Sessile serrated adenoma - Revision history

Michael: /* Sign out */

2022-04-05T17:47:22Z

Sign out

← Older revision		Revision as of 17:47, 5 April 2022
Line 110:		Line 110:
	- Sessile serrated adenoma, NEGATIVE for conventional adenomatous dysplasia.		- Sessile serrated adenoma, NEGATIVE for conventional adenomatous dysplasia.
	</pre>		</pre>
			====Block letters====
	<pre>		<pre>
	POLYP, CECUM, POLYPECTOMY:		POLYP, CECUM, POLYPECTOMY:

Michael: /* Sign out */ alternate

2022-04-05T17:46:57Z

Sign out: alternate

← Older revision		Revision as of 17:46, 5 April 2022
Line 106:		Line 106:

	==Sign out==		==Sign out==
			<pre>
			Polyp, Hepatic Flexure of Colon, Polypectomy or Biopsy:
			- Sessile serrated adenoma, NEGATIVE for conventional adenomatous dysplasia.
			</pre>

	<pre>		<pre>
	POLYP, CECUM, POLYPECTOMY:		POLYP, CECUM, POLYPECTOMY:

Mark: ref tags

2018-11-27T21:51:08Z

ref tags

← Older revision		Revision as of 21:51, 27 November 2018
Line 67:		Line 67:
	*Horizontal crypts = crypt long axis parallel to the muscularis mucosae.		*Horizontal crypts = crypt long axis parallel to the muscularis mucosae.
	*Crypt branching.		*Crypt branching.
			*Submucosal [[lipoma]] or pseudolipoma is often seen in associated with SSA.{{fact}}
			*Perineuriomas are also seen in a small proportion of cases

	Minimal extent criteria - number of abnormal crypts with the above features:		Minimal extent criteria - number of abnormal crypts with the above features:
Line 76:		Line 78:
	**The 5th edition is likely to make a single crypt sufficient for diagnosis.		**The 5th edition is likely to make a single crypt sufficient for diagnosis.

	*Submucosal [[lipoma]] or pseudolipoma is often seen in associated with SSA.{{fact}}
	*Perineuriomas are also seen in a small proportion of cases

	===Dysplasia===		===Dysplasia===
	Sessile serrated adenomas typically lack "conventional" nuclear atypia, as seen in adenomata in the tubulovillous spectrum. ~~There~~ are nonetheless neoplastic lesions ~~based~~ on architectural "dysplasia". Additionally, dysplasia may manifest in more than one way:		Sessile serrated adenomas typically lack "conventional" nuclear atypia, as seen in adenomata in the tubulovillous spectrum. They are nonetheless neoplastic lesions on account of architectural "dysplasia". Additionally, dysplasia may manifest in more than one way:
	;Intestinal or "cytological" dysplasia: As seen in conventional adenomata, i.e. nuclear hyperchromasia and crowding. SSAs with nuclear atypia may be referred to as ''advanced sessile serrated adenomas''		;Intestinal or "cytological" dysplasia: As seen in conventional adenomata, i.e. nuclear hyperchromasia and crowding. SSAs with nuclear atypia may be referred to as ''advanced sessile serrated adenomas''
	;Serrated dysplasia: Round nuclei, prominent nucleoli and eosinophilic cytoplasm		;Serrated dysplasia: Round nuclei, prominent nucleoli and eosinophilic cytoplasm
	;Minimal deviation dysplasia: As the name suggests, there is only minor architectural and cytological changes. These areas are associated with loss of MLH1 immunostaining.{{Cite journal \| last1 = Liu \| first1 = C. \| last2 = Walker \| first2 = NI. \| last3 = Leggett \| first3 = BA. \| last4 = Whitehall \| first4 = VL. \| last5 = Bettington \| first5 = ML. \| last6 = Rosty \| first6 = C. \| title = Sessile serrated adenomas with dysplasia: morphological patterns and correlations with MLH1 immunohistochemistry. \| journal = Mod Pathol \| volume = 30 \| issue = 12 \| pages = 1728-1738 \| month = 12 \| year = 2017 \| doi = 10.1038/modpathol.2017.92 \| PMID = 28752838 }}		;Minimal deviation dysplasia: As the name suggests, there is only minor architectural and cytological changes. These areas are associated with loss of MLH1 immunostaining.<ref name=pmid28752838>{{Cite journal \| last1 = Liu \| first1 = C. \| last2 = Walker \| first2 = NI. \| last3 = Leggett \| first3 = BA. \| last4 = Whitehall \| first4 = VL. \| last5 = Bettington \| first5 = ML. \| last6 = Rosty \| first6 = C. \| title = Sessile serrated adenomas with dysplasia: morphological patterns and correlations with MLH1 immunohistochemistry. \| journal = Mod Pathol \| volume = 30 \| issue = 12 \| pages = 1728-1738 \| month = 12 \| year = 2017 \| doi = 10.1038/modpathol.2017.92 \| PMID = 28752838 }}</ref>

