Colorectal polyp: Difference between revisions

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{|class="wikitable"
{|class="wikitable"
|+ Colorectal adenoma
|+ Colorectal adenoma
! Type !! Risk of containing malignant cells !! Histopathology !! Image
! Type !! Risk of containing malignant cells !!colspan=2| Histopathology !! Image
|-
|-
! [[Hyperplastic polyp]]
! [[Hyperplastic polyp]]
| 0%
| 0%
| No dysplasia.<ref name=UpToDate>{{cite web|url=https://www.uptodate.com/contents/overview-of-colon-polyps#H695577522|title=Overview of colon polyps|author=Finlay A Macrae|website=UpToDate}} This topic last updated: Dec 10, 2018.</ref>
|colspan=2| No dysplasia.<ref name=UpToDate>{{cite web|url=https://www.uptodate.com/contents/overview-of-colon-polyps#H695577522|title=Overview of colon polyps|author=Finlay A Macrae|website=UpToDate}} This topic last updated: Dec 10, 2018.</ref>
*Mucin-rich type: Serrated (“saw tooth”) appearance, containing glands with star-shaped lumina.<ref name=Stanford>{{cite web|url=http://surgpathcriteria.stanford.edu/gitumors/colorectal-hyperplastic-polyp/|title=Hyperplastic Polyp of the Colon and Rectum|author=Robert V Rouse|website=Stanford University School of Medicine|date=2010-01-31}} Last updated 6/2/2015</ref> Crypts that are elongated but straight, narrow and hyperchromatic at the base. All crypts reach to the muscularis mucosae.<ref name=Stanford/>
*Mucin-rich type: Serrated (“saw tooth”) appearance, containing glands with star-shaped lumina.<ref name=Stanford>{{cite web|url=http://surgpathcriteria.stanford.edu/gitumors/colorectal-hyperplastic-polyp/|title=Hyperplastic Polyp of the Colon and Rectum|author=Robert V Rouse|website=Stanford University School of Medicine|date=2010-01-31}} Last updated 6/2/2015</ref> Crypts that are elongated but straight, narrow and hyperchromatic at the base. All crypts reach to the muscularis mucosae.<ref name=Stanford/>
*Goblet cell-rich type: Elongated, fat crypts and little to no serration. Filled with goblet cells, extending to surface, which commonly has a tufted appearance.<ref name=Stanford/>
*Goblet cell-rich type: Elongated, fat crypts and little to no serration. Filled with goblet cells, extending to surface, which commonly has a tufted appearance.<ref name=Stanford/>
| [[File:Hyperplastic Polyp of the Rectum (14060044206).jpg|180px]]
| [[File:Hyperplastic Polyp of the Rectum (14060044206).jpg|180px]]
|-
|-
! Tubular adenoma  
! [[Tubular adenoma]]
|rowspan=3| Low to high grade dysplasia<ref name=stanford-criteria>{{cite web|url=http://surgpathcriteria.stanford.edu/gitumors/colorectal-adenoma/|title=Adenoma of the Colon and Rectum|author=Robert V Rouse}} Original posting/last update : 1/31/10, 1/19/14</ref>
| '''2%''' at 1.5cm<ref>{{cite web|url=https://www.msdmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gastrointestinal-tract/polyps-of-the-colon-and-rectum|title=Polyps of the Colon and Rectum|author=Minhhuyen Nguyen|website=MSD Manual}} Last full review/revision June 2019</ref> || Over 75% of volume has tubular appearance.<ref name=WHO>{{cite book | last=Bosman | first=F. T. | title=WHO classification of tumours of the digestive system | publisher=International Agency for Research on Cancer | publication-place=Lyon | year=2010 | isbn=92-832-2432-9 | oclc=688585784 | ref=harv}}</ref>
| '''2%''' at 1.5cm<ref>{{cite web|url=https://www.msdmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gastrointestinal-tract/polyps-of-the-colon-and-rectum|title=Polyps of the Colon and Rectum|author=Minhhuyen Nguyen|website=MSD Manual}} Last full review/revision June 2019</ref> || Over 75% of volume has tubular appearance.<ref name=WHO>{{cite book | last=Bosman | first=F. T. | title=WHO classification of tumours of the digestive system | publisher=International Agency for Research on Cancer | publication-place=Lyon | year=2010 | isbn=92-832-2432-9 | oclc=688585784 | ref=harv}}</ref>
| [[File:Tubular adenoma of the colon.jpg|180px]]
| [[File:Tubular adenoma of the colon.jpg|180px]]
|-
|-
! Tubulovillous adenoma  
! [[Tubulovillous adenoma]]
| '''20%''' to '''25%'''<ref name="AmersiAgustin2005">{{cite journal|last1=Amersi|first1=Farin|last2=Agustin|first2=Michelle|last3=Ko|first3=Clifford Y|title=Colorectal Cancer: Epidemiology, Risk Factors, and Health Services|journal=Clinics in Colon and Rectal Surgery|volume=18|issue=03|year=2005|pages=133–140|issn=1531-0043|doi=10.1055/s-2005-916274}}</ref>
| '''20%''' to '''25%'''<ref name="AmersiAgustin2005">{{cite journal|last1=Amersi|first1=Farin|last2=Agustin|first2=Michelle|last3=Ko|first3=Clifford Y|title=Colorectal Cancer: Epidemiology, Risk Factors, and Health Services|journal=Clinics in Colon and Rectal Surgery|volume=18|issue=03|year=2005|pages=133–140|issn=1531-0043|doi=10.1055/s-2005-916274}}</ref>
| 25%-75% villous<ref name=WHO/>
| 25%-75% villous<ref name=WHO/>
| [[File:Micrograph of tubulovillous adenoma.jpg|180px]]
| [[File:Micrograph of tubulovillous adenoma.jpg|180px]]
|-
|-
! Villous adenoma
! [[Villous adenoma]]
| '''15%'''<ref name=Ramji2016>{{cite web|url=https://emedicine.medscape.com/article/170283-followup#e3|title=Villous Adenoma Follow-up|website=Medscape|author=Alnoor Ramji}} Updated: Oct 24, 2016</ref> to '''40%'''<ref name="AmersiAgustin2005"/>
| '''15%'''<ref name=Ramji2016>{{cite web|url=https://emedicine.medscape.com/article/170283-followup#e3|title=Villous Adenoma Follow-up|website=Medscape|author=Alnoor Ramji}} Updated: Oct 24, 2016</ref> to '''40%'''<ref name="AmersiAgustin2005"/>
| Over 75% villous<ref name=WHO/>
| Over 75% villous<ref name=WHO/>
Line 57: Line 58:
}}</ref>
}}</ref>
|
|
|  
|colspan=2|
*Basal dilation of the crypts
*Basal dilation of the crypts
*Basal crypt serration
*Basal crypt serration
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! Colorectal adenocarcinoma
! Colorectal adenocarcinoma
| '''100%'''
| '''100%'''
|
|colspan=2|
*In carcinoma in situ (Tis): cancer cells invading into the lamina propria, and may involve but not penetrating the muscularis mucosae. Can be classified as "high-grade dysplasia", because prognosis and management are essentially the same.<ref name=UpToDate/>
*In carcinoma in situ (Tis): cancer cells invading into the lamina propria, and may involve but not penetrating the muscularis mucosae. Can be classified as "high-grade dysplasia", because prognosis and management are essentially the same.<ref name=UpToDate/>
*Invasive adenocarcinoma: Extending through the muscularis mucosae into the submucosa and beyond.<ref name=UpToDate/>
*Invasive adenocarcinoma: Extending through the muscularis mucosae into the submucosa and beyond.<ref name=UpToDate/>

