Difference between revisions of "Gastrointestinal tract polyps"

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Gastrointestinal tract polyps (view source)

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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]] vs. HP|L=Normal vs. VA}}
{{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]]
| [http://www.pathology.med.ohio-state.edu/paxit/deptbase/Paxit/Images/10534/PAXIT032.JPG Normal - low mag. (ohio-state.edu)]
| [[Image:Rectum - intermed mag.jpg|thumb|center|150px| Normal rectum (WC)]]
|-
|-
| [[Hyperplastic polyp]]
| [[Hyperplastic polyp]]
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| may be syndromic, e.g. [[hyperplastic polyposis syndrome]]
| may be syndromic, e.g. [[hyperplastic polyposis syndrome]]
| [[sessile serrated adenoma]]
| [[sessile serrated adenoma]]
| [[Image:Hyperplastic_polyp2.jpg|thumb|center|150px| HP (WC)]]
| [[Image:Hyperplastic polyp -- intermed mag.jpg |thumb|center|150px| HP (WC)]]
|-
|-
| [[Traditional adenoma]]
| [[Traditional adenoma]]
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| only seen in [[IBD]]; Dx implies IBD
| only seen in [[IBD]]; Dx implies IBD
| juvenile polyp
| juvenile polyp
| Image
| [[Image:Inflammatory polyp -- low mag.jpg|thumb|center|120px|IP (WC)]]
|-
|-
| [[Peutz-Jeghers polyp]] (PJP)
| [[Peutz-Jeghers polyp]] (PJP)
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| PJP not pre-malignant lesion in itself; see ''[[Peutz-Jeghers syndrome]]''
| PJP not pre-malignant lesion in itself; see ''[[Peutz-Jeghers syndrome]]''
| normal, classically in the small bowel
| normal, classically in the small bowel
| [[Image:Peutz-Jeghers_syndrome_polyp.jpg|thumb|center|150px|PJP (WC)]]
| [[Image:Peutz-Jeghers_syndrome_polyp.jpg|thumb|center|120px|PJP (WC)]]
|}
|}


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===Adenomatous vs. hyperplastic===
===Adenomatous vs. hyperplastic===
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 name=pmid17516746>{{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>):  
{| class="wikitable"
{| class="wikitable"
! Attribute
! Attribute
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|-
|-
|Image(s)
|Image(s)
| [[Image:Hyperplastic_polyp2.jpg|thumb|center|150px|HP (WC)]]
| [[Image:Hyperplastic polyp -- intermed mag.jpg |thumb|center|150px|HP (WC)]]
| [[Image:Sessile_serrated_adenoma_2_low_mag.jpg|thumb|center|150px|SSA (WC)]]
| [[Image:Sessile_serrated_adenoma_2_low_mag.jpg|thumb|center|150px|SSA (WC)]]
| [[Image:Traditional_serrated_adenoma_low_mag.jpg|thumb|center|150px|TSA (WC)]]
| [[Image:Traditional_serrated_adenoma_low_mag.jpg|thumb|center|150px|TSA (WC)]]
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*Abundant goblet cells.
*Abundant goblet cells.
*Moderate inflammation.
*Moderate inflammation.
*Paneth cells - present in right colon.
*[[Paneth cell]]s - present in right colon.
*Glands - straight, no branching; "test tube" shape.
*Glands - straight, no branching; "test tube" shape.


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====Images====
====Images====
<gallery>
<gallery>
Image:Tubular_adenoma_2_intermed_mag.jpg| Normal colon adjacent to a tubular adenoma. (WC/Nephron)
Image:Rectum - low mag.jpg | Rectum - low mag. (WC)
Image:Rectum - intermed mag.jpg | Rectum - intermed. mag. (WC)
Image:Rectum - alt - intermed mag.jpg | Rectum - intermed. mag. (WC)
Image:Rectum - high mag.jpg | Rectum - high mag. (WC)
</gallery>
</gallery>
www:
www:
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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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COLON, 70 CM, BIOPSY:
COLON, 70 CM, BIOPSY:
- COLORECTAL-TYPE MUCOSA WITHIN NORMAL LIMITS.
- COLORECTAL-TYPE MUCOSA WITHIN NORMAL LIMITS.
</pre>
=====Polypoid fragments=====
<pre>
POLYP, SIGMOID COLON, BIOPSY:
- POLYPOID FRAGMENT OF COLORECTAL-TYPE MUCOSA WITHIN NORMAL LIMITS.
</pre>
</pre>


