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Presented by Ralph Hruban, M.D. and prepared by Zarir E. Karanjawala, M.D., Ph.D.
Case 5: This >50 year old man was found to have a colon polyp on routine screening.
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Week 335: Case 5
This 50 year old man was found to have a colon polyp on routine screening. A polpectomy was performed.images/hruban121707_5a.jpg
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images/hruban121707_5d.jpgCorrect
Answer: Tubular adenoma with pseudoinvasion
Histology: The surface epithelium of this polyp is lined by the cells of a tubular adenoma. The polyp is remarkable for several large dilated glands in the stalk of the polyp. On close inspection, these glands lack significant atypia and they have “brought” their lamina propria down with them.
Discussion: Pseudoinvasion is a common mimicker of true invasion in colon polyps. Pseudoinvasion occurs when adenomatous epithelium is displaced into the submucosa of the polyp. Pseudoinvasion occurs most frequently in polyps in the rectum and sigmoid colon. Features which can be used to identify pseudoinvasion include the absence of a desmoplastic reaction, and the presence of lamina propria with associated hemorrhage. The glands of pseudoinvasion are often dilated and can be ruptured.
Reference(s):
– C. Iacobuzio-Donahue and E. Montgomery, Gastrointestinal and Liver Pathology, 2005, Churchill, Livingstone and Elsevier.Incorrect
Answer: Tubular adenoma with pseudoinvasion
Histology: The surface epithelium of this polyp is lined by the cells of a tubular adenoma. The polyp is remarkable for several large dilated glands in the stalk of the polyp. On close inspection, these glands lack significant atypia and they have “brought” their lamina propria down with them.
Discussion: Pseudoinvasion is a common mimicker of true invasion in colon polyps. Pseudoinvasion occurs when adenomatous epithelium is displaced into the submucosa of the polyp. Pseudoinvasion occurs most frequently in polyps in the rectum and sigmoid colon. Features which can be used to identify pseudoinvasion include the absence of a desmoplastic reaction, and the presence of lamina propria with associated hemorrhage. The glands of pseudoinvasion are often dilated and can be ruptured.
Reference(s):
– C. Iacobuzio-Donahue and E. Montgomery, Gastrointestinal and Liver Pathology, 2005, Churchill, Livingstone and Elsevier.
