Traditional serrated adenoma

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Traditional serrated adenoma
Diagnosis in short

LM ectopic crypt foci (ECF), serrated, eosinophilic cytoplasm, villous-like architecture, "pine cone, fernlike, stellate pit pattern"
Subtypes With and without high grade dysplasia, mixed with other types of polyps
LM DDx villous adenoma, hyperplasic polyp, sessiles serrated adenoma
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
Molecular BRAF & KRAS
Site colon - usu. left side / gastrointestinal polyps

Prevalence very rare
Endoscopy q3year surveillance colonoscopy
Prognosis benign (pre-malignant)
Clin. DDx other GI polyps
Treatment polypectomy

Traditional serrated adenoma, abbreviated TSA, are a rare type of gastrointestinal polyp.

Before the sessile serrated adenomas were recognized, these lesions were known as serrated adenomas.[1]

General

  • Very rare.
  • Pre-malignant.[2]

Gross

  • Polypoid mass.
  • Usually in the left colon.

Microscopic

Features:[3]

  • Serrated - essential.
  • Eosinophilic cytoplasm - key feature.
  • Nuclear atypia as in tubular adenoma.
    • Nuclear hyperchromasia, enlargement and pseudostratification.
  • Villous-like architecture.

DDx:

Images

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POLYP, SIGMOID COLON, POLYPECTOMY:
- TRADITIONAL SERRATED ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.

See also

References

  1. Noffsinger, AE.; Hart, J. (Jul 2010). "Serrated adenoma: a distinct form of non-polypoid colorectal neoplasia?". Gastrointest Endosc Clin N Am 20 (3): 543-63. doi:10.1016/j.giec.2010.03.012. PMID 20656251.
  2. Rosty, C.; Hewett, DG.; Brown, IS.; Leggett, BA.; Whitehall, VL. (Mar 2013). "Serrated polyps of the large intestine: current understanding of diagnosis, pathogenesis, and clinical management.". J Gastroenterol 48 (3): 287-302. doi:10.1007/s00535-012-0720-y. PMID 23208018.
  3. Li SC, Burgart L (March 2007). "Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps". Arch. Pathol. Lab. Med. 131 (3): 440-5. PMID 17516746. http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=131&page=440.