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====Lymphoid nodule present====
====Lymphoid nodule present====
*Lymphoid nodules manifest endoscopically as a small polypoid protuberances. It is worthwhile to report the presence of lymphoid nodules as they reassure the endoscopist that they probably sampled the abnormality they saw.
<pre>
POLYP, RECTUM, BIOPSY:
- RECTAL MUCOSA WITHIN NORMAL LIMITS WITH A MORPHOLOGICALLY BENIGN LYMPHOID AGGREGATE.
</pre>
<pre>
COLON, RIGHT SIDE, BIOPSY:
- COLONIC MUCOSA WITH MORPHOLOGICALLY BENIGN LYMPHOID AGGREGATES,
  NO SIGNIFICANT PATHOLOGY.
</pre>
=====Submucosa present=====
<pre>
<pre>
POLYP, ASCENDING COLON, BIOPSY:
POLYP, ASCENDING COLON, BIOPSY:
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</pre>
</pre>


Note:
*Lymphoid nodules manifest endoscopically as a small polypoid protuberances. It is worthwhile to report the presence of lymphoid nodules as they reassure the endoscopist that they probably sampled the abnormality they saw.
====Suspected missed lesion====
====Suspected missed lesion====
<pre>
<pre>
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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.
</pre>
</pre>


==Fecal material==
====Micro - suspected IBD====
:''Fecal matter'' redirects here.
The sections show colorectal-type mucosa. The glands show no significant architectural
===General===
abnormalities and mature normally to the surface. Rare apoptotic epithelial cells are seen. There is no cryptitis.  Neutrophils are not apparent in the lamina propria.
*Common.
*Associated with poor bowel preparation.
*Endoscopists go after anything that is polypoid and that may be nothing more than poo.


===Microscopic===
====Rare PMNs - no cryptitis====
Features:
The sections show colorectal mucosa with rare lymphoid aggregates. The architecture is
*Plant material:
within normal limits. The epithelium matures normally to the surface. Very rare neutrophils
**Yellow staining chicken wire-like material - may be linear.
are present within the lamina propria. A very small number of crypts have one or two
***Thick cell walls often without cytoplasm and usually without a nucleus.
neutrophils. No definite cryptitis is present.
*Meat:
**Eosinophilic honeycomb-like material without nuclei and without inflammation.
***Essentially ischemic skeletal muscle without inflammation.
*+/-Microorganisms.
*+/-Inflammatory cells.


DDx:
==Fecal material==
*Necrosis.
{{Main|Fecal material}}
**[[Gastrointestinal tract polyps#Colorectal adenocarcinoma|Colorectal adenocarcinoma]].
 
===Sign out===
<pre>
TRANSVERSE COLON, BIOPSY:
- FECAL MATERIAL.
- NO DEFINITE COLONIC MUCOSA IDENTIFIED.
</pre>
 
====Rectum====
<pre>
RECTUM, BIOPSY:
- FECAL MATERIAL.
- NO DEFINITE RECTAL MUCOSA IDENTIFIED.
</pre>


=Hyperplastic polyp=
=Hyperplastic polyp=
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=Inflammatory pseudopolyp=
=Inflammatory pseudopolyp=
*[[AKA]] ''inflammatory polyp''.
{{Main|Inflammatory pseudopolyp}}
===General===
*Not a true polyp.
*The label ''inflammatory pseudopolyp'' = [[inflammatory bowel disease]] (IBD).
**If there is no history of IBD... reconsider the diagnosis.
 
===Microscopic===
Features:
*Polypoid shape.
*Inflammation - esp. neutrophils - '''key feature'''.
 
Negatives:
*No nuclear atypia.
**May have focal nuclear hyperchromasia and nuclear enlargement.
*No dilated glands.
 
DDx:
*[[Juvenile polyp]].
*[[Solitary rectal ulcer]].
 
Images:
*[http://www.humpath.com/spip.php?article8234&id_document=18554 Pseudopolyp (humpath.com)].
*[http://missinglink.ucsf.edu/lm/IDS_106_LowerGI/Lower_GI_histo_small/24-UC-pseudoplp.jpg Pseudopolyp (ucsf.edu)].
 
===Sign out===
<pre>
SIGMOID COLON POLYP, PERI-DIVERTICULAR, BIOPSY:
- INFLAMMATORY PSEUDOPOLYP.
</pre>
 
<pre>
POLYP, DESCENDING COLON, BIOPSY:
- INFLAMED POLYPOID FRAGMENT OF COLORECTAL-TYPE MUCOSA.
-- NEGATIVE FOR DYSPLASIA.
</pre>
 
====Micro====
The sections show a fragment of colorectal mucosa with focal ulceration, acute inflammation and a well-vascularized stroma with plump stromal cells.  Occasional stromal cells have nuclear hyperchromasia.


