Image Description
The villous processes are lined by columnar epithelium with low-grade dysplasia. There is hypercellularity and nuclear overcrowding. The nuclei are slightly enlarged, elongated, and hyperchromatic but are still uniform and maintain their polarity. Nucleoli are not prominent. There is some loss of goblet cell mucin. Mitotic activity is not significantly increased. Architecturally, the glands show crowding and branching. There is lack of maturation as the epithelial cells move from crypts to the surface. The cytologic features impart a basophilic appearance to the adenomatous epithelium on routine H&E staining.
About the Disease
Introduction: A gastrointestinal polyp is any discrete mass of tissue protruding into the lumen. They can occur anywhere in the GI tract but are most common in the colo-rectal region. They may be pedunculated (with a well-defined stalk) or sessile (broad-based with no stalk). Colonic polyps are subdivided into two major groups: non-neoplastic and neoplastic. Non-neoplastic group includes hyperplastic polyps, hamartomatous polyps (juvenile polyps, Peutz-Jeghers polyps), inflammatory polyps and mucosal polyps. Hamartomatous polyps in syndromic settings can show germline mutations in tumor suppressor genes or oncogenes and carry malignant potential. Submucosal lesions may also lift the mucosa giving it a polypoid appearance. Neoplastic polyps show epithelial dysplasia by definition and include adenomas and carcinomas. Adenomas can be tubular, tubulovillous, or villous based on the glandular architecture. Serrated adenomas, which are related to hyperplastic polyps, have malignant potential and are now considered neoplastic. References: 1. Feldman, M., Friedman, L. S., & Brandt, L. J. (2016). Sleisenger & Fordtrans Gastrointestinal & Liver Disease; 10th Edition. Philadelphia, PA. Elsevier Saunders. 2. Goldblum, J. R. et al (2018). Rosai and Ackermans Surgical Pathology; Eleventh Edition. Philadelphia, PA. Elsevier. 3. Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran Pathologic Basis of Disease; Ninth Edition. Philadelphia, PA. Elsevier.