Difference between revisions of "Traditional adenoma"

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Traditional adenoma (view source)

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| Micro      = nuclear changes - esp. at the surface (hyperchromatic elongated nuclei or round cleared nuclei), nuclear crowding/pseudostratification, +/- loss of nuclear polarity, loss/decrease of goblet cells, cytoplasmic hyperchromasia
| Micro      = nuclear changes - esp. at the surface (hyperchromatic elongated nuclei or round cleared nuclei), nuclear crowding/pseudostratification, +/- loss of nuclear polarity, loss/decrease of goblet cells, cytoplasmic hyperchromasia
| Subtypes  = [[tubular adenoma]], [[villous adenoma]], [[tubulovillous adenoma]]
| Subtypes  = [[tubular adenoma]], [[villous adenoma]], [[tubulovillous adenoma]]
| LMDDx      = [[sessile serrated adenoma]] with dysplasia, [[gastrointestinal polyps]]
| LMDDx      = [[sessile serrated adenoma]] with dysplasia, reactive changes in other [[gastrointestinal polyps]], invasive adenocarcinoma, adenoma-like adenocarcinoma
| Stains    =
| Stains    =
| IHC        =
| IHC        =
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| Prognosis  = good
| Prognosis  = good
| Other      =
| Other      =
| ClinDDx    = invasive [[colorectal adenocarcinoma]], [[Normal_colorectal_mucosa|benign colorectal mucosa]], [[hyperplastic polyp]]
| ClinDDx    = invasive [[colorectal adenocarcinoma]], [[Normal_colorectal_mucosa|benign colorectal mucosa]], [[hyperplastic polyp]], other [[gastrointestinal tract polyps]]
| Tx  = usually endoscopic resection ([[polypectomy]])
}}
}}
{{ Infobox external links
{{ Infobox external links
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#*Size and shape ''or'' size change:
#*Size and shape ''or'' size change:
#**Cigar-shaped (elongated) nucleus (usu. length:width > 3:1) with nuclear hyperchromasia (more blue).
#**Cigar-shaped (elongated) nucleus (usu. length:width > 3:1) with nuclear hyperchromasia (more blue).
#**Large round nuclei +/- vesicular appearance (clearing) -- nuclei have white space.
#**Large round nuclei +/- [[vesicular nuclei|vesicular]] appearance (clearing) -- nuclei have white space.
#*Nuclear crowding/pseudostratification - '''important'''.
#*Nuclear crowding/pseudostratification - '''important'''.
#*+/-Loss of nuclear polarity (nuclei no longer on basement membrane).
#*+/-Loss of nuclear polarity (nuclei no longer on basement membrane).
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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).
*[[Ampullary adenoma]]s often have less prominent pseudostratification and fine chromatin.
*[[Ampullary adenoma]]s often have less prominent pseudostratification and fine chromatin.
DDx:
*Reactive changes due to inflammation.
*Invasive adenocarcinoma.
**Adenoma-like adenocarcinoma.<ref name=pmid25913616>{{Cite journal  | last1 = Gonzalez | first1 = RS. | last2 = Cates | first2 = JM. | last3 = Washington | first3 = MK. | last4 = Beauchamp | first4 = RD. | last5 = Coffey | first5 = RJ. | last6 = Shi | first6 = C. | title = Adenoma-like adenocarcinoma: a subtype of colorectal carcinoma with good prognosis, deceptive appearance on biopsy and frequent KRAS mutation. | journal = Histopathology | volume = 68 | issue = 2 | pages = 183-90 | month = Jan | year = 2016 | doi = 10.1111/his.12725 | PMID = 25913616 }}</ref>


===Images===
===Images===
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Image:Tubular_adenoma_2_intermed_mag.jpg| Tubular adenoma - intermed. mag. (WC/Nephron).
Image:Tubular_adenoma_2_intermed_mag.jpg| Tubular adenoma - intermed. mag. (WC/Nephron).
Image:Tubulovillous_adenoma.jpg| Tubulovillous adenoma (WC/Nephron).
Image:Tubulovillous_adenoma.jpg| Tubulovillous adenoma (WC/Nephron).
Image: Tubular adenoma - ase -- low mag.jpg | TA - low mag. (WC/Nephron)
Image: Tubular adenoma - ase -- intermed mag.jpg | TA - intermed. mag. (WC/Nephron)
</gallery>
</gallery>


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Note 2:
Note 2:
*There is no formal definition of "villous" architecture.<ref>R. Riddell. 12 August 2011.</ref>
*There is no formal definition of "villous" architecture.<ref>R. Riddell. 12 August 2011.</ref>
**''[[Onlinepathology]]'' suggests: slender finger-like projections with length-to-width ratio greater than 4.
**''[[Libre Pathology]]'' suggests: slender finger-like projections with length-to-width ratio greater than 4.


