Difference between revisions of "Invisible colonic dysplasia"
Jump to navigation
Jump to search
(→Sign out: +alternate) |
|||
| (4 intermediate revisions by the same user not shown) | |||
| Line 2: | Line 2: | ||
==General== | ==General== | ||
*The reason for random biopsies in inflammatory bowel disease. | *The reason for random biopsies in [[inflammatory bowel disease]]. | ||
*Relatively uncommon - one series of [[ulcerative colitis]] patients estimated ~12% of lesions are "invisible".<ref>{{cite journal |authors=Blonski W, Kundu R, Lewis J, Aberra F, Osterman M, Lichtenstein GR |title=Is dysplasia visible during surveillance colonoscopy in patients with ulcerative colitis? |journal=Scand J Gastroenterol |volume=43 |issue=6 |pages=698–703 |date=2008 |pmid=18569987 |doi=10.1080/00365520701866150 |url=}}</ref> | *Relatively uncommon - one series of [[ulcerative colitis]] patients estimated ~12% of lesions are "invisible".<ref>{{cite journal |authors=Blonski W, Kundu R, Lewis J, Aberra F, Osterman M, Lichtenstein GR |title=Is dysplasia visible during surveillance colonoscopy in patients with ulcerative colitis? |journal=Scand J Gastroenterol |volume=43 |issue=6 |pages=698–703 |date=2008 |pmid=18569987 |doi=10.1080/00365520701866150 |url=}}</ref> | ||
| Line 29: | Line 29: | ||
*Reactive changes due to inflammation. | *Reactive changes due to inflammation. | ||
*Invasive adenocarcinoma. | *Invasive adenocarcinoma. | ||
==Sign out== | |||
<pre> | |||
Submitted as "Colon Right, Biopsy": | |||
- Colonic mucosa with low-grade dysplasia, NEGATIVE for high-grade dysplasia, | |||
see comment. | |||
Comment: | |||
If the tissue was NOT a polyp on endoscopy, close follow-up, a re-examination of the history/family history and re-biopsies are suggested. | |||
</pre> | |||
===Alternate=== | |||
<pre> | |||
Rectum, Biopsy: | |||
- Polypoid fragment of rectal mucosa with LOW-GRADE DYSPLASIA, see comment. | |||
- NEGATIVE for high-grade dysplasia and NEGATIVE for malignancy. | |||
Comment: | |||
The histomorphology would be in keeping with a tubular adenoma; however, this specimen was not submitted as a polyp. Clinical correlation is recommended. Close follow-up with re-biopsy is suggested. | |||
</pre> | |||
==See also== | ==See also== | ||
*[[ | *[[Dysplasia-associated lesion or mass]] (DALM). | ||
==References== | ==References== | ||
Latest revision as of 14:38, 5 October 2021
Invisible colonic dysplasia is colonic dysplasia that is not seen on endoscopy.
General
- The reason for random biopsies in inflammatory bowel disease.
- Relatively uncommon - one series of ulcerative colitis patients estimated ~12% of lesions are "invisible".[1]
Gross
- Not visible - definitional.
Microscopic
Features:
- Nuclear changes at the surface of the mucosa - key feature.
- Size and shape or size change:
- Cigar-shaped (elongated) nucleus (usu. length:width > 3:1) with nuclear hyperchromasia (more blue).
- Large round nuclei +/- vesicular appearance (clearing) -- nuclei have white space.
- Nuclear crowding/pseudostratification - important.
- +/-Loss of nuclear polarity (nuclei no longer on basement membrane).
- Size and shape or size change:
- Loss/decrease of goblet cells (common).
- Cytoplasmic hyperchromasia.
Notes:
- Nuclear changes deep to the surface are non-neoplastic if normal appearing mucosa (with small round nuclei) is superficial to it; mucosa that is more blue and atypical deep and less blue without nuclear atypia at the surface is said to be "maturing".
- Classically, adenomatous polyps have "reverse maturation":
- The surface is more hyperchromatic (more blue).
- The base is more mature (more globlet cells, no nuclear changes -- less blue).
- Classically, adenomatous polyps have "reverse maturation":
- Ampullary adenomas often have less prominent pseudostratification and fine chromatin.
DDx:
- Reactive changes due to inflammation.
- Invasive adenocarcinoma.
Sign out
Submitted as "Colon Right, Biopsy":
- Colonic mucosa with low-grade dysplasia, NEGATIVE for high-grade dysplasia,
see comment.
Comment:
If the tissue was NOT a polyp on endoscopy, close follow-up, a re-examination of the history/family history and re-biopsies are suggested.
Alternate
Rectum, Biopsy:
- Polypoid fragment of rectal mucosa with LOW-GRADE DYSPLASIA, see comment.
- NEGATIVE for high-grade dysplasia and NEGATIVE for malignancy.
Comment:
The histomorphology would be in keeping with a tubular adenoma; however, this specimen was not submitted as a polyp. Clinical correlation is recommended. Close follow-up with re-biopsy is suggested.
See also
References
- ↑ Blonski W, Kundu R, Lewis J, Aberra F, Osterman M, Lichtenstein GR (2008). "Is dysplasia visible during surveillance colonoscopy in patients with ulcerative colitis?". Scand J Gastroenterol 43 (6): 698–703. doi:10.1080/00365520701866150. PMID 18569987.