Difference between revisions of "Gastrointestinal tract polyps"

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Gastrointestinal tract polyps (view source)

Revision as of 20:20, 22 December 2010

261 bytes added ,  20:20, 22 December 2010
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m (moved Intestinal polyps to Gastrointestinal tract polyps: applies to all the GI tract)
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'''Intestinal polyps''' are often the bread & butter of a GI pathologists workload.  Some of 'em are benign... some pre-malignant... some malignant... some weird.
'''Gastrointestinal tract polyps''', also '''gastrointestinal polyps''' or '''GI polyps''', are the bread & butter of a GI pathologists workload.  Some of 'em are benign... some pre-malignant... some malignant... some weird.  Most GI polyps are from the intestine, i.e. intestinal polyps.


Overview - there are four basic types:<ref name=Ref_PBoD856>{{Ref PBoD|856}}</ref>
Overview - there are four basic types:<ref name=Ref_PBoD856>{{Ref PBoD|856}}</ref>
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# Serrated architecture?
# Serrated architecture?


==Decision tree for colorectal polyps==
==Decision tree for GI polyps==


'''Decision tree - colorectal polyps'''
'''Decision tree - GI polyps'''
{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | | A | | | | | | | | |A=Colorectal<br>polyp}}
{{familytree | | | | | | | | | A | | | | | | | | |A=GI<br>polyp}}
{{familytree | | | | |,|-|-|-|-|^|-|-|-|-|-|.| | | |}}
{{familytree | | | | |,|-|-|-|-|^|-|-|-|-|-|.| | | |}}
{{familytree | | | | B | | | | | | | | | C | | |B=Polypoid<br>(Lollipop-like)|C=Sessile<br>(flat)}}
{{familytree | | | | B | | | | | | | | | C | | |B=Polypoid<br>(Lollipop-like)|C=Sessile<br>(flat)}}
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Notes:
Notes:
*Juvenile polyps may have marked inflammation.
*Juvenile polyps may have marked inflammation.


Hamartomatous polyps - basic DDx:
Hamartomatous polyps - basic DDx:
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*Peutz-Jeghers polyp (PJP) - frond-like with all mucosa components .
*Peutz-Jeghers polyp (PJP) - frond-like with all mucosa components .


==Tabular comparison==
==Tabular comparison of colonic polyps==


Adenomatous polyps & hyperplastic polyps - a comparison (adapted from Li and Burgart<ref>{{cite journal |author=Li SC, Burgart L |title=Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps |journal=Arch. Pathol. Lab. Med. |volume=131 |issue=3 |pages=440-5 |year=2007 |month=March |pmid=17516746 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=131&page=440}}</ref>):  
Adenomatous polyps & hyperplastic polyps - a comparison (adapted from Li and Burgart<ref>{{cite journal |author=Li SC, Burgart L |title=Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps |journal=Arch. Pathol. Lab. Med. |volume=131 |issue=3 |pages=440-5 |year=2007 |month=March |pmid=17516746 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=131&page=440}}</ref>):  
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They are all considered pre-malignant, i.e. if you leave 'em in place they often develop into cancer.
They are all considered pre-malignant, i.e. if you leave 'em in place they often develop into cancer.


===Management of polyps===
===Management of (intestinal) polyps===
Follow-up interval for polyps (colonoscopy interval):<ref name=pmid17167138>{{cite journal |author=Levine JS, Ahnen DJ |title=Clinical practice. Adenomatous polyps of the colon |journal=N. Engl. J. Med. |volume=355 |issue=24 |pages=2551–7 |year=2006 |month=December |pmid=17167138 |doi=10.1056/NEJMcp063038 |url=http://content.nejm.org/cgi/reprint/355/24/2551.pdf}}</ref>
Follow-up interval for polyps (colonoscopy interval):<ref name=pmid17167138>{{cite journal |author=Levine JS, Ahnen DJ |title=Clinical practice. Adenomatous polyps of the colon |journal=N. Engl. J. Med. |volume=355 |issue=24 |pages=2551–7 |year=2006 |month=December |pmid=17167138 |doi=10.1056/NEJMcp063038 |url=http://content.nejm.org/cgi/reprint/355/24/2551.pdf}}</ref>
*Normal follow-up (includes presence of ''hyperplastic polyps''): ~10 years.
*Normal follow-up (includes presence of ''hyperplastic polyps''): ~10 years.
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===Sessile serrated adenomas===
===Sessile serrated adenomas===
====General====
====General====
*Colonic lesion.
*More common in the right colon, i.e. ascending colon.
*More common in the right colon, i.e. ascending colon.


