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Presented by Ralph Hruban, M.D. and prepared by Maryam Farinola M.D.
Case 5: This elderly patient noted blood per rectum.
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1. Question
Week 198: Case 5
This elderly patient noted blood per rectum. A 2.5 cm rectal mass was resected.images/dysplastic polyp 1.jpg
images/dysplastic polyp 2.jpg
images/dysplastic polyp 3.jpg
images/dysplastic polyp 4.jpgCorrect
Answer: Adenoma with pseudoinvasion
Histology: The epithelium covering this pedunculated polyp shows mild to moderate dysplasia. Deeper glands can be found. The degree of dysplasia in these deeper glands is similar to that seen on the surface of the polyp, and a rim of lamina propria accompanies the epithelium.
Discussion: Neoplastic and hyperplastic polyps may show misplaced epithelium within the submucosa. This finding can simulate an invasive adenocarcinoma. Features that favor “pseudoinvasion” or epithelial misplacement over invasive cancer include:
a) a similar degree of dysplasia in the misplaced epithelium and the surface epithelium,
b) no desmoplasia,
c) a rim of lamina propria around the glands, and
d) a lobulated nodule with round, smooth borders.Reference(s):
– Pascal et al, Pseudoinvasion with high-grade dysplasia in a colonic adenoma. Distinction from adenocarcinoma. Am J Surg Pathol. 1990 Jul;14(7):694-7.Incorrect
Answer: Adenoma with pseudoinvasion
Histology: The epithelium covering this pedunculated polyp shows mild to moderate dysplasia. Deeper glands can be found. The degree of dysplasia in these deeper glands is similar to that seen on the surface of the polyp, and a rim of lamina propria accompanies the epithelium.
Discussion: Neoplastic and hyperplastic polyps may show misplaced epithelium within the submucosa. This finding can simulate an invasive adenocarcinoma. Features that favor “pseudoinvasion” or epithelial misplacement over invasive cancer include:
a) a similar degree of dysplasia in the misplaced epithelium and the surface epithelium,
b) no desmoplasia,
c) a rim of lamina propria around the glands, and
d) a lobulated nodule with round, smooth borders.Reference(s):
– Pascal et al, Pseudoinvasion with high-grade dysplasia in a colonic adenoma. Distinction from adenocarcinoma. Am J Surg Pathol. 1990 Jul;14(7):694-7.
