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COLONIC POLYPS, TVA, Juvenile, Hyperplastic, TSA, SSA, Inflammatory, Peutz…
COLONIC POLYPS
HAMARTOMATOUS
JUVENILE:
- Flat surface and prominent dilation of glands
- Eroded surface
- LP expansion and cystically dilated non-dysplastic glands
- Prominent reactive surface change with several neutrophils
PEUTZ-JEGHERS:
- Characteristic branching smooth muscle if large endoscopic biopsy
- When biopsies are superficial or when ulceration distorts them, the features are unrecognizable
- The polyps display arborizing smooth muscle cores from which the mucosa emanates
- These polyps occasionally have associated dysplasia or (rarely) invasive carcinoma
- PJ polyps may also produce a striking transmural polyposis cystica profunda ('pseudoinvasion': in which the glands herniate rather than invade into the small bowel wall)
- The eosinophilic cords of smooth muscle partition groups of specific mucosa
- The appearance is that of disorganized site specific mucosa that has produced a polyp
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ADENOMATOUS
TUBULAR ADENOMA (TA):
- Nuclei larger and more hyperchromatic than surrounding normal colonic epithelial cells
- 'Top-down' growth pattern: Altered cells begin at top with normal colonic crypts below and lesion then begins to fill in the bottom gradually
- Architecture: Abnormal
- Cytology: Dysplastic
- Low-grade dysplasia: regular nuclei showing maintained nuclear polarity and nuclei are elongated, not round
- High-grade dysplasia: Equivalent to Tis but in the colon
TUBULOVILLOUS ADENOMA (TVA):
- As for TA architecture and features but with the addition of a villous component
- TVAs are said to warrant closer surveillance than TAs
- If a lesion has plentiful villous structures but is clearly neoplastic, then this is reported as villous adenoma (VA)
INFLAMMATORY
INFLAMMATORY PSEUDOPOLYP:
- Irregularly shaped islands of residual intact colonic mucosa that are the result of mucosal ulceration that occurs in response to localized or diffuse inflammation e.g. Crohn's or UC
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SESSILE SERRATED LESIONS
HYPERPLASTIC:
- Open serrated glands towards the lumen but the bases of the crypts are slender
- The serrations are associated with eosinophilic bubbly cytoplasm and extend only about halfway down the crypts
- Essential architecture of the colon is maintained i.e., the glands communicate between the lumen and the muscularis mucosae
- More common in the left side of the colon
SESSILE SERRATED LESION/ADENOMA (SSL/SSA):
- Essential colonic architecture is maintained in that lumina of glands communicate with muscularis mucosae
- The crypts have sideways extensions and serrations that extend to the bottoms of the crypts
- More common in the right side of the colon
TRADITIONAL SERRATED ADENOMA (TSA):
- Usually arise in left colon
- Disorganized architecture
- Cytoplasm is more eosinophilic and less basophilic than typical adenomas
- Tiny crypt outpouchings from the main glands are present, called ectopic crypts
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