Sessile serrated adenoma: Difference between revisions

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{{Top
<noinclude>{{Top
|author1=[[User:Mikael Häggström|Mikael Häggström]]
|author1=[[User:Mikael Häggström|Mikael Häggström]]
|author2=
|author2=
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==Presentation==
==Presentation==
*[[Colorectal polyp]]
*[[Colorectal polyp]]
</noinclude>


==Microscopic examination==
==Microscopic examination==
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*Abundant '''mucin''', similar to hyperplastic polyps
*Abundant '''mucin''', similar to hyperplastic polyps
*'''Basal crypt dilation''', with mucous retention, and lateral spread of the crypt bases, commonly described as boot shaped or anchor shaped crypts.
*'''Basal crypt dilation''', with mucous retention, and lateral spread of the crypt bases, commonly described as boot shaped or anchor shaped crypts.


===Variations===
===Variations===
On low magnification, a sessile serrated adenoma may be flat (left) or protuberant (right):<ref name=Liu2017>{{cite journal|last1=Liu|first1=Cheng|last2=Walker|first2=Neal I|last3=Leggett|first3=Barbara A|last4=Whitehall|first4=Vicki LJ|last5=Bettington|first5=Mark L|last6=Rosty|first6=Christophe|title=Sessile serrated adenomas with dysplasia: morphological patterns and correlations with MLH1 immunohistochemistry|journal=Modern Pathology|volume=30|issue=12|year=2017|pages=1728–1738|issn=0893-3952|doi=10.1038/modpathol.2017.92}}<br>- "This work is licensed under a Creative Commons Attribution 4.0 International License."</ref>
On low magnification, a sessile serrated adenoma may be flat (left) or protuberant (right):<ref name=Liu2017>{{cite journal|last1=Liu|first1=Cheng|last2=Walker|first2=Neal I|last3=Leggett|first3=Barbara A|last4=Whitehall|first4=Vicki LJ|last5=Bettington|first5=Mark L|last6=Rosty|first6=Christophe|title=Sessile serrated adenomas with dysplasia: morphological patterns and correlations with MLH1 immunohistochemistry|journal=Modern Pathology|volume=30|issue=12|year=2017|pages=1728–1738|issn=0893-3952|doi=10.1038/modpathol.2017.92}}<br>- "This work is licensed under a Creative Commons Attribution 4.0 International License."</ref>
<gallery mode=packed>
<gallery mode=packed heights=240>
File:Histopathology of a flat sessile serrated adenoma.jpg
File:Histopathology of a flat sessile serrated adenoma.jpg
File:Histopathology of a protuberant sessile serrated adenoma.jpg
File:Histopathology of a protuberant sessile serrated adenoma.jpg
</gallery>
</gallery>
Variations on higher magnification:
<noinclude>Variations on higher magnification:
<gallery mode=packed>
<gallery mode=packed heights=200>
File:Histopathology of sessile serrated adenoma with crypt crowding and little serration.jpg|Sessile serrated adenoma with crypt crowding and little serration, loss of cytoplasmic mucin and marked cytological atypia.<ref name=Liu2017/>
File:Histopathology of sessile serrated adenoma with crypt crowding and little serration.jpg|Sessile serrated adenoma with '''crypt crowding''' and little serration, loss of cytoplasmic mucin and marked cytological atypia.<ref name=Liu2017/>
File:Histopathology of sessile serrated adenoma with elongated crypts.jpg|With '''elongated crypts'''.<ref name=Liu2017/>
File:Histopathology of sessile serrated adenoma with elongated crypts.jpg|With '''elongated crypts'''.<ref name=Liu2017/>
File:Histopathology of a sessile serrated adenoma with minimal deviation dysplasia, intermediate magnification.jpg|'''Minimal deviation dysplasia''': architectural changes are subtle with mild crowding of crypts separated by less lamina propria and showing some degree of disorganization.<ref name=Liu2017/>
File:Histopathology of a sessile serrated adenoma with minimal deviation dysplasia, intermediate magnification.jpg|'''Minimal deviation dysplasia''': architectural changes are subtle with mild crowding of crypts separated by less lamina propria and showing some degree of disorganization.<ref name=Liu2017/>
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File:Histopathology of a sessile serrated adenoma with serrated dysplasia, high magnification.jpg|High magnification of sessile serrated adenoma with '''serrated dysplasia''': The dysplastic nuclei are round and vesicular with often prominent nucleoli.<ref name=Liu2017/>
File:Histopathology of a sessile serrated adenoma with serrated dysplasia, high magnification.jpg|High magnification of sessile serrated adenoma with '''serrated dysplasia''': The dysplastic nuclei are round and vesicular with often prominent nucleoli.<ref name=Liu2017/>
File:Histopathology of sessile serrated adenoma with gastric phenotype.jpg|Sessile serrated adenoma with '''gastric phenotype''', characterized by foveolar mucin and round nuclei.<ref name=Liu2017/>
File:Histopathology of sessile serrated adenoma with gastric phenotype.jpg|Sessile serrated adenoma with '''gastric phenotype''', characterized by foveolar mucin and round nuclei.<ref name=Liu2017/>
</gallery>
</gallery></noinclude>
 