=Adenomatous polyps=
=Adenomatous polyps=
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==Pseudoinvasion in colorectal adenomatous polyps==
==Pseudoinvasion in colorectal adenomatous polyps==
*[[AKA]] ''pseudoinvasion''.
*[[AKA]] ''pseudoinvasion''.
===General===
*[[AKA]] ''epithelial misplacement''.
*Mimic of invasion.
{{Main|Pseudoinvasion in colorectal adenomatous polyps}}
*Pedunculated polyps.<ref>{{Cite journal  | last1 = Byun | first1 = TJ. | last2 = Han | first2 = DS. | last3 = Ahn | first3 = SB. | last4 = Cho | first4 = HS. | last5 = Eun | first5 = CS. | last6 = Jeon | first6 = YC. | last7 = Sohn | first7 = JH. | last8 = Oh | first8 = YH. | title = Pseudoinvasion in an adenomatous polyp of the colon mimicking invasive colon cancer. | journal = Gut Liver | volume = 3 | issue = 2 | pages = 130-3 | month = Jun | year = 2009 | doi = 10.5009/gnl.2009.3.2.130 | PMID = 20431736 | PMC = PMC2852693 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852693/ }}</ref>
*Left-sided lesions, esp. sigmoid colon.<ref name=Ref_Odze512>{{Ref Odze|512}}</ref>
 
===Microscopic===
Features - classic:<ref name=pmid4540378>{{Cite journal  | last1 = Muto | first1 = T. | last2 = Bussey | first2 = HJ. | last3 = Morson | first3 = BC. | title = Pseudo-carcinomatous invasion in adenomatous polyps of the colon and rectum. | journal = J Clin Pathol | volume = 26 | issue = 1 | pages = 25-31 | month = Jan | year = 1973 | doi =  | PMID = 4540378 | PMC = 477644 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC477644/?tool=pubmed }}</ref>
#Dysplastic glands surrounded by lamina propria.
#Hemosiderin.
#Lack of [[desmoplastic reaction]].
*+/-Cystic spaces with rounded contours without cells floating in them.
 
Memory device (classic features) ''LDH'':
*'''L'''amina propria.
*'''D'''esmoplasia lacking.
*'''H'''emosiderin.
 
DDx:
*[[Gastrointestinal_tract_polyps#Colorectal_adenocarcinoma|Colorectal adenocarcinoma]].
 
===Sign out===
<pre>
COLON POLYP, SIGMOID COLON AT 45 CM, EXCISION:
- TUBULAR ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
- SUBMUCOSA PRESENT, NO EVIDENCE OF INVASION.
- ABUNDANT HEMOSIDERIN-LADEN MACROPHAGES.
</pre>


==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 area/bud -- 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>.
#***A 40x objective, the field is approximately 0.238 mm<sup>2</sup> -- to match the area/bud -- it would be 6.17 buds/0.238 mm<sup>2</sup>.
#***A 40x objective, the field is approximately 0.238 mm<sup>2</sup> -- to match the buds/area -- it would be 6.17 buds/0.238 mm<sup>2</sup>.
#Extensive submucosal invasion.
#Extensive submucosal invasion.
#*>= 4 mm width ''or'' >= 2 mm depth.
#*>= 4 mm width ''or'' >= 2 mm depth.


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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RECTOSIGMOID TUMOUR, BIOPSY:
RECTOSIGMOID TUMOUR, BIOPSY:
- INVASIVE ADENOCARCINOMA, MODERATELY DIFFERENTIATED.
- INVASIVE ADENOCARCINOMA, MODERATELY DIFFERENTIATED.
</pre>
<pre>
RECTUM, BIOPSY:
- INVASIVE ADENOCARCINOMA, MODERATELY DIFFERENTIATED.
</pre>
<pre>
RECTUM, BIOPSY:
- HIGHLY SUSPICIOUS FOR INVASIVE ADENOCARCINOMA, SEE MICROSCOPIC.
- TUBULOVILLOUS ADENOMA WITH HIGH-GRADE DYSPLASIA.
</pre>
</pre>


