval):<ref name=pmid17167138>{{cite journal |author=Levine JS, Ahnen DJ |title=Clinical practice. Adenomatous polyps of the colon |journal=N. Engl. J. Med. |volume=355 |issue=24 |pages=2551–7 |year=2006 |month=December |pmid=17167138 |doi=10.1056/NEJMcp063038 |url=http://content.nejm.org/cgi/reprint/355/24/2551.pdf}}</ref> | Follow-up interval for polyps (colonoscopy interval):<ref name=pmid17167138>{{cite journal |author=Levine JS, Ahnen DJ |title=Clinical practice. Adenomatous polyps of the colon |journal=N. Engl. J. Med. |volume=355 |issue=24 |pages=2551–7 |year=2006 |month=December |pmid=17167138 |doi=10.1056/NEJMcp063038 |url=http://content.nejm.org/cgi/reprint/355/24/2551.pdf}}</ref> | ||
*Normal follow-up (includes presence of ''hyperplastic polyps''): ~10 years. | *Normal follow-up (includes presence of ''hyperplastic polyps''): ~10 years. | ||
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Mnemonic: ''GAS'' = grade (high), architecture (tubulovillous, villous), size (>1 cm). | Mnemonic: ''GAS'' = grade (high), architecture (tubulovillous, villous), size (>1 cm). | ||
==Traditional adenoma== | |||
===Microscopic=== | |||
#Nuclear changes at the surface (of the mucosa) - '''key feature'''. | #Nuclear changes at the surface (of the mucosa) - '''key feature'''. | ||
#*Cigar-shaped (elongated) nucleus (usu. length:width > 3:1) - '''key feature'''. | #*Cigar-shaped (elongated) nucleus (usu. length:width > 3:1) - '''key feature'''. | ||
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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). | ||
===Typing=== | |||
Subclassified as:<ref name=pbod860>{{Ref PBoD|860}}</ref> | Subclassified as:<ref name=pbod860>{{Ref PBoD|860}}</ref> | ||
*Tubular (most common), tubular component >75%. | *Tubular (most common), tubular component >75%. | ||
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**Health Organization (WHO) criteria: villous adenomas >80% villous architecture. | **Health Organization (WHO) criteria: villous adenomas >80% villous architecture. | ||
===Grading=== | |||
Most institutions grade adenomas into:<ref>[http://www.pathologyoutlines.com/colontumor.html#adenoma http://www.pathologyoutlines.com/colontumor.html#adenoma]</ref> | Most institutions grade adenomas into:<ref>[http://www.pathologyoutlines.com/colontumor.html#adenoma http://www.pathologyoutlines.com/colontumor.html#adenoma]</ref> | ||
*Low grade. | *Low grade. | ||
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*[http://commons.wikimedia.org/wiki/File:Tubular_adenoma_high_mag.jpg Tubular adenoma negative for high grade dysplasia - high mag.] - wikimedia.org. | *[http://commons.wikimedia.org/wiki/File:Tubular_adenoma_high_mag.jpg Tubular adenoma negative for high grade dysplasia - high mag.] - wikimedia.org. | ||
===Margins=== | |||
*Some pathologists believe it is impossible to determine margins in polypectomies. | *Some pathologists believe it is impossible to determine margins in polypectomies. | ||
*Others comment on what they see and then disclaim based on limitations with something like "... margin clear in plane of section." | *Others comment on what they see and then disclaim based on limitations with something like "... margin clear in plane of section." | ||
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*Dr. Haggitt is know for his tragic demise. He was shot by a resident that was about to be fired.<ref>Two die in UW medical school shooting. seattlepi.com. URL: [http://www.seattlepi.com/local/pathweb.shtml http://www.seattlepi.com/local/pathweb.shtml]. Accessed on: April 23, 2009.</ref> | *Dr. Haggitt is know for his tragic demise. He was shot by a resident that was about to be fired.<ref>Two die in UW medical school shooting. seattlepi.com. URL: [http://www.seattlepi.com/local/pathweb.shtml http://www.seattlepi.com/local/pathweb.shtml]. Accessed on: April 23, 2009.</ref> | ||
==Traditional serrated adenoma== | |||
===General=== | |||
*Very rare. | *Very rare. | ||
===Microscopic=== | |||
Features: | Features: | ||
*Serrated. | *Serrated. | ||
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*[http://commons.wikimedia.org/wiki/File:Traditional_serrated_adenoma_very_high_mag.jpg TSA - very high mag. (WC)]. | *[http://commons.wikimedia.org/wiki/File:Traditional_serrated_adenoma_very_high_mag.jpg TSA - very high mag. (WC)]. | ||
==Sessile serrated adenoma== | |||
*Often abbreviated ''SSA''. | *Often abbreviated ''SSA''. | ||
*[[AKA]] sessile serrated polyp. | *[[AKA]] sessile serrated polyp. | ||
===General=== | |||
*Colonic lesion. | *Colonic lesion. | ||
*More common in the right colon, i.e. ascending colon. | *More common in the right colon, i.e. ascending colon. | ||
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*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. | ||
===Microscopic=== | |||
Features: | Features: | ||
*Serrated. | *Serrated. | ||
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*[http://commons.wikimedia.org/wiki/File:Sessile_serrated_adenoma3.jpg SSA - high mag. (WC)]. | *[http://commons.wikimedia.org/wiki/File:Sessile_serrated_adenoma3.jpg SSA - high mag. (WC)]. | ||
=Hamartomatous polyps (overview)= | |||
Numerous types of hamartomatous polyps exist: | Numerous types of hamartomatous polyps exist: | ||
*Peutz-Jeghers syndrome. | *Peutz-Jeghers syndrome. | ||
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*Polyps have same morphology as juvenile polyp/retension polyp. | *Polyps have same morphology as juvenile polyp/retension polyp. | ||
=See also= | |||
*[[Gastrointestinal pathology]]. | *[[Gastrointestinal pathology]]. | ||
*[[Stomach]]. | *[[Stomach]]. | ||
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*[[Colon]]. | *[[Colon]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gastrointestinal pathology]] | [[Category:Gastrointestinal pathology]] | ||