- Email: [email protected]
Serrated colorectal polyps – developments since the 2010 WHO classification
IAP 2014 ABSTRACTS
Among these 228 cases were downstaged to pseudoneoplastic regeneration, 489 clear cut gastric carcinomas and 19 cases were diagnosed as tubular adenoma (LGD). Results: There were no gender differences in cases with regenerative changes (1.1:1) and adenomas (0.9:1) but carcinomas were more likely to be diagnosed in males (1.6:1). Patients with regernative changes significantly younger than carcinoma patients (62.8 vs 68.3 years). Regenerative lesions were found in 80% of the cases in the antrum whereas only 62% of the carcinomas occurred in the antrum. Following the time line from 2001 to 2011 it became evident that the overdiagnosis of regenerative changes as carcinomatous lesions decreased to 20% from the intial number in 2001. In parallel an increase in correct carcinoma diagnoses was observed. The gastritis status may help in a questionable situation since in regenerative changes less than 20% of the individuals had an active Helicobacter gastritis whereas this was in more than 70% the case in carcinoma patients. Discussion: The diagnosis of pseudocarcinomatous regeneration is an important differential diagnosis of neoplastic gastric lesions. In some cases it can be really hard to distinguish bizarre epithelial changes due to drug incuded lesions from carcinomatous foci. Without Helicobacter gastritis the diagnosis of carcinoma should be made even more carefully and the differential diagnosis of pseudocarcinomatous changes should be considered. Fortunatly with time the number of erroneously carcinoma diagnoses went down in 2011 to 20% compared to the year 2001. Nevertheless gastric ulcerations should always receive proper follow-up with biopsies until healed. In difficult cases a second opinion by an experienced GI-pathologist may be helpful to confirm pseudocarcinomatous changes vs carcinomatous lesions. References
S17
microsatellite instability but p53 mutation and wnt pathway activation. In a study of 200 traditional serrated adenomas (TSAs), we demonstrated flat as well as protuberant growth, slit-like serrations as an important diagnostic feature and different clinicopathological associations of morphologically identical BRAF- and KRASmutated TSAs. Advanced TSAs showed abrupt transition to overt dysplasia with p53 mutation, wnt pathway activation and in BRAFmutated polyps, loss of p16. Morphologically similar serrated tubulovillous adenomas show some TSA-like features but not slit-like serrations. They demonstrate KRAS mutation, negligible CIMP and are the likely precursors of most microsatellite stable serrated adenocarcinomas.
Gynecologic Pathology: SS 12-1 INTERESTING CASES IN GYNECOLOGIC PATHOLOGY: CASE 5 Takako Kiyokawa Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
Gastrointestinal Pathology: SY10-2
An 8.5-year-old girl presented with breast development, irregular uterine bleeding, and a spurt in height during the previous 9 months. She also complained of rapid increase of abdominal girth and body weight (4 kg). No remarkable past history or family history was noted. Her height (143 cm), breast development (Tanner stage 3), and pubic hair (Tanner stage 2) were compatible with precocious puberty. Laboratory examinations showed microcytic hypochromic anemia (Hb 9.2 g/dL), and serum estradiol was 138 pg/mL. LH and FSH were in the undetectable level even after a LH-RH (100 mg) injection. Ovarian tumor markers including CEA, CA19-9, CA125, a-fetoprotein, and hCG were within the normal range. Magnetic resonance imaging revealed a giant multilocular cystic tumor (25 14 10 cm) in the lower abdomen. Tumor resection was performed. The tumor originated from the right ovary and contained 3500 mL of yellowish serous fluid. The left ovary was grossly normal. The resected right ovarian tumor was multilocular cystic, measuring 16.0 cm in the greatest dimension, with occasional foci of whitish yellow elevated components in the cystic wall.