Revision as of 03:40, 30 September 2019

Author: Mikael Häggström [note 1]

Gross examination

Further information: Colon

Tissue selection and trimming

File:Gross pathology of minimally invasive colorectal surgery of tubulovillous adenoma.jpg
There is a separate article for the Grossing of minimally invasive colorectal surgery.

Depending on sample format:[1]

  • Biopsies and polyps of <4 mm are embedded in their entirety. Samples less than 0.3 mm should be stained with eosin to avoid getting lost processing.
  • Polyps 4-8 mm with short stem or without stem: Identify the excision surface and divide the polyp longitudinally through the excision surface.
  • Polyps > 8 mm with a stem long enough to make it possible to take a transverse, whole slice from the stem closest to the excision surface: First, take a transverse slice through the peripheral portion of the stem, encompassing the entire circumference. Then take a 3-4 mm thick slice longitudinally through the polyp and the middle of the stem, after which the two remaining parts on either side are cut into equally thick slices, parallel to the previous slice.
  • Polyps >8 mm with short stem or without stem: Identify the excision surface and cut out a 3-4 mm thick disk that extends longitudinally through the center of the excision surface. Then divide the two remaining portions into equally thick slices, parallel to the previous slice.
  • Polyps that come in parts: Pick out the largest pieces, which are cut as similar as possible to above. Small fragments are sieved and embedded in a separate box.

