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Presented by Dr. Pedram Argani and prepared by Dr. Yembur Ahmad
This case talks about a 82 year old man with colon polyps.
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1. Question
This is an 82 year old male with diverticulosis and associated mucosal polyps.
Diagnoses:
Correct
Answer: D
Histologic Description: This polypoid lesion is characterized by a lamina propria which has abundant fresh hemorrhage and hemosiderin, and has been replaced by bundles of smooth muscle. The crypts within tend to have a “diamond shaped appearance.” Superficially, the lesion is ulcerated, and the glands have a more hyperplastic appearance. These are the typical features of mucosal prolapse. Adjacent to diverticula, this constellation of findings has been referred to as “polypoid prolapsing mucosal fold.” The late Johns Hopkins pathologist Dr. Belur Bhagavan was one of the first to recognize this lesion.
Differential Diagnosis: Sessile serrated adenomas would typically demonstrate boat-shaped crypts at their base, and demonstrate greater serrations superficially. Adenomatous polyps would demonstrate nuclear stratification and hyperchromasia, typically at the top of the lesion. Neither a sessile serrated polyp nor adenomatous polyp would typically have the prominent smooth muscle replacement of lamina propria and hemosiderin seen in the current case. Peutz-Jeghers polyps typically have bands of smooth muscle which are well-formed and have a branching pattern, which is dissimilar to that seen in the current case.
Incorrect
Answer: D
Histologic Description: This polypoid lesion is characterized by a lamina propria which has abundant fresh hemorrhage and hemosiderin, and has been replaced by bundles of smooth muscle. The crypts within tend to have a “diamond shaped appearance.” Superficially, the lesion is ulcerated, and the glands have a more hyperplastic appearance. These are the typical features of mucosal prolapse. Adjacent to diverticula, this constellation of findings has been referred to as “polypoid prolapsing mucosal fold.” The late Johns Hopkins pathologist Dr. Belur Bhagavan was one of the first to recognize this lesion.
Differential Diagnosis: Sessile serrated adenomas would typically demonstrate boat-shaped crypts at their base, and demonstrate greater serrations superficially. Adenomatous polyps would demonstrate nuclear stratification and hyperchromasia, typically at the top of the lesion. Neither a sessile serrated polyp nor adenomatous polyp would typically have the prominent smooth muscle replacement of lamina propria and hemosiderin seen in the current case. Peutz-Jeghers polyps typically have bands of smooth muscle which are well-formed and have a branching pattern, which is dissimilar to that seen in the current case.