SERRATED COLORECTAL POLYPS – DEVELOPMENTS SINCE THE 2010 WHO CLASSIFICATION
Gynecologic Pathology: SY12-3
1. Douthwaite AJ, Lintott GAM. Gastroscopic observation of the effect of aspirin and certain other substances on the stomach. Lancet 1938; 232: 1222. 2. Vieth M, Mu¨ller H, Stolte M. Can the diagnosis of NSAID-induced or Hpassociated gastric ulceration be predicted from histology? Z Gastroenterol 2002; 40: 783–8. 3. Vieth M, Go¨rgens D, Langner C. Pseudoneoplastic regneration of the stomach. Histopathology and differential diagnosis. Pathologe 2010; 31: 171–6. 4. Stolte M, Panayiotou S, Schmitz J. Can NSAID/ASA induced erosions of the gastric mucosa be identified at histology? Pathol Res Pract 1999; 195: 137–42.
Neal I. Walker1,2 and Mark Bettington1,2,3 1Envoi Specialist Pathologists, Brisbane, Australia, 2The School of Medicine, The University of Queensland, Brisbane, Australia, and 3The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia An expert panel has recommended sessile serrated adenoma/polyp (SSA/P) be diagnosed if one crypt in a serrated polyp shows unequivocal architectural distortion, dilation and/or horizontal branching. In our practice, SSA/Ps represent 12.1% (WHO criteria) or 14.7% (expert panel criteria) of all polyps received, the highest levels yet reported. The expert panel defined SSA/Ps with cytological dysplasia (SSAD) as an advanced polyp with abrupt transition from typical SSA/P morphology to an area of cytological dysplasia. In our study, SSADs were no larger than SSA/Ps, represented 3.5% of SSA/Ps and 11% occurred in the left colon. Progression to SSAD involves not only MLH1 loss and
IMMUNOHISTOCHEMICAL AND MOLECULAR ADJUNCT TECHNIQUES IN DIFFERENTIAL DIAGNOSIS OF MOLAR LESIONS Annie N. Y. Cheung Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong Extensive use of ultrasound in early pregnancy has given rise to increased diagnostic dilemma, particularly the differential diagnosis of early complete mole, partial mole and abnormal nonmolar villous lesions. The rare entities of placental mesenchymal dysplasia, twin pregnancy with one complete mole further pose problems. Overdiagnosis of hydatidiform mole in ectopic pregnancy should also be avoided. Molecular cytogenetic studies, besides enhancing our understanding of pathogenesis, also facilitate diagnosis and management.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
Among these 228 cases were downstaged to pseudoneoplastic regeneration, 489 clear cut gastric carcinomas and 19 cases were diagnosed as tubular adenoma (LGD). Results: There were no gender differences in cases with regenerative changes (1.1:1) and adenomas (0.9:1) but carcinomas were more likely to be diagnosed in males (1.6:1). Patients with regernative changes significantly younger than carcinoma patients (62.8 vs 68.3 years). Regenerative lesions were found in 80% of the cases in the antrum whereas only 62% of the carcinomas occurred in the antrum. Following the time line from 2001 to 2011 it became evident that the overdiagnosis of regenerative changes as carcinomatous lesions decreased to 20% from the intial number in 2001. In parallel an increase in correct carcinoma diagnoses was observed. The gastritis status may help in a questionable situation since in regenerative changes less than 20% of the individuals had an active Helicobacter gastritis whereas this was in more than 70% the case in carcinoma patients. Discussion: The diagnosis of pseudocarcinomatous regeneration is an important differential diagnosis of neoplastic gastric lesions. In some cases it can be really hard to distinguish bizarre epithelial changes due to drug incuded lesions from carcinomatous foci. Without Helicobacter gastritis the diagnosis of carcinoma should be made even more carefully and the differential diagnosis of pseudocarcinomatous changes should be considered. Fortunatly with time the number of erroneously carcinoma diagnoses went down in 2011 to 20% compared to the year 2001. Nevertheless gastric ulcerations should always receive proper follow-up with biopsies until healed. In difficult cases a second opinion by an experienced GI-pathologist may be helpful to confirm pseudocarcinomatous changes vs carcinomatous lesions. References
S17
microsatellite instability but p53 mutation and wnt pathway activation. In a study of 200 traditional serrated adenomas (TSAs), we demonstrated flat as well as protuberant growth, slit-like serrations as an important diagnostic feature and different clinicopathological associations of morphologically identical BRAF- and KRASmutated TSAs. Advanced TSAs showed abrupt transition to overt dysplasia with p53 mutation, wnt pathway activation and in BRAFmutated polyps, loss of p16. Morphologically similar serrated tubulovillous adenomas show some TSA-like features but not slit-like serrations. They demonstrate KRAS mutation, negligible CIMP and are the likely precursors of most microsatellite stable serrated adenocarcinomas.
