Difference between revisions of "Sessile serrated adenoma"

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 '''Sessile serrated adenoma''', abbreviated ''SSA'', is a premalignant [[GI polyps|polyp]] of the large bowel.
-It is also known as '''sessile serrated polyp''' (abbreviated ''SSP''), '''sessile serrated lesion''' and '''sessile serrated adenoma/polyp''' (abbreviated ''SSA/P'').
+It is also known as '''sessile serrated polyp''' (abbreviated ''SSP''), '''sessile serrated lesion''' and '''sessile serrated adenoma/polyp''' (abbreviated ''SSA/P''). In the United Kingdom, this entity and is known as a sessile serrated lesion, a terminology that is likely to be adopted in the 2019/5th edition WHO Blue Book.
 This lesion should not be confused with the ''[[traditional serrated adenoma]]'', previously known as ''[[serrated adenoma]]''.
 ==General==
 *Colonic lesion.
@@ Line 66: / Line 67: @@
 *Horizontal crypts = crypt long axis parallel to the muscularis mucosae.
 *Crypt branching.
+*Submucosal [[lipoma]] or pseudolipoma is often seen in associated with SSA.{{fact}}
+*Perineuriomas are also seen in a small proportion of cases
 Minimal extent criteria - number of abnormal crypts with the above features:
 *''German Society of Pathology'' proposal: at least two abnormal crypts -- crypts do not have to be adjacent.<ref name=pmid23052370>{{Cite journal  | last1 = Ensari | first1 = A. | last2 = Bilezikçi | first2 = B. | last3 = Carneiro | first3 = F. | last4 = Doğusoy | first4 = GB. | last5 = Driessen | first5 = A. | last6 = Dursun | first6 = A. | last7 = Flejou | first7 = JF. | last8 = Geboes | first8 = K. | last9 = de Hertogh | first9 = G. | title = Serrated polyps of the colon: how reproducible is their classification? | journal = Virchows Arch | volume = 461 | issue = 5 | pages = 495-504 | month = Nov | year = 2012 | doi = 10.1007/s00428-012-1319-7 | PMID = 23052370 }}</ref><ref name=pmid20617338>{{Cite journal  | last1 = Aust | first1 = DE. | last2 = Baretton | first2 = GB. | title = Serrated polyps of the colon and rectum (hyperplastic polyps, sessile serrated adenomas, traditional serrated adenomas, and mixed polyps)-proposal for diagnostic criteria. | journal = Virchows Arch | volume = 457 | issue = 3 | pages = 291-7 | month = Sep | year = 2010 | doi = 10.1007/s00428-010-0945-1 | PMID = 20617338 }}</ref>
 *An expert panel lead by ''Rex'' states that one unequivocally altered crypt should prompt calling SSA.<ref name=pmid22710576>{{Cite journal  | last1 = Rex | first1 = DK. | last2 = Ahnen | first2 = DJ. | last3 = Baron | first3 = JA. | last4 = Batts | first4 = KP. | last5 = Burke | first5 = CA. | last6 = Burt | first6 = RW. | last7 = Goldblum | first7 = JR. | last8 = Guillem | first8 = JG. | last9 = Kahi | first9 = CJ. | title = Serrated lesions of the colorectum: review and recommendations from an expert panel. | journal = Am J Gastroenterol | volume = 107 | issue = 9 | pages = 1315-29; quiz 1314, 1330 | month = Sep | year = 2012 | doi = 10.1038/ajg.2012.161 | PMID = 22710576 }}</ref>
-*The WHO requires - depending on what you read:
+*The 4th edition of the WHO blue book requires - depending on what you read:
 **Three adjacent crypts to be abnormal.<ref>URL: [http://surgpathcriteria.stanford.edu/gitumors/sessile-serrated-polyp-adenoma/ http://surgpathcriteria.stanford.edu/gitumors/sessile-serrated-polyp-adenoma/]. Accessed on: 26 September 2012.</ref>
 **Two or three adjacent crypts to be abnormal.<ref name=pmid23052370/>
+**The 5th edition is likely to make a single crypt sufficient for diagnosis.
-Notes:
+===Dysplasia===
-*Typically do not have nuclear atypia, i.e. no nuclear crowding, no nuclear hyperchromasia, no cigar-shaped nuclei.
+Sessile serrated adenomas typically lack "conventional" nuclear atypia, as seen in adenomata in the tubulovillous spectrum. They are nonetheless neoplastic lesions on account of architectural "dysplasia". Additionally, dysplasia may manifest in more than one way:
-**SSAs with nuclear atypia may be referred to as ''advanced sessile serrated adenomas''.
+;Intestinal or "cytological" dysplasia: As seen in conventional adenomata, i.e. nuclear hyperchromasia and crowding. SSAs with nuclear atypia may be referred to as ''advanced sessile serrated adenomas''
-*Submucosal [[lipoma]] or pseudolipoma is often seen in associated with SSA.{{fact}}
+;Serrated dysplasia: Round nuclei, prominent nucleoli and eosinophilic cytoplasm
+;Minimal deviation dysplasia: As the name suggests, there is only minor architectural and cytological changes. These areas are associated with loss of MLH1 immunostaining.<ref name=pmid28752838>{{Cite journal  | last1 = Liu | first1 = C. | last2 = Walker | first2 = NI. | last3 = Leggett | first3 = BA. | last4 = Whitehall | first4 = VL. | last5 = Bettington | first5 = ML. | last6 = Rosty | first6 = C. | title = Sessile serrated adenomas with dysplasia: morphological patterns and correlations with MLH1 immunohistochemistry. | journal = Mod Pathol | volume = 30 | issue = 12 | pages = 1728-1738 | month = 12 | year = 2017 | doi = 10.1038/modpathol.2017.92 | PMID = 28752838 }}</ref>
 ===DDx===
@@ Line 95: / Line 101: @@
 ==IHC==
-*[[Chromogranin A]] -ve; complete loss of staining.
+*[[Chromogranin A]] -ve; complete loss of staining.<ref>Vitkovski T, Jawale R, Goldblum J ''et al.'' Density of neuroendocrine cells can distinguish hyperplastic polyps from small sessile serrated polyps. Modern Pathology (USCAP Annual Meeting 2018, Abstract Number 865), URL: [https://www.nature.com/articles/modpathol20189.pdf https://www.nature.com/articles/modpathol20189.pdf]. Accessed on: 10 May 2018.</ref>
 **Normal colorectal mucosa has scattered Chromogranin A-positive cells.
 **[[Hyperplastic polyp]] has increased scattered Chromogranin A-positive cells.
 ==Sign out==
+<pre>
+Polyp, Hepatic Flexure of Colon, Polypectomy or Biopsy:
+	- Sessile serrated adenoma, NEGATIVE for conventional adenomatous dysplasia.
+</pre>
+====Block letters====
 <pre>
 POLYP, CECUM, POLYPECTOMY:
@@ Line 121: / Line 132: @@
 <pre>
 Polyp, Ascending Colon, Polypectomy or Biopsy:
-      - Sessile serrated adenoma with dysplasia, see comment.
+      - Sessile serrated adenoma with low-grade dysplasia, see comment.
 Comment:

Difference between revisions of "Sessile serrated adenoma"

Sessile serrated adenoma (view source)

Revision as of 17:47, 5 April 2022

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