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Presented by Dr. Pedram Argani and prepared by Dr. J. Judd Fite
This is a 65 year old male who undergoes a right hemicolectomy following the diagnosis of colonic adenoma on colon biopsy.
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Question 1 of 1
1. Question
This is a 65 year old male who undergoes a right hemicolectomy following the diagnosis of colonic adenoma on colon biopsy.
Correct
Answer: C. Composite villous adenoma-microcarcinoid
Histologic Description: This is large high risk villous adenoma which is associated with areas of dissecting mucin that lacks epithelium, and hence does not qualify as mucinous carcinoma. The striking features of the lesion are the infiltrative nests with mixed endocrine and squamoid features which involve the lamina propria. Unlike the intestinal adenoma, these nests lack intracellular mucin, mitoses and atypia, and hence do not represent adenocarcinoma. By immunohistochemistry, they label for both endocrine markers (synaptophysin) and squamous markers (cytokeratin 5/6, p63). These are the features of a composite intestinal adenoma-microcarcinoid. These are indolent lesions.
Differential Diagnosis: Adenocarcinoma would be associated with greater atypia and intracellular mucin in the infiltrating cells. Pseudoinvasion is associated with irregular nests of intact mucosa (including lamina propria) which herniate into the submucosa, simulating invasion. Mucinous adenocarcinoma is associated with neoplastic mucinous epithelium floating in pools of dissecting mucin.
References
Lin J et al. Am J Surg Pathol 2012; 36:292-295.
Sarlin J et al Am J Surg Pathol 1984; 8:281-285.
Salaria S et al J Clin Pathol 2013; 66:302-306.Incorrect
Answer: C. Composite villous adenoma-microcarcinoid
Histologic Description: This is large high risk villous adenoma which is associated with areas of dissecting mucin that lacks epithelium, and hence does not qualify as mucinous carcinoma. The striking features of the lesion are the infiltrative nests with mixed endocrine and squamoid features which involve the lamina propria. Unlike the intestinal adenoma, these nests lack intracellular mucin, mitoses and atypia, and hence do not represent adenocarcinoma. By immunohistochemistry, they label for both endocrine markers (synaptophysin) and squamous markers (cytokeratin 5/6, p63). These are the features of a composite intestinal adenoma-microcarcinoid. These are indolent lesions.
Differential Diagnosis: Adenocarcinoma would be associated with greater atypia and intracellular mucin in the infiltrating cells. Pseudoinvasion is associated with irregular nests of intact mucosa (including lamina propria) which herniate into the submucosa, simulating invasion. Mucinous adenocarcinoma is associated with neoplastic mucinous epithelium floating in pools of dissecting mucin.
References
Lin J et al. Am J Surg Pathol 2012; 36:292-295.
Sarlin J et al Am J Surg Pathol 1984; 8:281-285.
Salaria S et al J Clin Pathol 2013; 66:302-306.