	===DDx===		===DDx===

Mark: patterns of dysplasia; WHO 2019 likely to required just 1 crypt

2018-11-27T19:39:14Z

patterns of dysplasia; WHO 2019 likely to required just 1 crypt

← Older revision		Revision as of 19:39, 27 November 2018
Line 31:		Line 31:
	'''Sessile serrated adenoma''', abbreviated ''SSA'', is a premalignant [[GI polyps\|polyp]] of the large bowel.		'''Sessile serrated adenoma''', abbreviated ''SSA'', is a premalignant [[GI polyps\|polyp]] of the large bowel.

	It is also known as '''sessile serrated polyp''' (abbreviated ''SSP''), '''sessile serrated lesion''' and '''sessile serrated adenoma/polyp''' (abbreviated ''SSA/P'').		It is also known as '''sessile serrated polyp''' (abbreviated ''SSP''), '''sessile serrated lesion''' and '''sessile serrated adenoma/polyp''' (abbreviated ''SSA/P''). In the United Kingdom, this entity and is known as a sessile serrated lesion, a terminology that is likely to be adopted in the 2019/5th edition WHO Blue Book.

	This lesion should not be confused with the ''[[traditional serrated adenoma]]'', previously known as ''[[serrated adenoma]]''.		This lesion should not be confused with the ''[[traditional serrated adenoma]]'', previously known as ''[[serrated adenoma]]''.