===Microscopic report===
A brief report is sufficient:
{|class=wikitable
| Cecum polyp, polypectomy:<br>Sessile serrated adenoma.
|}


===Differential diagnoses===
===Differential diagnoses===
<gallery mode=packed>
<gallery mode=packed heights=200>
File:Histopathology of a flat traditional serrated adenoma arising from a sessile serrated adenoma.jpg|thumb|A flat traditional serrated adenoma arising from a sessile serrated adenoma.<ref name=Liu2017/>
File:Traditional Serrated Adenoma of Colon (5203904731).jpg|'''[[Traditional serrated adenoma]]''', having protuberant exophytic configuration, complex villous growth pattern, and cells with abundant eosinophilic cytoplasm and elongated penicillate nuclei with dispersed chromatin.<ref name="TorlakovicGomez2008">{{cite journal|last1=Torlakovic|first1=Emina Emilia|last2=Gomez|first2=Jose D.|last3=Driman|first3=David K.|last4=Parfitt|first4=Jeremy R.|last5=Wang|first5=Chang|last6=Benerjee|first6=Tama|last7=Snover|first7=Dale C.|title=Sessile Serrated Adenoma (SSA) vs. Traditional Serrated Adenoma (TSA)|journal=The American Journal of Surgical Pathology|volume=32|issue=1|year=2008|pages=21–29|issn=0147-5185|doi=10.1097/PAS.0b013e318157f002}}</ref>
File:Hyperplastic Polyp of the Rectum (14060044206).jpg|'''[[Hyperplastic polyp]]''', should not have dilation of crypts, branching of crypts or horizontal glands at the base. Size larger than 0.5<ref>{{cite web|url=https://emedicine.medscape.com/article/1731536-overview#a6|title=Pathology of Serrated Colon Adenomas|website=Medscape|author=Andrea L Haws, MD, MS}} Updated: Apr 28, 2017</ref> cm slightly indicates a sessile serrated adenoma.
</gallery>
</gallery>
 
Regarding '''location''', the diagnosis of a sessile serrated adenoma is supported by a location within the proximal colon (cecum, ascending, and transverse colon), while hyperplastic polyps are most common in the sigmoid colon and rectum. However, both may occur throughout the colon.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/colontumorhyperplastic.html|title=Colon - Polyps - Hyperplastic polyp|website=Pathology Outlines|author=Author: Adrian C. Bateman, M.B.B.S., M.D.}} Minor changes: 23 September 2021</ref><ref>{{cite web|url=https://www.mypathologyreport.ca/sessile-serrated-adenoma/#:~:text=Sessile%20serrated%20adenomas%20are%20most,any%20location%20including%20the%20rectum|title=Sessile serrated adenoma of the colon|website=MyPathologyReport|author=David Driman, MBChB FRCPC}} Updated July 23, 2021</ref>
{{Bottom}}
<noinclude>{{Bottom}}</noinclude>

Latest revision as of 18:30, 6 December 2023

Author: Mikael Häggström [note 1]

Presentation


Microscopic examination

The characteristics of sessile serrated adenoma are:[1]

  • Sawtooth serrations of the epithelium
  • Abundant mucin, similar to hyperplastic polyps
  • Basal crypt dilation, with mucous retention, and lateral spread of the crypt bases, commonly described as boot shaped or anchor shaped crypts.

