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Difference between revisions of "Hyperplastic polyp"
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# | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Hyperplastic_polyp1.jpg | |||
| Width = | |||
| Caption = Hyperplastic polyp. [[H&E stain]]. | |||
| Micro = serrated architecture without glandular abnormalities | |||
| Subtypes = microvesicular serrated polyps (MVSPs), goblet cell serrated polyps (GCSPs). | |||
| LMDDx = [[sessile serrated adenoma]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = usually rectum or sigmoid | |||
| Grossing = | |||
| Site = [[colon]], [[rectum]] | |||
| Assdx = | |||
| Syndromes = [[hyperplastic polyposis syndrome]] | |||
| Signs = | |||
| Symptoms = asymptomatic | |||
| Prevalence = very common | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = pedunculated or sessile | |||
| Prognosis = good | |||
| Other = | |||
| ClinDDx = normal colon, sessile serrated adenoma | |||
}} | |||
:''The [[stomach]] lesion is dealt with in [[hyperplastic polyp of the stomach]]''. | |||
The '''hyperplastic polyp''' of the [[colon]] and rectum is very common. It is commonly abbreviated '''HP'''. | |||
==General== | |||
*Most common type of polyp: | |||
**Approximately 90% of all colonic polyps.<ref name=Ref_PBoD858>{{Ref PBoD|858}}</ref> | |||
**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. | |||
==See also== | |||
*[[Gastrointestinal tract polyps]]. | |||
*[[Gastrointestinal pathology]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | |||
[[Category:Gastrointestinal pathology]] | |||