	==General==		==General==
	*Colonic lesion.		*Colonic lesion.
Line 70:		Line 71:
	*''German Society of Pathology'' proposal: at least two abnormal crypts -- crypts do not have to be adjacent.<ref name=pmid23052370>{{Cite journal \| last1 = Ensari \| first1 = A. \| last2 = Bilezikçi \| first2 = B. \| last3 = Carneiro \| first3 = F. \| last4 = Doğusoy \| first4 = GB. \| last5 = Driessen \| first5 = A. \| last6 = Dursun \| first6 = A. \| last7 = Flejou \| first7 = JF. \| last8 = Geboes \| first8 = K. \| last9 = de Hertogh \| first9 = G. \| title = Serrated polyps of the colon: how reproducible is their classification? \| journal = Virchows Arch \| volume = 461 \| issue = 5 \| pages = 495-504 \| month = Nov \| year = 2012 \| doi = 10.1007/s00428-012-1319-7 \| PMID = 23052370 }}</ref><ref name=pmid20617338>{{Cite journal \| last1 = Aust \| first1 = DE. \| last2 = Baretton \| first2 = GB. \| title = Serrated polyps of the colon and rectum (hyperplastic polyps, sessile serrated adenomas, traditional serrated adenomas, and mixed polyps)-proposal for diagnostic criteria. \| journal = Virchows Arch \| volume = 457 \| issue = 3 \| pages = 291-7 \| month = Sep \| year = 2010 \| doi = 10.1007/s00428-010-0945-1 \| PMID = 20617338 }}</ref>		*''German Society of Pathology'' proposal: at least two abnormal crypts -- crypts do not have to be adjacent.<ref name=pmid23052370>{{Cite journal \| last1 = Ensari \| first1 = A. \| last2 = Bilezikçi \| first2 = B. \| last3 = Carneiro \| first3 = F. \| last4 = Doğusoy \| first4 = GB. \| last5 = Driessen \| first5 = A. \| last6 = Dursun \| first6 = A. \| last7 = Flejou \| first7 = JF. \| last8 = Geboes \| first8 = K. \| last9 = de Hertogh \| first9 = G. \| title = Serrated polyps of the colon: how reproducible is their classification? \| journal = Virchows Arch \| volume = 461 \| issue = 5 \| pages = 495-504 \| month = Nov \| year = 2012 \| doi = 10.1007/s00428-012-1319-7 \| PMID = 23052370 }}</ref><ref name=pmid20617338>{{Cite journal \| last1 = Aust \| first1 = DE. \| last2 = Baretton \| first2 = GB. \| title = Serrated polyps of the colon and rectum (hyperplastic polyps, sessile serrated adenomas, traditional serrated adenomas, and mixed polyps)-proposal for diagnostic criteria. \| journal = Virchows Arch \| volume = 457 \| issue = 3 \| pages = 291-7 \| month = Sep \| year = 2010 \| doi = 10.1007/s00428-010-0945-1 \| PMID = 20617338 }}</ref>
	*An expert panel lead by ''Rex'' states that one unequivocally altered crypt should prompt calling SSA.<ref name=pmid22710576>{{Cite journal \| last1 = Rex \| first1 = DK. \| last2 = Ahnen \| first2 = DJ. \| last3 = Baron \| first3 = JA. \| last4 = Batts \| first4 = KP. \| last5 = Burke \| first5 = CA. \| last6 = Burt \| first6 = RW. \| last7 = Goldblum \| first7 = JR. \| last8 = Guillem \| first8 = JG. \| last9 = Kahi \| first9 = CJ. \| title = Serrated lesions of the colorectum: review and recommendations from an expert panel. \| journal = Am J Gastroenterol \| volume = 107 \| issue = 9 \| pages = 1315-29; quiz 1314, 1330 \| month = Sep \| year = 2012 \| doi = 10.1038/ajg.2012.161 \| PMID = 22710576 }}</ref>		*An expert panel lead by ''Rex'' states that one unequivocally altered crypt should prompt calling SSA.<ref name=pmid22710576>{{Cite journal \| last1 = Rex \| first1 = DK. \| last2 = Ahnen \| first2 = DJ. \| last3 = Baron \| first3 = JA. \| last4 = Batts \| first4 = KP. \| last5 = Burke \| first5 = CA. \| last6 = Burt \| first6 = RW. \| last7 = Goldblum \| first7 = JR. \| last8 = Guillem \| first8 = JG. \| last9 = Kahi \| first9 = CJ. \| title = Serrated lesions of the colorectum: review and recommendations from an expert panel. \| journal = Am J Gastroenterol \| volume = 107 \| issue = 9 \| pages = 1315-29; quiz 1314, 1330 \| month = Sep \| year = 2012 \| doi = 10.1038/ajg.2012.161 \| PMID = 22710576 }}</ref>
	*The WHO requires - depending on what you read:		*The 4th edition of the WHO blue book requires - depending on what you read:
	**Three adjacent crypts to be abnormal.<ref>URL: [http://surgpathcriteria.stanford.edu/gitumors/sessile-serrated-polyp-adenoma/ http://surgpathcriteria.stanford.edu/gitumors/sessile-serrated-polyp-adenoma/]. Accessed on: 26 September 2012.</ref>		**Three adjacent crypts to be abnormal.<ref>URL: [http://surgpathcriteria.stanford.edu/gitumors/sessile-serrated-polyp-adenoma/ http://surgpathcriteria.stanford.edu/gitumors/sessile-serrated-polyp-adenoma/]. Accessed on: 26 September 2012.</ref>
	**Two or three adjacent crypts to be abnormal.<ref name=pmid23052370/>		**Two or three adjacent crypts to be abnormal.<ref name=pmid23052370/>
			**The 5th edition is likely to make a single crypt sufficient for diagnosis.