Gross reporting

  • Polyp and/or fragment sizes
  • Presence or absence of stem of polyps

Example, for a gastrointestinal biopsy:

Labeled: "Sigmoid colon biopsy". The specimen is received in formalin and consists of 4 fragments of pink-tan tissue with a vaguely recognizable mucosal surface, mixed with food-like material. The fragments measure 0.2-0.3 cm in greatest dimension. The entire specimen is submitted for microscopic examination in one cassette.

Microscopic evaluation

Consider at least the following conditions:

File:Pie chart of colorectal polyp etiologies.png
Incidences and malignancy risks of various types of colorectal polyps.[2]
Colorectal adenoma
Type Risk of containing malignant cells Histopathology Image
Hyperplastic polyp 0% No dysplasia.[3]
  • Mucin-rich type: Serrated (“saw tooth”) appearance, containing glands with star-shaped lumina.[4] Crypts that are elongated but straight, narrow and hyperchromatic at the base. All crypts reach to the muscularis mucosae.[4]
  • Goblet cell-rich type: Elongated, fat crypts and little to no serration. Filled with goblet cells, extending to surface, which commonly has a tufted appearance.[4]
 File:Hyperplastic Polyp of the Rectum (14060044206).jpg
Tubular adenoma Low to high grade dysplasia[5] 2% at 1.5cm[6] Over 75% of volume has tubular appearance.[7] File:Tubular adenoma of the colon.jpg
Tubulovillous adenoma 20% to 25%[8] 25%-75% villous[7] File:Micrograph of tubulovillous adenoma.jpg
Villous adenoma 15%[9] to 40%[8] Over 75% villous[7] File:Villous adenoma of the colorectum (high power view).jpg
Sessile serrated adenoma (SSA)[10]
  • Basal dilation of the crypts
  • Basal crypt serration
  • Crypts that run horizontal to the basement membrane (horizontal crypts)
  • Crypt branching.
 File:Sessile Serrated Adenoma, Transverse Colon, 0.4 cm (3632298679).jpg
Colorectal adenocarcinoma 100%
  • In carcinoma in situ (Tis): cancer cells invading into the lamina propria, and may involve but not penetrating the muscularis mucosae. Can be classified as "high-grade dysplasia", because prognosis and management are essentially the same.[3]
  • Invasive adenocarcinoma: Extending through the muscularis mucosae into the submucosa and beyond.[3]
 File:Adenocarcinoma highly differentiated (rectum) H&E magn 400x.jpg

Microscopy report

It should include:[11]

  • Size of polyp (from gross examination)
  • Histopathologic type
  • Depth of growth and/or infiltration
  • Whether the resection is radical

Optionally, it can include degree of differentiation and/or dysplasia.

Example:

50 mm large tubulovillous adenoma with up to high grade columnar epithelial dysplasia. No infiltration. Radical excision.
This example is Public Domain, and can be copied without any need for author attribution.

  See also: General notes on reporting


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. ↑ Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg (1997-02-13). Lilla utskärningen.
  2. ↑ References for pie chart are located at separate image description page.
  3. ↑ 3.0 3.1 3.2 Finlay A Macrae. Overview of colon polyps. UpToDate. This topic last updated: Dec 10, 2018.
  4. ↑ 4.0 4.1 4.2 Robert V Rouse (2010-01-31). Hyperplastic Polyp of the Colon and Rectum. Stanford University School of Medicine. Last updated 6/2/2015
  5. ↑ Robert V Rouse. Adenoma of the Colon and Rectum. Original posting/last update : 1/31/10, 1/19/14
  6. ↑ Minhhuyen Nguyen. Polyps of the Colon and Rectum. MSD Manual. Last full review/revision June 2019
  7. ↑ 7.0 7.1 7.2 Bosman, F. T. (2010). WHO classification of tumours of the digestive system . Lyon: International Agency for Research on Cancer. ISBN 92-832-2432-9. OCLC 688585784. 
  8. ↑ 8.0 8.1 Amersi, Farin; Agustin, Michelle; Ko, Clifford Y (2005). "Colorectal Cancer: Epidemiology, Risk Factors, and Health Services ". Clinics in Colon and Rectal Surgery 18 (03): 133–140. doi:10.1055/s-2005-916274. ISSN 1531-0043. 
  9. ↑ Alnoor Ramji. Villous Adenoma Follow-up. Medscape. Updated: Oct 24, 2016
  10. ↑ Rosty, C; Hewett, D. G.; Brown, I. S.; Leggett, B. A.; Whitehall, V. L. (2013). "Serrated polyps of the large intestine: Current understanding of diagnosis, pathogenesis, and clinical management ". Journal of Gastroenterology 48 (3): 287–302. doi:10.1007/s00535-012-0720-y. PMID 23208018. 
  11. ↑ Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.

Image sources


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