Difference between revisions of "Gastrointestinal tract polyps"

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Gastrointestinal tract polyps (view source)

Revision as of 20:59, 25 June 2013

4,649 bytes removed ,  20:59, 25 June 2013
→‎Hyperplastic polyp: split out
(→‎Traditional adenoma: split-out into separate article)
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=Hyperplastic polyp=
=Hyperplastic polyp=
:''The [[stomach]] lesion is dealt with in [[hyperplastic polyp of the stomach]]''.
:''The [[stomach]] lesion is dealt with in [[hyperplastic polyp of the stomach]]''.
*Abbreviated ''HP''.
{{Main|Hyperplastic polyp}}
===General===
*Most common type of polyp:
**Approximately 90% of all colonic polyps.<ref name=Ref_PBoD858/>
**Most common type of [[gastric hyperplastic polyp|gastric polyp]].<ref name=pmid19037727>{{Cite journal  | last1 = Jain | first1 = R. | last2 = Chetty | first2 = R. | title = Gastric hyperplastic polyps: a review. | journal = Dig Dis Sci | volume = 54 | issue = 9 | pages = 1839-46 | month = Sep | year = 2009 | doi = 10.1007/s10620-008-0572-8 | PMID = 19037727 }}</ref>
*May be part of [[hyperplastic polyposis syndrome]].<ref name=pmid21045813>{{Cite journal  | last1 = Huang | first1 = CS. | last2 = Farraye | first2 = FA. | last3 = Yang | first3 = S. | last4 = O'Brien | first4 = MJ. | title = The clinical significance of serrated polyps. | journal = Am J Gastroenterol | volume = 106 | issue = 2 | pages = 229-40; quiz 241 | month = Feb | year = 2011 | doi = 10.1038/ajg.2010.429 | PMID = 21045813 }}</ref>
 
===Gross===
Features:<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>
*Flat lesion, usually <= 5mm.
*Typically in the distal large bowel (rectum, sigmoid colon).
 
===Microscopic===
Features:<ref name=Ref_PBoD858/>
*Irregular crypt architecture - tortuosity.
*Serrated epithelial cells (at the surface of the gland) - only colorectal polyps - '''key feature'''.
**''Serrated'' appearance = ''saw-tooth'' appearance, epithelium has jagged edge.
 
Notes:
*Significant negatives:
**No nuclear atypia; glands ''d''arker staining ''d''eep... ''l''ighter staining ''l''uminal.
**In the colon goblet cells should be present (as is usual).
*Inflammation -- cryptitis or even crypt abscesses -- is considered to arise due to trauma.{{fact}}
**It is usually ''not'' reported.
 
DDx:
*[[Sessile serrated adenoma]].
*[[Normal colon]].
 
====Images====
<gallery>
Image:Hyperplastic_polyp1.jpg | HP - high mag. (WC/Nephron)
Image:Hyperplastic_polyp2.jpg | HP - lower mag. (WC/Nephron)
Image:Hyperplastic_polyp_of_the_colon,_HE.jpg | HP (WC/Patho)
</gallery>
www:
*[http://www.flickr.com/photos/jthetzel/4317282727/ Microvesicular HP (flickr.com/jhetzel)].
*[http://www.flickr.com/photos/jian-hua_qiao_md/3984355417/ HP of colon (flickr.com/jian-hua_qiao_md)].
 
====Subclassification====
*Usually '''not subclassified''' as there is no demonstrated prognostic significance;<ref name=pmid21045813/> the subtyping is an academic exercise.
 
HPs may be subclassified into two groups:<ref name=pmid21045813/>
#Microvesicular serrated polyps (MVSPs).
#Goblet cell serrated polyps (GCSPs).
 
Features of the HP subtypes:<ref name=pmid21045813/>
{| class="wikitable sortable"
| '''Subtype'''
| '''Histology'''
| '''Mutations'''
| '''Clinical relevance'''
|-
| Microvesicular
| microvesicles at the surface, serration<br> at the surface to the mid portion of glands
| BRAF V600E, CIMP
| possible [[sessile serrated adenoma]] precursor
|-
| Goblet cell
| superficial goblet cells, serration at <br>the surface
| KRAS
| unknown; probably benign
|}
Notes:
*CIMP = CpG island methylation phenotype.
 
===Sign out===
<pre>
COLONIC POLYP, 35 CM, BIOPSY:
- HYPERPLASTIC POLYP.
</pre>
 
<pre>
COLONIC POLYP, SIGMOID COLON, BIOPSY:
- HYPERPLASTIC POLYP.
</pre>
 
<pre>
POLYP, RECTUM, BIOPSY:
- HYPERPLASTIC POLYP.
</pre>
 
=====Numerous hyperplastic polyps=====
<pre>
COLONIC POLYP(S), BIOPSY:
- HYPERPLASTIC POLYP, SEE COMMENT. 
 
COMMENT:
Eight pieces of tissue were received.  On microscopy eight pieces of tissue
are identified and all eight (individually) have the diagnostic features of a
hyperplastic polyp.  If these fragments all represent individual polyps and more
polyps of this type are present in the individual, it raises the possibility of
a serrated polyposis syndrome.
</pre>
 
====Micro====
=====Goblet cell type=====
The sections show colonic-type mucosa with superficial serrations rich in goblet cells.  There are no serrations in the crypt base and there is no crypt base dilation.  No dysplasia is present.
 
=====Generic=====
The sections show colonic-type mucosa with superficial serrations.  There are no serrations in the crypt base and there is no crypt base dilation.  No dysplasia is present.


=Inflammatory pseudopolyp=
=Inflammatory pseudopolyp=
Michael
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