Variations

On low magnification, a sessile serrated adenoma may be flat (left) or protuberant (right):[2]

Variations on higher magnification:

  • Sessile serrated adenoma with crypt crowding and little serration, loss of cytoplasmic mucin and marked cytological atypia.[2]
    Sessile serrated adenoma with crypt crowding and little serration, loss of cytoplasmic mucin and marked cytological atypia.[2]
  • With elongated crypts.[2]
    With elongated crypts.[2]
  • Minimal deviation dysplasia: architectural changes are subtle with mild crowding of crypts separated by less lamina propria and showing some degree of disorganization.[2]
    Minimal deviation dysplasia: architectural changes are subtle with mild crowding of crypts separated by less lamina propria and showing some degree of disorganization.[2]
  • Minimal deviation dysplasia, showing hypermucinous with some crowding of nuclei, focal hyperchromasia, loss of polarity, mitotic figures (red arrow) and dystrophic mucus cells on the surface (black arrow).[2]
    Minimal deviation dysplasia, showing hypermucinous with some crowding of nuclei, focal hyperchromasia, loss of polarity, mitotic figures (red arrow) and dystrophic mucus cells on the surface (black arrow).[2]
  • Adenomatous dysplasia, having a ‘top–down’ dysplasia distribution similarly to conventional adenomas.[2]
    Adenomatous dysplasia, having a ‘top–down’ dysplasia distribution similarly to conventional adenomas.[2]
  • Low magnification of sessile serrated adenoma with serrated dysplasia, with small packed glandular structures with abundant eosinophilic cytoplasm.[2]
    Low magnification of sessile serrated adenoma with serrated dysplasia, with small packed glandular structures with abundant eosinophilic cytoplasm.[2]
  • High magnification of sessile serrated adenoma with serrated dysplasia: The dysplastic nuclei are round and vesicular with often prominent nucleoli.[2]
    High magnification of sessile serrated adenoma with serrated dysplasia: The dysplastic nuclei are round and vesicular with often prominent nucleoli.[2]
  • Sessile serrated adenoma with gastric phenotype, characterized by foveolar mucin and round nuclei.[2]
    Sessile serrated adenoma with gastric phenotype, characterized by foveolar mucin and round nuclei.[2]

Microscopic report

A brief report is sufficient:

Cecum polyp, polypectomy:
Sessile serrated adenoma.

Differential diagnoses

  • Traditional serrated adenoma, having protuberant exophytic configuration, complex villous growth pattern, and cells with abundant eosinophilic cytoplasm and elongated penicillate nuclei with dispersed chromatin.[3]
    Traditional serrated adenoma, having protuberant exophytic configuration, complex villous growth pattern, and cells with abundant eosinophilic cytoplasm and elongated penicillate nuclei with dispersed chromatin.[3]
  • Hyperplastic polyp, should not have dilation of crypts, branching of crypts or horizontal glands at the base. Size larger than 0.5[4] cm slightly indicates a sessile serrated adenoma.
    Hyperplastic polyp, should not have dilation of crypts, branching of crypts or horizontal glands at the base. Size larger than 0.5[4] cm slightly indicates a sessile serrated adenoma.

Regarding location, the diagnosis of a sessile serrated adenoma is supported by a location within the proximal colon (cecum, ascending, and transverse colon), while hyperplastic polyps are most common in the sigmoid colon and rectum. However, both may occur throughout the colon.[5][6]

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ Enoch Kuo, M.D., Raul S. Gonzalez, M.D.. Colon - Polyps - Sessile serrated adenoma. PathologyOutlines. Topic Completed: 1 January 2018. Minor changes: 1 October 2020
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Liu, Cheng; Walker, Neal I; Leggett, Barbara A; Whitehall, Vicki LJ; Bettington, Mark L; Rosty, Christophe (2017). "Sessile serrated adenomas with dysplasia: morphological patterns and correlations with MLH1 immunohistochemistry ". Modern Pathology 30 (12): 1728–1738. doi:10.1038/modpathol.2017.92. ISSN 0893-3952. 
    - "This work is licensed under a Creative Commons Attribution 4.0 International License."
  3. ↑ Torlakovic, Emina Emilia; Gomez, Jose D.; Driman, David K.; Parfitt, Jeremy R.; Wang, Chang; Benerjee, Tama; Snover, Dale C. (2008). "Sessile Serrated Adenoma (SSA) vs. Traditional Serrated Adenoma (TSA) ". The American Journal of Surgical Pathology 32 (1): 21–29. doi:10.1097/PAS.0b013e318157f002. ISSN 0147-5185. 
  4. ↑ Andrea L Haws, MD, MS. Pathology of Serrated Colon Adenomas. Medscape. Updated: Apr 28, 2017
  5. ↑ Author: Adrian C. Bateman, M.B.B.S., M.D.. Colon - Polyps - Hyperplastic polyp. Pathology Outlines. Minor changes: 23 September 2021
  6. ↑ David Driman, MBChB FRCPC. Sessile serrated adenoma of the colon. MyPathologyReport. Updated July 23, 2021

Image sources


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