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Difference between revisions of "Traditional serrated adenoma"
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| Width = Traditional serrated adenoma. [[H&E stain]]. | | Width = Traditional serrated adenoma. [[H&E stain]]. | ||
| Caption = | | Caption = | ||
| Micro = serrated, eosinophilic cytoplasm, villous-like architecture | | Micro = ectopic crypt foci (ECF), serrated, eosinophilic cytoplasm, villous-like architecture, "pine cone, fernlike, stellate pit pattern" | ||
| Subtypes = | | Subtypes = With and without high grade dysplasia, mixed with other types of polyps | ||
| LMDDx = [[villous adenoma]] | | LMDDx = [[villous adenoma]], [[hyperplastic polyp]], [[sessile serrated adenoma]] | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = CK20 in the eosinophilic cells, absent in ECF; Ki67 (MIB1) stains ECF and absent in eosinophilic cells, MUC2+, MUC5CA+, MUC6-; In areas of dysplasia TP53+, nuclear B-catenin+; p16+ in late dysplasia | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = [[BRAF]] & [[KRAS]] | ||
| IF = | | IF = | ||
| Gross = | | Gross = | ||
| Line 27: | Line 27: | ||
| Other = | | Other = | ||
| ClinDDx = other [[GI polyps]] | | ClinDDx = other [[GI polyps]] | ||
| Tx = polypectomy | | Tx = [[polypectomy]], q3years surveillance colonoscopy | ||
}} | }} | ||
'''Traditional serrated adenoma''', abbreviated '''TSA''', are a rare type of [[gastrointestinal polyp]]. | '''Traditional serrated adenoma''', abbreviated '''TSA''', are a rare type of [[gastrointestinal polyp]]. | ||
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==Gross== | ==Gross== | ||
*Polypoid mass. | *Polypoid mass. | ||
*Usually in the left colon. | *Usually in the [[left colon]]. | ||
==Microscopic== | ==Microscopic== | ||
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**Nuclear hyperchromasia, enlargement and pseudostratification. | **Nuclear hyperchromasia, enlargement and pseudostratification. | ||
*Villous-like architecture. | *Villous-like architecture. | ||
*Ectopic crypt foci (ECF) - short crypts oriented perpendicular to the main crypt, do not reach muscularis mucosae.<ref>URL: [http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/printable.html http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/printable.html]. Accessed on: 5 June 2017.</ref>‡ | |||
DDx: | Note: | ||
*‡ECF considered pathognomonic for TSA - but seen in other entities.<ref name=pmid27281826>{{Cite journal | last1 = Väyrynen | first1 = SA. | last2 = Väyrynen | first2 = JP. | last3 = Klintrup | first3 = K. | last4 = Mäkelä | first4 = J. | last5 = Tuomisto | first5 = A. | last6 = Mäkinen | first6 = MJ. | title = Ectopic crypt foci in conventional and serrated colorectal polyps. | journal = J Clin Pathol | volume = 69 | issue = 12 | pages = 1063-1069 | month = Dec | year = 2016 | doi = 10.1136/jclinpath-2015-203593 | PMID = 27281826 }}</ref> | |||
DDx:<ref>URL: [http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/differential-diagnosis.html http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/differential-diagnosis.html]. Accessed on: 28 May 2015.</ref> | |||
*[[Villous adenoma]]. | *[[Villous adenoma]]. | ||
*[[Hyperplastic polyp]]. | |||
*[[Sessile serrated adenoma]]. | |||
===Images=== | ===Images=== | ||
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==Sign out== | ==Sign out== | ||
<pre> | |||
Polyp, Sigmoid Colon, Polypectomy: | |||
- Traditional serrated adenoma. | |||
-- NEGATIVE for high-grade dysplasia. | |||
</pre> | |||
===Block letters=== | |||
<pre> | <pre> | ||
POLYP, SIGMOID COLON, POLYPECTOMY: | POLYP, SIGMOID COLON, POLYPECTOMY: | ||
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-- NEGATIVE FOR HIGH-GRADE DYSPLASIA. | -- NEGATIVE FOR HIGH-GRADE DYSPLASIA. | ||
</pre> | </pre> | ||
===Micro=== | |||
====Nonvilliform TSA==== | |||
This polyp has cytologic dysplasia and serrations at the surface; however, it does not have a villiform architecture. The surface epithelium has eosinophilic cytoplasm. Overall, the morphology is most in keeping with a traditional serrated adenoma. | |||
==See also== | ==See also== | ||