Gynecologic Pathology: SS 12-1 INTERESTING CASES IN GYNECOLOGIC PATHOLOGY: CASE 5 Takako Kiyokawa Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
Gastrointestinal Pathology: SY10-2
An 8.5-year-old girl presented with breast development, irregular uterine bleeding, and a spurt in height during the previous 9 months. She also complained of rapid increase of abdominal girth and body weight (4 kg). No remarkable past history or family history was noted. Her height (143 cm), breast development (Tanner stage 3), and pubic hair (Tanner stage 2) were compatible with precocious puberty. Laboratory examinations showed microcytic hypochromic anemia (Hb 9.2 g/dL), and serum estradiol was 138 pg/mL. LH and FSH were in the undetectable level even after a LH-RH (100 mg) injection. Ovarian tumor markers including CEA, CA19-9, CA125, a-fetoprotein, and hCG were within the normal range. Magnetic resonance imaging revealed a giant multilocular cystic tumor (25 14 10 cm) in the lower abdomen. Tumor resection was performed. The tumor originated from the right ovary and contained 3500 mL of yellowish serous fluid. The left ovary was grossly normal. The resected right ovarian tumor was multilocular cystic, measuring 16.0 cm in the greatest dimension, with occasional foci of whitish yellow elevated components in the cystic wall.
SERRATED COLORECTAL POLYPS – DEVELOPMENTS SINCE THE 2010 WHO CLASSIFICATION
Gynecologic Pathology: SY12-3
1. Douthwaite AJ, Lintott GAM. Gastroscopic observation of the effect of aspirin and certain other substances on the stomach. Lancet 1938; 232: 1222. 2. Vieth M, Mu¨ller H, Stolte M. Can the diagnosis of NSAID-induced or Hpassociated gastric ulceration be predicted from histology? Z Gastroenterol 2002; 40: 783–8. 3. Vieth M, Go¨rgens D, Langner C. Pseudoneoplastic regneration of the stomach. Histopathology and differential diagnosis. Pathologe 2010; 31: 171–6. 4. Stolte M, Panayiotou S, Schmitz J. Can NSAID/ASA induced erosions of the gastric mucosa be identified at histology? Pathol Res Pract 1999; 195: 137–42.
Neal I. Walker1,2 and Mark Bettington1,2,3 1Envoi Specialist Pathologists, Brisbane, Australia, 2The School of Medicine, The University of Queensland, Brisbane, Australia, and 3The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia An expert panel has recommended sessile serrated adenoma/polyp (SSA/P) be diagnosed if one crypt in a serrated polyp shows unequivocal architectural distortion, dilation and/or horizontal branching. In our practice, SSA/Ps represent 12.1% (WHO criteria) or 14.7% (expert panel criteria) of all polyps received, the highest levels yet reported. The expert panel defined SSA/Ps with cytological dysplasia (SSAD) as an advanced polyp with abrupt transition from typical SSA/P morphology to an area of cytological dysplasia. In our study, SSADs were no larger than SSA/Ps, represented 3.5% of SSA/Ps and 11% occurred in the left colon. Progression to SSAD involves not only MLH1 loss and
IMMUNOHISTOCHEMICAL AND MOLECULAR ADJUNCT TECHNIQUES IN DIFFERENTIAL DIAGNOSIS OF MOLAR LESIONS Annie N. Y. Cheung Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong Extensive use of ultrasound in early pregnancy has given rise to increased diagnostic dilemma, particularly the differential diagnosis of early complete mole, partial mole and abnormal nonmolar villous lesions. The rare entities of placental mesenchymal dysplasia, twin pregnancy with one complete mole further pose problems. Overdiagnosis of hydatidiform mole in ectopic pregnancy should also be avoided. Molecular cytogenetic studies, besides enhancing our understanding of pathogenesis, also facilitate diagnosis and management.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.