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There is cribriforming of glands and epithelial budding. Plump spindle cells with eosinophilic cytoplasm surround the abnormal epithelium (desmoplastic stroma). No definite submucosa is identified; the diagnosis is based on the stromal desmoplasia.
There is cribriforming of glands and epithelial budding. Plump spindle cells with eosinophilic cytoplasm surround the abnormal epithelium (desmoplastic stroma). No definite submucosa is identified; the diagnosis is based on the stromal desmoplasia.
=====Suspicious=====
The sections shows multiple fragments of colorectal-type mucosa with a tubule-forming and villous-forming epithelium that has cellular pseudostratification and enlarged hyperchromatic nuclei, from
the crypt base to the luminal aspect (dysplasia).
Cribriforming of glands is identified at multiple foci. Goblet cells are rare in the
dysplastic epithelium.
One fragment of tissue, measuring approximately 2 millimetres, has increased numbers of plump stromal cells (desmoplastic response); this is suspicious for invasive adenocarcinoma.


=Hamartomatous polyps=
=Hamartomatous polyps=
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==Juvenile polyp==
==Juvenile polyp==
*[[AKA]] ''retention polyp'' in adults.
{{Main|Juvenile polyp}}
===General===
May be part of a syndrome:
*[[Juvenile polyposis syndrome]] (JPS) - see JPS article for criteria.
*[[Cronkhite-Canada syndrome]].
*[[Cowden syndrome]].
 
===Gross===
*Mushroom-like shape.
 
===Microscopic===
Features:<ref name=Ref_PBoD859>{{Ref PBoD|859}}</ref><ref name=pmid12692201>{{Cite journal  | last1 = Bronner | first1 = MP. | title = Gastrointestinal inherited polyposis syndromes. | journal = Mod Pathol | volume = 16 | issue = 4 | pages = 359-65 | month = Apr | year = 2003 | doi = 10.1097/01.MP.0000062992.54036.E4 | PMID = 12692201 | url = http://www.nature.com/modpathol/journal/v16/n4/full/3880773a.html }}</ref>
*Eroded, smooth or lobulated surface.
*Pedunculated.
*Increased lamina propria (LP) +/- edema.
*Cystically dilated gland.
*Often inflammed.
 
Mnemonic ''DIES'' = dilated glands, increased LP & inflammation of the LP, eroded/smooth surface, stalk.
 
Notes:
*May have nuclear changes like those seen in adenomatous polyps.
 
DDx:
*[[Inflammatory polyp]].
*[[Hyperplastic polyp of the stomach]] - less lamina propria, foveolar hyperplasia (long tortuous glands).
*[[Cronkhite-Canada syndrome]] - have changes in the surrounding mucosa, clinical findings (nail atrophy, skin pigment, alopecia).
 
====Images====
www:
*[http://www.nature.com/modpathol/journal/v16/n4/fig_tab/3880773f4.html Juvenile polyp (nature.com)].
<gallery>
Image:Gastric_juvenile_polyp_-_very_low_mag.jpg | Juvenile polyp of the stomach - very low mag. (WC/Nephron)
Image:Gastric_juvenile_polyp_-_2_-_very_low_mag.jpg | Juvenile polyp of the stomach - very low mag. (WC/Nephron)
</gallery>
===IHC===
*Usually none.
 
Notes:
*IHC can be used if it is suspected to have dysplasia (p53, Ki-67).
**p53 mutations in dysplastic epithelium -- negative stain (normal).
 
===Sign out===
<pre>
RECTOSIGMOID POLYP, BIOPSY:
- RETENTION POLYP.
</pre>


==Peutz-Jeghers polyp==
==Peutz-Jeghers polyp==
===General===
{{Main|Peutz-Jeghers polyp}}
====Epidemiology====
Features:<ref name=Ref_PBoD859/><ref name=pmid12692201>{{Cite journal  | last1 = Bronner | first1 = MP. | title = Gastrointestinal inherited polyposis syndromes. | journal = Mod Pathol | volume = 16 | issue = 4 | pages = 359-65 | month = Apr | year = 2003 | doi = 10.1097/01.MP.0000062992.54036.E4 | PMID = 12692201 | url = http://www.nature.com/modpathol/journal/v16/n4/full/3880773a.html }}</ref>
*[[Peutz-Jeghers syndrome]] is autosomal dominant.
*Altered gene: STK11.
 
====Clinical====
Features:<ref>URL: [http://www.ncbi.nlm.nih.gov/omim/175200 http://www.ncbi.nlm.nih.gov/omim/175200]. Accessed on: 13 July 2010.</ref>
*Melanocytic macules.
**Lips, buccal mucosa, and digits.
**Multiple Peutz-Jeghers polyps.
 