	~~Notes:~~
	*Typically do not have nuclear atypia, i.e. no nuclear crowding, no nuclear hyperchromasia, no cigar-shaped nuclei.
	**SSAs with nuclear atypia may be referred to as ''advanced sessile serrated adenomas''.
	*Submucosal [[lipoma]] or pseudolipoma is often seen in associated with SSA.{{fact}}		*Submucosal [[lipoma]] or pseudolipoma is often seen in associated with SSA.{{fact}}
			*Perineuriomas are also seen in a small proportion of cases

			===Dysplasia===
			Sessile serrated adenomas typically lack "conventional" nuclear atypia, as seen in adenomata in the tubulovillous spectrum. There are nonetheless neoplastic lesions based on architectural "dysplasia". Additionally, dysplasia may manifest in more than one way:
			;Intestinal or "cytological" dysplasia: As seen in conventional adenomata, i.e. nuclear hyperchromasia and crowding. SSAs with nuclear atypia may be referred to as ''advanced sessile serrated adenomas''
			;Serrated dysplasia: Round nuclei, prominent nucleoli and eosinophilic cytoplasm
			;Minimal deviation dysplasia: As the name suggests, there is only minor architectural and cytological changes. These areas are associated with loss of MLH1 immunostaining.{{Cite journal \| last1 = Liu \| first1 = C. \| last2 = Walker \| first2 = NI. \| last3 = Leggett \| first3 = BA. \| last4 = Whitehall \| first4 = VL. \| last5 = Bettington \| first5 = ML. \| last6 = Rosty \| first6 = C. \| title = Sessile serrated adenomas with dysplasia: morphological patterns and correlations with MLH1 immunohistochemistry. \| journal = Mod Pathol \| volume = 30 \| issue = 12 \| pages = 1728-1738 \| month = 12 \| year = 2017 \| doi = 10.1038/modpathol.2017.92 \| PMID = 28752838 }}

	===DDx===		===DDx===

Michael: /* Dysplasia present */

2018-11-23T20:38:49Z

Dysplasia present

← Older revision		Revision as of 20:38, 23 November 2018
Line 121:		Line 121:
	<pre>		<pre>
	Polyp, Ascending Colon, Polypectomy or Biopsy:		Polyp, Ascending Colon, Polypectomy or Biopsy:
	- Sessile serrated adenoma with dysplasia, see comment.		- Sessile serrated adenoma with low-grade dysplasia, see comment.

	Comment:		Comment:

Michael: /* IHC */

2018-05-10T13:31:56Z

IHC

← Older revision		Revision as of 13:31, 10 May 2018
Line 95:		Line 95:

	==IHC==		==IHC==
	*[[Chromogranin A]] -ve; complete loss of staining.		*[[Chromogranin A]] -ve; complete loss of staining.<ref>Vitkovski T, Jawale R, Goldblum J ''et al.'' Density of neuroendocrine cells can distinguish hyperplastic polyps from small sessile serrated polyps. Modern Pathology (USCAP Annual Meeting 2018, Abstract Number 865), URL: [https://www.nature.com/articles/modpathol20189.pdf https://www.nature.com/articles/modpathol20189.pdf]. Accessed on: 10 May 2018.</ref>
	**Normal colorectal mucosa has scattered Chromogranin A-positive cells.		**Normal colorectal mucosa has scattered Chromogranin A-positive cells.
	**[[Hyperplastic polyp]] has increased scattered Chromogranin A-positive cells.		**[[Hyperplastic polyp]] has increased scattered Chromogranin A-positive cells.

