Sessile serrated adenoma
Author:
Mikael Häggström [note 1]
Contents
Presentation
Microscopic examination
The characteristics of sessile serrated adenoma are:[1]
- Sawtooth serrations of the epithelium
- Abundant mucin, similar to hyperplastic polyps
- Basal crypt dilation, with mucous retention, and lateral spread of the crypt bases, commonly described as boot shaped or anchor shaped crypts.
Variations
On low magnification, a sessile serrated adenoma may be flat (left) or protuberant (right):[2]
Variations on higher magnification:
Sessile serrated adenoma with crypt crowding and little serration, loss of cytoplasmic mucin and marked cytological atypia.[2]
With elongated crypts.[2]
Minimal deviation dysplasia: architectural changes are subtle with mild crowding of crypts separated by less lamina propria and showing some degree of disorganization.[2]
Minimal deviation dysplasia, showing hypermucinous with some crowding of nuclei, focal hyperchromasia, loss of polarity, mitotic figures (red arrow) and dystrophic mucus cells on the surface (black arrow).[2]
Adenomatous dysplasia, having a ‘top–down’ dysplasia distribution similarly to conventional adenomas.[2]
Low magnification of sessile serrated adenoma with serrated dysplasia, with small packed glandular structures with abundant eosinophilic cytoplasm.[2]
High magnification of sessile serrated adenoma with serrated dysplasia: The dysplastic nuclei are round and vesicular with often prominent nucleoli.[2]
Sessile serrated adenoma with gastric phenotype, characterized by foveolar mucin and round nuclei.[2]
Microscopic report
A brief report is sufficient:
Cecum polyp, polypectomy: Sessile serrated adenoma. |
Differential diagnoses
Traditional serrated adenoma, having protuberant exophytic configuration, complex villous growth pattern, and cells with abundant eosinophilic cytoplasm and elongated penicillate nuclei with dispersed chromatin.[3]
Hyperplastic polyp, should not have dilation of crypts, branching of crypts or horizontal glands at the base.
Regarding location, the diagnosis of a sessile serrated adenoma is supported by a location within the proximal colon (cecum, ascending, and transverse colon), while hyperplastic polyps are most common in the sigmoid colon and rectum. However, both may occur throughout the colon.[4][5]
Notes
- ↑ 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
- ↑ Enoch Kuo, M.D., Raul S. Gonzalez, M.D.. Colon - Polyps - Sessile serrated adenoma. PathologyOutlines. Topic Completed: 1 January 2018. Minor changes: 1 October 2020
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Liu, Cheng; Walker, Neal I; Leggett, Barbara A; Whitehall, Vicki LJ; Bettington, Mark L; Rosty, Christophe (2017). "Sessile serrated adenomas with dysplasia: morphological patterns and correlations with MLH1 immunohistochemistry
". Modern Pathology 30 (12): 1728–1738. doi: . ISSN 0893-3952.
- "This work is licensed under a Creative Commons Attribution 4.0 International License." - ↑ Torlakovic, Emina Emilia; Gomez, Jose D.; Driman, David K.; Parfitt, Jeremy R.; Wang, Chang; Benerjee, Tama; Snover, Dale C. (2008). "Sessile Serrated Adenoma (SSA) vs. Traditional Serrated Adenoma (TSA) ". The American Journal of Surgical Pathology 32 (1): 21–29. doi: . ISSN 0147-5185.
- ↑ Author: Adrian C. Bateman, M.B.B.S., M.D.. Colon - Polyps - Hyperplastic polyp. Pathology Outlines. Minor changes: 23 September 2021
- ↑ David Driman, MBChB FRCPC. Sessile serrated adenoma of the colon. MyPathologyReport. Updated July 23, 2021
Image sources