Difference between revisions of "Invisible colonic dysplasia"
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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 | 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. | ||
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===Alternate=== | |||
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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> | </pre> | ||
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.