Michael: /* IHC */

2018-04-25T18:24:28Z

IHC

← Older revision		Revision as of 18:24, 25 April 2018
Line 95:		Line 95:

	==IHC==		==IHC==
	*[[Chromogranin A]] ~~negative~~; complete loss of staining.		*[[Chromogranin A]] -ve; complete loss of staining.
	**Normal colorectal mucosa has scattered Chromogranin A-positive cells.		**Normal colorectal mucosa has scattered Chromogranin A-positive cells.
	**[[Hyperplastic polyp]] has increased scattered Chromogranin A-positive cells.		**[[Hyperplastic polyp]] has increased scattered Chromogranin A-positive cells.

Michael: tweak

2018-04-25T18:18:11Z

tweak

← Older revision		Revision as of 18:18, 25 April 2018
Line 9:		Line 9:
	\| LMDDx = [[hyperplastic polyp]], [[tubular adenoma]] when with dysplasia, [[mucosal prolapse]] for left sided lesions or background of [[diverticulosis]]		\| LMDDx = [[hyperplastic polyp]], [[tubular adenoma]] when with dysplasia, [[mucosal prolapse]] for left sided lesions or background of [[diverticulosis]]
	\| Stains =		\| Stains =
	\| IHC = Chromogranin A ~~loss~~		\| IHC = Chromogranin A (completely) -ve
	\| EM =		\| EM =
	\| Molecular =		\| Molecular =

Michael at 18:14, 25 April 2018

2018-04-25T18:14:27Z

← Older revision		Revision as of 18:14, 25 April 2018
Line 9:		Line 9:
	\| LMDDx = [[hyperplastic polyp]], [[tubular adenoma]] when with dysplasia, [[mucosal prolapse]] for left sided lesions or background of [[diverticulosis]]		\| LMDDx = [[hyperplastic polyp]], [[tubular adenoma]] when with dysplasia, [[mucosal prolapse]] for left sided lesions or background of [[diverticulosis]]
	\| Stains =		\| Stains =
	\| IHC =		\| IHC = Chromogranin A loss
	\| EM =		\| EM =
	\| Molecular =		\| Molecular =
Line 93:		Line 93:
	Image:Sessile_serrated_adenoma_3_very_high_mag.jpg \| SSA - very high mag. (WC/Nephron)		Image:Sessile_serrated_adenoma_3_very_high_mag.jpg \| SSA - very high mag. (WC/Nephron)
	</gallery>		</gallery>

			==IHC==
			*[[Chromogranin A]] negative; complete loss of staining.
			**Normal colorectal mucosa has scattered Chromogranin A-positive cells.
			**[[Hyperplastic polyp]] has increased scattered Chromogranin A-positive cells.

	==Sign out==		==Sign out==

Michael: /* Dysplasia present */

2017-06-08T14:01:50Z

Dysplasia present

← Older revision		Revision as of 14:01, 8 June 2017
Line 114:		Line 114:

	===Dysplasia present===		===Dysplasia present===
			<pre>
			Polyp, Ascending Colon, Polypectomy or Biopsy:
			- Sessile serrated adenoma with dysplasia, see comment.

			Comment:
			Sessile serrated adenomas with dysplasia are considered to be advanced lesions that
			have an increased propensity to transform to adenocarcinoma. Complete endoscopic removal is recommended. If complete endoscopic removal cannot be achieved, short-term re-endoscopy and biopsy, or surgical resection should be considered.
			</pre>

			===Block letters===
	<pre>		<pre>
	POLYP, ASCENDING COLON, POLYPECTOMY:		POLYP, ASCENDING COLON, POLYPECTOMY: