Difference between revisions of "Traditional serrated adenoma"

Traditional serrated adenoma
	Diagnosis in short
LM	ectopic crypt foci (ECF), serrated, eosinophilic cytoplasm, villous-like architecture, "pine cone, fernlike, stellate pit pattern"
Subtypes	With and without high grade dysplasia, mixed with other types of polyps
LM DDx	villous adenoma, hyperplastic polyp, sessile serrated adenoma
IHC	CK20 in the eosinophilic cells, absent in ECF; Ki67 (MIB1) stains ECF and absent in eosinophilic cells, MUC2+, MUC5CA+, MUC6-; In areas of dysplasia TP53+, nuclear B-catenin+; p16+ in late dysplasia
Molecular	BRAF & KRAS
Site	colon - usu. left side / gastrointestinal polyps
Prevalence	very rare
Prognosis	benign (pre-malignant)
Clin. DDx	other GI polyps
Treatment	polypectomy, q3years surveillance colonoscopy

Revision as of 12:32, 2 October 2015

Traditional serrated adenoma, abbreviated TSA, are a rare type of gastrointestinal polyp.

Before the sessile serrated adenomas were recognized, these lesions were known as serrated adenomas.^[1]

General

Very rare.
Pre-malignant.^[2]

Gross

Polypoid mass.
Usually in the left colon.

Microscopic

Features:^[3]

Serrated - essential.
Eosinophilic cytoplasm - key feature.
Nuclear atypia as in tubular adenoma.
- Nuclear hyperchromasia, enlargement and pseudostratification.
Villous-like architecture.

DDx:^[4]

Images

TSA - low mag. (WC/Nephron)
TSA - intermed. mag. (WC/Nephron)
TSA - very high mag. (WC/Nephron)

TSA - low mag. (WC/Nephron)
TSA - intermed. mag. (WC/Nephron)
TSA - high mag. (WC/Nephron)
TSA - very high mag. (WC/Nephron)

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Polyp, Sigmoid Colon, Polypectomy:
- Traditional serrated adenoma.
-- NEGATIVE for high-grade dysplasia.

Block letters

POLYP, SIGMOID COLON, POLYPECTOMY:
- TRADITIONAL SERRATED ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.

Micro

Nonvilliform TSA

This polyp has cytologic dysplasia and serrations at the surface; however, it does not have a villiform architecture. The surface epithelium has eosinophilic cytoplasm. Overall, the morphology is most in keeping with a traditional serrated adenoma.

References

↑ Noffsinger, AE.; Hart, J. (Jul 2010). "Serrated adenoma: a distinct form of non-polypoid colorectal neoplasia?". Gastrointest Endosc Clin N Am 20 (3): 543-63. doi:10.1016/j.giec.2010.03.012. PMID 20656251.
↑ Rosty, C.; Hewett, DG.; Brown, IS.; Leggett, BA.; Whitehall, VL. (Mar 2013). "Serrated polyps of the large intestine: current understanding of diagnosis, pathogenesis, and clinical management.". J Gastroenterol 48 (3): 287-302. doi:10.1007/s00535-012-0720-y. PMID 23208018.
↑ Li SC, Burgart L (March 2007). "Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps". Arch. Pathol. Lab. Med. 131 (3): 440-5. PMID 17516746. http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=131&page=440.
↑ URL: http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/differential-diagnosis.html. Accessed on: 28 May 2015.

[pmid20656251-1] Noffsinger, AE.; Hart, J. (Jul 2010). "Serrated adenoma: a distinct form of non-polypoid colorectal neoplasia?". Gastrointest Endosc Clin N Am 20 (3): 543-63. doi:10.1016/j.giec.2010.03.012. PMID 20656251.

[pmid23208018-2] Rosty, C.; Hewett, DG.; Brown, IS.; Leggett, BA.; Whitehall, VL. (Mar 2013). "Serrated polyps of the large intestine: current understanding of diagnosis, pathogenesis, and clinical management.". J Gastroenterol 48 (3): 287-302. doi:10.1007/s00535-012-0720-y. PMID 23208018.

[pmid17516746-3] Li SC, Burgart L (March 2007). "Histopathology of serrated adenoma, its variants, and differentiation from conventional adenomatous and hyperplastic polyps". Arch. Pathol. Lab. Med. 131 (3): 440-5. PMID 17516746. http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=131&page=440.

[4] URL: http://surgpathcriteria.stanford.edu/gitumors/traditional-serrated-adenoma/differential-diagnosis.html. Accessed on: 28 May 2015.

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