Prolapse-related changes are a confounding factor in misdiagnosis of sessile serrated adenomas in the rectum

Huang, Cheng; Frankel, Wendy L.; Doukides, Theodore; Zhou, Xiaoping; Zhao, Weiqiang; Yearsley, Martha

doi:10.1016/j.humpath.2012.06.011

Cited by 22 publications

(23 citation statements)

References 28 publications

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“…3 Sometimes being limited by the size, orientation and other biopsy artifacts, the differential diagnosis of SSA/p from hyperplastic polyp (HP) could be morphologically challenging based on the histology only. Especially, in the left colon, prolapse colonic mucosa can mimic SSA/p, which has been recognized and described by Huang et al 4 Interobserver agreement for the diagnosis of SSA/p has been moderate based on hematoxylin and eosin (H&E) staining. 5 The distinction between SSA/p and HP is clinically important because they have different recommended surveillance interval based on their apparently different cancer risk.…”

Section: Introductionmentioning

confidence: 96%

Loss of Hes1 Differentiates Sessile Serrated Adenoma/Polyp From Hyperplastic Polyp

Cui

Awadallah

Liu

et al. 2016

American Journal of Surgical Pathology

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Sessile serrated adenoma/polyp (SSA/p) is a precancerous lesion, and its differential diagnosis from hyperplastic polyp (HP) could be challenging in certain circumstances based on morphology alone. Hes1 is a downstream target of Notch signaling pathway and plays an important role in intestinal development by regulating differentiation of enterocytes. In this study, we evaluated the expression patterns of Hes1 in SSA/p and hyperplastic polyp (HP), and determine whether Hes1 immunostaining can help differentiate between these two entities. Serrated polyps with cytological dysplasia (sessile serrated adenoma with cytological dysplasia, tubular adenoma, and traditional serrated adenoma) were also studied. Hes1 is ubiquitously expressed in the nuclei of normal colon epithelial cells. The complete loss or a very weak expression of Hes1 is observed in the majority of the SSA/p in the study (58/63, 92%) compared to the normal expression of Hes1 in HP (35/35,100%). In SSA/p with cytological dysplasia, dysplastic area demonstrated cytoplasmic and/or nuclear staining for Hes1. Tubular adenoma and traditional serrated adenoma showed variability of Hes1 staining within the polyp with a mixed positive and negative staining pattern. Our study suggests that loss of Hes1 could be used as a sensitive and specific marker to differentiate SSA/p from HP, which helps the diagnosis in morphologically challenging cases.

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Section: Introductionmentioning

confidence: 96%

Loss of Hes1 Differentiates Sessile Serrated Adenoma/Polyp From Hyperplastic Polyp

Cui

Awadallah

Liu

et al. 2016

American Journal of Surgical Pathology

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“… 14 , 16 In fact, a recent study found that 26.9% of originally diagnosed rectal SSAs were reclassified as MPP (hyperplastic polyps associated with prolapse) when strict diagnostic criteria for SSAs were applied. 17 Small biopsies, fragmented or tangentially orientated specimens may contribute with additional difficulties in the distinction of SSAs and MPP.…”

Section: Discussionmentioning

confidence: 99%

Mucosal Prolapse Polyp Mimicking Rectal Malignancy: A Case Report

Libânio

Meireles

Afonso

et al. 2016

GE Portuguese Journal of Gastroenterology

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Mucosal prolapse polyps (MPPs) are rare inflammatory lesions that are part of the mucosal prolapse syndrome. We present the case of a 40-year-old male with history of constipation referred to our institution with suspected rectal malignancy due to hematochezia and a palpable rectal mass. Colonoscopy revealed a 25 mm wide lesion suggestive of subepithelial origin but with marked erythema and erosion in the mucosa. Crypt dilatation and distortion, mixed inflammatory infiltrate and fibrosis were apparent on histological evaluation after bite-on-bite biopsies. Due to the initial suspicion of malignancy, resection was decided after discussion with the patient. However, due to non-elevation partial resection was performed allowing the diagnosis of MPP. Hematochezia ceased after obstipation treatment and endoscopic follow-up showed maintenance of the lesion with the same characteristics except for reduced dimension. MPP may mimic neoplastic lesions and should be considered in the differential diagnosis of rectal masses. History, endoscopy and histological characteristics are all necessary and important in the diagnosis of MPP.

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“…Although our case of eosinophilic colitis was easily diagnosed, caution must be exercised to avoid overdiagnosing colitis, because polyps commonly attract eosinophils and lymphocytes [20–22]. Mucosal prolapse may mimic hyperplastic polyps, sessile serrated adenomas, traditional nonserrated adenomas, inflammatory bowel disease, and other entities [4, 23]. …”

Section: Discussionmentioning

confidence: 99%

Specimens from Biopsies of Colorectal Polyps Often Harbor Additional Diagnoses

Chopra

2013

Pathology Research International

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Objectives. The utility of examining specimens from colorectal biopsies of polyps for nonneoplastic diseases is currently unknown. Our objectives were to characterize such additional diagnoses that could be rendered. Methods. We retrospectively and prospectively reviewed specimens from endoscopic biopsies of colorectal polyps obtained during routine screening or surveillance. Results. 17 of 168 specimens (10.1%) contained additional diagnoses, including schistosomiasis, eosinophilic colitis, intestinal spirochetosis, melanosis coli, and other entities. These findings were easily overlooked because they often affected mucosa that was spared by the polyps or were often evident only at high magnification. Schistosomiasis, eosinophilic colitis, and intestinal spirochetosis were clinically occult. Conclusions. Specimens from biopsies of colorectal polyps often harbor other diagnoses, in addition to polyps, and can be simultaneously screened for polyps and examined for nonneoplastic diseases. Detection of other diagnoses in addition to polyps requires awareness, examination at high magnification, and examination of areas spared by the polyps.

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Prolapse-related changes are a confounding factor in misdiagnosis of sessile serrated adenomas in the rectum

Cited by 22 publications

References 28 publications

Loss of Hes1 Differentiates Sessile Serrated Adenoma/Polyp From Hyperplastic Polyp

Loss of Hes1 Differentiates Sessile Serrated Adenoma/Polyp From Hyperplastic Polyp

Mucosal Prolapse Polyp Mimicking Rectal Malignancy: A Case Report

Specimens from Biopsies of Colorectal Polyps Often Harbor Additional Diagnoses

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