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Presented by Ralph Hruban, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 5: This middle-aged patient had her appendix, and a portion of her cecum and ileum removed for another indication.
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Question 1 of 1
1. Question
Week 224: Case 5
This middle-aged patient had her appendix, and a portion of her cecum and ileum removed for another indication.images/may 23 2005 case 5 2 1.jpg
images/may 23 2005 case 5 2 2.jpg
images/may 23 2005 case 5 2 3.jpg
images/may 23 2005 case 5 2 4.jpgCorrect
Answer: Sessile serrated polyp
Histology: The appendix in this case is remarkable for a polyp. The polyp has an overall dysplasia, but the crypts are dilated and notable for focal lateral growth along the muscularis mucosa.
Discussion: A variety of polyps have an overall serrated architecture. By serrated architecture we mean a prominent “sawtooth” luminal surface caused by infolding of the crypt epithelium. Serrated adenomas have obviously dysplastic epithelia, while hyperplastic polyps are small (<5 mm) and lack overt dysplasia. Sessile serrated polyps are usually larger (>5 mm). They typically lack overt dysplasia, and, as in this case, they characteristically show lateral growth at the base of the crypts (at the muscularis mucosae). Sessile serrated polyps occur more commonly in the right colon than in the left.
Incorrect
Answer: Sessile serrated polyp
Histology: The appendix in this case is remarkable for a polyp. The polyp has an overall dysplasia, but the crypts are dilated and notable for focal lateral growth along the muscularis mucosa.
Discussion: A variety of polyps have an overall serrated architecture. By serrated architecture we mean a prominent “sawtooth” luminal surface caused by infolding of the crypt epithelium. Serrated adenomas have obviously dysplastic epithelia, while hyperplastic polyps are small (<5 mm) and lack overt dysplasia. Sessile serrated polyps are usually larger (>5 mm). They typically lack overt dysplasia, and, as in this case, they characteristically show lateral growth at the base of the crypts (at the muscularis mucosae). Sessile serrated polyps occur more commonly in the right colon than in the left.