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====Microscopic====
====Microscopic====
Features:
*Serrated.
*Serrated.
*Crypt dilation at base - a '''key feature''' - very common.  
*Crypt dilation at base - a '''key feature''' - very common.  
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Micrographs:
Micrographs:
*[http://commons.wikimedia.org/wiki/File:Sessile_serrated_adenoma.jpg SSA - low mag. (wikimedia.org)].
*[http://commons.wikimedia.org/wiki/File:Sessile_serrated_adenoma.jpg SSA - low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Sessile_serrated_adenoma2.jpg SSA - intermed. mag. (wikimedia.org)].
*[http://commons.wikimedia.org/wiki/File:Sessile_serrated_adenoma2.jpg SSA - intermed. mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Sessile_serrated_adenoma3.jpg SSA - high mag. (wikimedia.org)].
*[http://commons.wikimedia.org/wiki/File:Sessile_serrated_adenoma3.jpg SSA - high mag. (WC)].


==Hamartomatous polyps==
==Hamartomatous polyps (overview)==
Numerous types of hamartomatous polyps exist:   
Numerous types of hamartomatous polyps exist:   
*Peutz-Jeghers syndrome.
*Peutz-Jeghers syndrome.
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There are several obscure/very rare types not listed above.   
There are several obscure/very rare types not listed above.   


Further reading: ''Gastrointestinal & Liver Pathology''<ref>{{Ref GLP|345}}</ref>
Further reading: ''Gastrointestinal & Liver Pathology''.<ref name=Ref_GLP345>{{Ref GLP|345}}</ref>


===Juvenile polyp===
==Juvenile polyp==
====General====
===General===
*Referred to ''retension polyps'' in non-juveniles.
*Referred to ''retension polyps'' in non-juveniles.


====Microscopic====
===Microscopic===
Features:<ref name=Ref_PBoD859>{{Ref PBoD|859}}</ref><ref name=pmid12692201>{{Cite journal  | last1 = Bronner | first1 = MP. | title = Gastrointestinal inherited polyposis syndromes. | journal = Mod Pathol | volume = 16 | issue = 4 | pages = 359-65 | month = Apr | year = 2003 | doi = 10.1097/01.MP.0000062992.54036.E4 | PMID = 12692201 | url = http://www.nature.com/modpathol/journal/v16/n4/full/3880773a.html }}</ref>
Features:<ref name=Ref_PBoD859>{{Ref PBoD|859}}</ref><ref name=pmid12692201>{{Cite journal  | last1 = Bronner | first1 = MP. | title = Gastrointestinal inherited polyposis syndromes. | journal = Mod Pathol | volume = 16 | issue = 4 | pages = 359-65 | month = Apr | year = 2003 | doi = 10.1097/01.MP.0000062992.54036.E4 | PMID = 12692201 | url = http://www.nature.com/modpathol/journal/v16/n4/full/3880773a.html }}</ref>
*Eroded, smooth or lobulated surface.
*Eroded, smooth or lobulated surface.
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Notes:  
Notes:  
*Nuclear changes may be like those seen in adenomatous polyps.
*Nuclear changes may be like those seen in adenomatous polyps.
*IHC can be used as an adjunct (p53, Ki67).
*IHC can be used as an adjunct (p53, Ki-67).
**p53 mutations in dysplastic epithelium -- negative stain (normal).
**p53 mutations in dysplastic epithelium -- negative stain (normal).


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*Inflammatory polyp.
*Inflammatory polyp.


===Peutz-Jeghers polyp===
==Peutz-Jeghers polyp==
===General===
====Epidemiology====
====Epidemiology====
Features:<ref name=Ref_PBoD859/><ref name=pmid12692201>{{Cite journal  | last1 = Bronner | first1 = MP. | title = Gastrointestinal inherited polyposis syndromes. | journal = Mod Pathol | volume = 16 | issue = 4 | pages = 359-65 | month = Apr | year = 2003 | doi = 10.1097/01.MP.0000062992.54036.E4 | PMID = 12692201 | url = http://www.nature.com/modpathol/journal/v16/n4/full/3880773a.html }}</ref>
Features:<ref name=Ref_PBoD859/><ref name=pmid12692201>{{Cite journal  | last1 = Bronner | first1 = MP. | title = Gastrointestinal inherited polyposis syndromes. | journal = Mod Pathol | volume = 16 | issue = 4 | pages = 359-65 | month = Apr | year = 2003 | doi = 10.1097/01.MP.0000062992.54036.E4 | PMID = 12692201 | url = http://www.nature.com/modpathol/journal/v16/n4/full/3880773a.html }}</ref>
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*Breast and gastrointestinal cancer.<ref name=pmid20581245>{{cite journal |author=Beggs AD, Latchford AR, Vasen HF, ''et al.'' |title=Peutz-Jeghers syndrome: a systematic review and recommendations for management |journal=Gut |volume=59 |issue=7 |pages=975–86 |year=2010 |month=July |pmid=20581245 |doi=10.1136/gut.2009.198499 |url=}}</ref>
*Breast and gastrointestinal cancer.<ref name=pmid20581245>{{cite journal |author=Beggs AD, Latchford AR, Vasen HF, ''et al.'' |title=Peutz-Jeghers syndrome: a systematic review and recommendations for management |journal=Gut |volume=59 |issue=7 |pages=975–86 |year=2010 |month=July |pmid=20581245 |doi=10.1136/gut.2009.198499 |url=}}</ref>


====Microscopy====  
===Microscopy===
Features:<ref name=Ref_PBoD859/><ref name=pmid12692201>{{Cite journal  | last1 = Bronner | first1 = MP. | title = Gastrointestinal inherited polyposis syndromes. | journal = Mod Pathol | volume = 16 | issue = 4 | pages = 359-65 | month = Apr | year = 2003 | doi = 10.1097/01.MP.0000062992.54036.E4 | PMID = 12692201 | url = http://www.nature.com/modpathol/journal/v16/n4/full/3880773a.html }}</ref>
Features:<ref name=Ref_PBoD859/><ref name=pmid12692201>{{Cite journal  | last1 = Bronner | first1 = MP. | title = Gastrointestinal inherited polyposis syndromes. | journal = Mod Pathol | volume = 16 | issue = 4 | pages = 359-65 | month = Apr | year = 2003 | doi = 10.1097/01.MP.0000062992.54036.E4 | PMID = 12692201 | url = http://www.nature.com/modpathol/journal/v16/n4/full/3880773a.html }}</ref>
*Frond-like polyp with all three components of mucosa:
*Frond-like polyp with all three components of mucosa:
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*[http://www.nature.com/modpathol/journal/v16/n4/fig_tab/3880773f3.html Peutz-Jeghers polyp (nature.com)].
*[http://www.nature.com/modpathol/journal/v16/n4/fig_tab/3880773f3.html Peutz-Jeghers polyp (nature.com)].


===Cowden disease===
==Cowden disease==
Features:<ref>{{Ref PBoD|858-9}}</ref>
===Etiology===
*Hamartomatous polyps  
*PTEN gene mutation.
*Facial trichilemmomas (hair follicle root sheath epithelium tumour),
 
*Oral papillomas,
Clinical features:<ref>{{Ref PBoD|858-9}}</ref>
*Hamartomatous polyps.
*Facial trichilemmomas (hair follicle root sheath epithelium tumour).
*Oral papillomas.
*Acral keratoses (peripheral keratoses).
*Acral keratoses (peripheral keratoses).


====Etiology====
==Cronkhite-Canada syndrome==
*PTEN gene mutation.
*Abbreviated ''CCS''.
 
===Cronkhite-Canada syndrome===  
Same morphology as juvenile polyp. ???


Features:<ref>{{Ref PBoD|858-9}}</ref>
===General===
*Hamartomatous polyps,
Clinical features:<ref>{{Ref PBoD|858-9}}</ref>
*Hamartomatous polyps.
*Ectodermal abnormalities (nail atrophy, skin pigment, alopecia).
*Ectodermal abnormalities (nail atrophy, skin pigment, alopecia).
===Microscopic===
Features:
*Polyps have same morphology as juvenile polyp/retension polyp.


==See also==
==See also==
Michael
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