Increased risk of various neoplasms - primarily:
*Breast and gastrointestinal cancer.<ref name=pmid20581245>{{cite journal |author=Beggs AD, Latchford AR, Vasen HF, ''et al.'' |title=Peutz-Jeghers syndrome: a systematic review and recommendations for management |journal=Gut |volume=59 |issue=7 |pages=975–86 |year=2010 |month=July |pmid=20581245 |doi=10.1136/gut.2009.198499 |url=}}</ref>
*Others tumours:<ref>URL: [http://www.ncbi.nlm.nih.gov/omim/175200 http://www.ncbi.nlm.nih.gov/omim/175200]. Accessed on: 22 December 2010.</ref>
**[[Granulosa cell tumour]].
**[[Sertoli cell tumour]] - esp. with calcification.
 
===Microscopic===
Features:<ref name=Ref_PBoD859/><ref name=pmid12692201>{{Cite journal  | last1 = Bronner | first1 = MP. | title = Gastrointestinal inherited polyposis syndromes. | journal = Mod Pathol | volume = 16 | issue = 4 | pages = 359-65 | month = Apr | year = 2003 | doi = 10.1097/01.MP.0000062992.54036.E4 | PMID = 12692201 | url = http://www.nature.com/modpathol/journal/v16/n4/full/3880773a.html }}</ref>
*Frond-like polyp with all three components of mucosa:
*# Muscosal epithelium (melanotic mucosa, goblet cells).
*# Lamina propria.
*# M. mucosae.
 
Notes:
*''Frond'' = leaflike expansion.<ref>URL: [http://dictionary.reference.com/browse/frond http://dictionary.reference.com/browse/frond]. Accessed on: 26 July 2011.</ref>
**The '''key''' is "thick" smooth muscle bundles - if one is lucky one sees branching.<ref>C. Streutker. 26 July 2011.</ref>
***"Thick" ~= thickness of muscularis mucosae.
 
====Images====
<gallery>
Image:Peutz-Jeghers_syndrome_polyp.jpg | Peutz-Jeghers polyp - intestine (WC/Nephron)
Image:Gastric_Peutz-Jeghers_polyp_-_very_low_mag.jpg | Peutz-Jeghers polyp - stomach (WC/Nephron)
</gallery>
www:
*[http://www.nature.com/modpathol/journal/v16/n4/fig_tab/3880773f3.html Peutz-Jeghers polyp (nature.com)].
 
===Sign out===
====Duodenum====
<pre>
POLYPS, DUODENUM, EXCISION:
- PEUTZ-JEGHERS POLYPS (x2) WITH BRUNNER'S GLANDS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
====Colon====
<pre>
POLYP, COLON (40 CM), EXCISION:
- PEUTZ-JEGHERS POLYP.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>


==Cowden disease==
==Cowden disease==
Line 661: Line 549:
==Cronkhite-Canada syndrome==
==Cronkhite-Canada syndrome==
*Abbreviated ''CCS''.
*Abbreviated ''CCS''.
 
{{Main|Cronkhite-Canada syndrome}}
===General===
Clinical features:<ref>{{Ref PBoD|858-9}}</ref>
*Hamartomatous polyps.
*Ectodermal abnormalities (nail atrophy, skin pigment, alopecia).
 
===Microscopic===
Features:
*Polyps have same morphology as [[juvenile polyp]]s/retension polyps.
*Crypt dilation and edema in non-polypoid mucosa<ref>{{Ref PCPBoD8|430}}</ref> - '''key feature'''.
 
DDx:
*[[Juvenile polyp]].
 
Images:
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20090508151729401 CCS (surgicalpathologyatlas.com)].


==Ganglioneuroma==
==Ganglioneuroma==
Line 686: Line 559:
*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====
Line 693: Line 569:
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===
Line 711: Line 588:
*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:
*[http://www.biomedcentral.com/1471-230X/10/10/figure/F3 IMP (biomedcentral.com)].<ref name=pmid20102635/>
*[http://www.biomedcentral.com/1471-230X/10/10/figure/F3 IMP (biomedcentral.com)].<ref name=pmid20102635/>
==Leiomyoma==
{{Main|Colonic 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>
==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=
Line 721: Line 621:
*[[Small bowel]].
*[[Small bowel]].
*[[Colon]].
*[[Colon]].
*[[Polypectomy]].


=References=
=References=
Michael
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