Note 3:
Note 3:
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===Tubular adenoma - negative for high-grade===
===Tubular adenoma - negative for high-grade===
<pre>
<pre>
POLYP, RECTUM, EXCISION:  
A. Colonic Polyp, Transverse Colon, Polypectomy:
- Tubular adenoma.
- NEGATIVE for high grade dysplasia.
 
B. Colonic Polyp, Transverse Colon, Polypectomy:
-Tubular adenoma.
-NEGATIVE for high grade dysplasia.
</pre>
 
<pre>
Polyp, Rectum, Polypectomy:
- Tubular adenoma.
-- NEGATIVE for high-grade dysplasia.
</pre>
 
====Block letters====
<pre>
POLYP, RECTUM, POLYPECTOMY:  
- TUBULAR ADENOMA.
- TUBULAR ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
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<pre>
<pre>
POLYP, SIGMOID COLON, EXCISION:  
POLYP, SIGMOID COLON, POLYPECTOMY:  
- TUBULAR ADENOMA.
- TUBULAR ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
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<pre>
<pre>
POLYP, DESCENDING COLON, EXCISION:  
POLYP, DESCENDING COLON, POLYPECTOMY:  
- TUBULAR ADENOMA.
- TUBULAR ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
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<pre>
<pre>
POLYP, SPLENIC FLEXURE OF COLON, EXCISION:  
POLYP, SPLENIC FLEXURE OF COLON, POLYPECTOMY:  
- TUBULAR ADENOMA.
- TUBULAR ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
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<pre>
<pre>
POLYP, TRANSVERSE COLON, EXCISION:  
POLYP, TRANSVERSE COLON, POLYPECTOMY:  
- TUBULAR ADENOMA.
- TUBULAR ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
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<pre>
<pre>
POLYP, HEPATIC FLEXURE OF COLON, EXCISION:  
POLYP, HEPATIC FLEXURE OF COLON, POLYPECTOMY:  
- TUBULAR ADENOMA.
- TUBULAR ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
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<pre>
<pre>
POLYP, ASCENDING COLON, EXCISION:  
POLYP, ASCENDING COLON, POLYPECTOMY:  
- TUBULAR ADENOMA.
- TUBULAR ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
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<pre>
<pre>
POLYP, CECUM, EXCISION:  
POLYP, CECUM, EXCISION:  
- TUBULAR ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
</pre>
<pre>
POLYP, LARGE BOWEL AT 30 CM, POLYPECTOMY:
- TUBULAR ADENOMA.
- TUBULAR ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
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===Tubulovillous adenoma - negative for high-grade===
===Tubulovillous adenoma - negative for high-grade===
<pre>
Polyp, Sigmoid Colon at 30 cm, Biopsy:
- Fragments of tubulovillous adenoma.
-- NEGATIVE for high-grade dysplasia.
Comment:
This biopsy may not be representative of the lesion as a whole.
Clinical correlation is required.
</pre>
====Block letters====
<pre>
<pre>
COLONIC POLYP, SIGMOID COLON, BIOPSY:  
COLONIC POLYP, SIGMOID COLON, BIOPSY:  
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<pre>
<pre>
POLYP, TRANSVERSE COLON, BIOPSY:
POLYP, TRANSVERSE COLON, BIOPSY:
- TUBULAR ADENOMA WITH FOCAL HIGH-GRADE DYSPLASIA.
- TUBULAR ADENOMA WITH FOCAL HIGH-GRADE DYSPLASIA, MARGINS CLEAR, SEE COMMENT.
 
COMMENT:
The case was partially reviewed internally by Dr. Pathology and there is agreement high-grade dysplasia is focally present.
</pre>
</pre>
Note:
*"Focal" is something that should prompt review; the management decision often turns on high grade versus low grade.


===Tubular adenoma with high-grade dysplasia===
===Tubular adenoma with high-grade dysplasia===
<pre>
<pre>
POLYP, SIGMOID COLON, BIOPSY:  
POLYP, SIGMOID COLON, BIOPSY:  
- TUBULAR ADENOMA WITH HIGH-GRADE DYSPLASIA.
- TUBULAR ADENOMA WITH HIGH-GRADE DYSPLASIA, MARGINS CLEAR.
</pre>
</pre>


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COMMENT:  
COMMENT:  
No stromal desmoplasia is identified. No definite submucosa is present; thus, the presence or absence of definite invasion cannot be assessed.
No stromal desmoplasia is identified. No definite submucosa is  
present; thus, the presence or absence of definite invasion  
cannot be assessed.
</pre>
 
===Biopsy of lesion clinically suspicious for cancer===
<pre>
FLAT LESION, HEPATIC FLEXURE OF COLON, BIOPSY:
- TUBULAR ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
 
COMMENT:
The provided clinical history is noted. The sampled tissue may
not be representative of the lesion seen. As it is at least
an adenoma, it should be completely excised.
</pre>
</pre>


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- TUBULAR ADENOMA (IN 1/3 TISSUE FRAGMENTS).
- TUBULAR ADENOMA (IN 1/3 TISSUE FRAGMENTS).
- NEGATIVE FOR HIGH-GRADE DYSPLASIA.  
- NEGATIVE FOR HIGH-GRADE DYSPLASIA.  
</pre>
===Surgical resection===
<pre>
RECTOSIGMOID, RESECTION:
- LARGE TUBULOVILLOUS ADENOMA WITH A SMALL FOCUS OF HIGH-GRADE DYSPLASIA.
-- SURGICAL MARGINS NEGATIVE FOR DYSPLASIA.
- FOURTEEN LYMPH NODES NEGATIVE FOR MALIGNANCY ( 0 POSITIVE / 14 ).
- NEGATIVE FOR MALIGNANCY.
</pre>
</pre>


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A small number of rare finger-like epithelial projections (villi) are noted; however these appear to comprise less than 20% of the sampled tissue. It is possible that the villous component is higher or lower due to sampling.
A small number of rare finger-like epithelial projections (villi) are noted; however these appear to comprise less than 20% of the sampled tissue. It is possible that the villous component is higher or lower due to sampling.


=====Abbreviated version=====
=====Abbreviated version 1=====
The sections shows colorectal-type mucosa with a tubule-forming epithelium that has
The sections shows colorectal-type mucosa with a tubule-forming epithelium that has
cellular pseudostratification and enlarged hyperchromatic nuclei, from the crypt base to
cellular pseudostratification and enlarged hyperchromatic nuclei, from the crypt base to
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A small number of finger-like epithelial projections (villi) are noted; however, these
A small number of finger-like epithelial projections (villi) are noted; however, these
appear to comprise less than 20% of the sampled tissue.
appear to comprise less than 20% of the sampled tissue.
=====Abbreviated version 2=====
A number of finger-like epithelial projections (villi) are noted; however, these appear to comprise less than 25% of the adenomatous tissue seen in section.
=====More abbreviated=====
A small number of villous structures are noted; however, these is still in keeping with a tubular adenoma.


=====Barely villous=====
=====Barely villous=====
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Focally, the nuclei are round and vesicular, and the glands do not have appreciable numbers of goblet cells. Occasionally, glands are fused and show moderate complexity. No desmoplastic response is evident. Benign fragments of submucosa are present.
Focally, the nuclei are round and vesicular, and the glands do not have appreciable numbers of goblet cells. Occasionally, glands are fused and show moderate complexity. No desmoplastic response is evident. Benign fragments of submucosa are present.
====Very small adenoma====
The sections show colorectal-type mucosa with one dysplastic appearing gland with nuclear hyperchromasia, enlargement and pseudostratification at the surface. It has an abrupt transition to the surrounding normal appearing mucosa. A histomorphologically benign lymphoid aggregate is present.


==See also==
==See also==
*[[Gastrointestinal polyps]].
*[[Gastrointestinal polyps]].
*[[Gastrointestinal pathology]].
*[[Gastrointestinal pathology]].
*"[[Intramucosal colorectal carcinoma]]".


==References==
==References==
Michael
48,466

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