Colon, Adenoma with high grade dysplasia [LMP76100]

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Image Details
Diagnostic Modality: 
Whole Slide Image
Disease Category: 
Tissue Renewal, Regeneration, and Repair
Diagnosis: 
Adenoma with high grade dysplasia
Species: 
Human
Organ System: 
Gastrointestinal Tract
Gender: 
Male
Age: 
80 years
Diagnosis Code: 
ICD-10: D12 | ICD-O: 8140/0
Slide Contributor Information
Forse, C., Mete, O.

Keywords

misplaced epithelium, tubular adenoma

Clinical History

80 year old male with post polypectomy resection. The section represents a colon with tattooed area.

Clinical Discussion

High grade dysplasia in a tubular adenoma is determined by both cytological and architectural features. Cytological features include enlarged hyperchromatic nuclei with prominent nucleoli and nuclear stratification. Architectural features include back-to-back glands, cribriform glands or irregular budding/ branching of crypts. This case is an example of residual adenomatous tissue after a polypectomy.

By definition, an adenoma does not have invasion through the muscularis mucosae into the submucosa. Distinguishing pseudoinvasion/misplaced epithelium from true invasion can be difficult. As seen in the slide, pseudoinvasion of an adenoma demonstrates smooth, rounded edges with an overall lobular configuration, a surrounding rim of lamina propria, hemorrhage or hemosiderin and lack of desmoplasia. The misplaced glands have the same degree of dysplasia as the overlying adenoma. Invasive glands, however, are associated with stromal desmoplasia, irregular glands and tumour budding. There is often greater cytological atypia and lymphovascular invasion.