Figure 1
Photomicrographs of hyperplastic polyps. (a)…
Figure 1
Photomicrographs of hyperplastic polyps. (a) Microvesicular hyperplastic polyp (MVHP). The crypts and surface…
Figure 1Photomicrographs of hyperplastic polyps. (a) Microvesicular hyperplastic polyp (MVHP). The crypts and surface epithelium show a luminal serrated or saw-toothed contour more prominent in the upper levels of the crypts than at the base. The epithelial layer is composed of cells with goblet cell differentiation and others with microvesicular cytoplasmic mucin. (b) Goblet cell hyperplastic polyp. In contrast to MVHP, this polyp shows a much less pronounced serrated or saw-toothed luminal epithelial growth pattern and shows a preponderance of goblet cells and an absence of cells with microvesicular mucin. The crypts are straight, linear, and without architectural distortion. (c) Mucin poor hyperplastic polyp. The overall configuration of this polyp is similar to the microvesicular hyperplastic polyp but the cells are mucin depleted. The nuclei also are more hyperchromatic than the MVHP.
Figure 1
Photomicrographs of hyperplastic polyps. (a)…
Figure 1
Photomicrographs of hyperplastic polyps. (a) Microvesicular hyperplastic polyp (MVHP). The crypts and surface…
Figure 1Photomicrographs of hyperplastic polyps. (a) Microvesicular hyperplastic polyp (MVHP). The crypts and surface epithelium show a luminal serrated or saw-toothed contour more prominent in the upper levels of the crypts than at the base. The epithelial layer is composed of cells with goblet cell differentiation and others with microvesicular cytoplasmic mucin. (b) Goblet cell hyperplastic polyp. In contrast to MVHP, this polyp shows a much less pronounced serrated or saw-toothed luminal epithelial growth pattern and shows a preponderance of goblet cells and an absence of cells with microvesicular mucin. The crypts are straight, linear, and without architectural distortion. (c) Mucin poor hyperplastic polyp. The overall configuration of this polyp is similar to the microvesicular hyperplastic polyp but the cells are mucin depleted. The nuclei also are more hyperchromatic than the MVHP.
Figure 1
Photomicrographs of hyperplastic polyps. (a)…
Figure 1
Photomicrographs of hyperplastic polyps. (a) Microvesicular hyperplastic polyp (MVHP). The crypts and surface…
Figure 1Photomicrographs of hyperplastic polyps. (a) Microvesicular hyperplastic polyp (MVHP). The crypts and surface epithelium show a luminal serrated or saw-toothed contour more prominent in the upper levels of the crypts than at the base. The epithelial layer is composed of cells with goblet cell differentiation and others with microvesicular cytoplasmic mucin. (b) Goblet cell hyperplastic polyp. In contrast to MVHP, this polyp shows a much less pronounced serrated or saw-toothed luminal epithelial growth pattern and shows a preponderance of goblet cells and an absence of cells with microvesicular mucin. The crypts are straight, linear, and without architectural distortion. (c) Mucin poor hyperplastic polyp. The overall configuration of this polyp is similar to the microvesicular hyperplastic polyp but the cells are mucin depleted. The nuclei also are more hyperchromatic than the MVHP.
Figure 2
Photomicrograph of sessile serrated adenoma/polyps.…
Figure 2
Photomicrograph of sessile serrated adenoma/polyps. (a) A sessile serrated adenoma/polyp showing a hyperserrated…
Figure 2Photomicrograph of sessile serrated adenoma/polyps. (a) A sessile serrated adenoma/polyp showing a hyperserrated luminal epithelial growth pattern more pronounced that in microvesicular hyperplastic polyps. In addition, the crypts show luminal dilation towards the bases of the crypts, some crypts show horizontal growth along the long axis of the muscularis mucosa (arrow). Goblet cells are present at all levels of the crypts, some of which are dystrophic. Mitotic figures are easily recognized, and located predominantly in the basal aspects of the crypts. (b) Sessile serrated adenoma/polyp with cytological dysplasia. The portion of the polyp without cytological dysplasia on the left shows cells with uniform nuclei without pseudostratification. The cytologically dysplastic portion on the right (arrows) show hyperchromatic pseudostratified nuclei with numerous mitoses.
Figure 2
Photomicrograph of sessile serrated adenoma/polyps.…
Figure 2
Photomicrograph of sessile serrated adenoma/polyps. (a) A sessile serrated adenoma/polyp showing a hyperserrated…
Figure 2Photomicrograph of sessile serrated adenoma/polyps. (a) A sessile serrated adenoma/polyp showing a hyperserrated luminal epithelial growth pattern more pronounced that in microvesicular hyperplastic polyps. In addition, the crypts show luminal dilation towards the bases of the crypts, some crypts show horizontal growth along the long axis of the muscularis mucosa (arrow). Goblet cells are present at all levels of the crypts, some of which are dystrophic. Mitotic figures are easily recognized, and located predominantly in the basal aspects of the crypts. (b) Sessile serrated adenoma/polyp with cytological dysplasia. The portion of the polyp without cytological dysplasia on the left shows cells with uniform nuclei without pseudostratification. The cytologically dysplastic portion on the right (arrows) show hyperchromatic pseudostratified nuclei with numerous mitoses.
Figure 3
Traditional serrated adenoma. This polyp…
Figure 3
Traditional serrated adenoma. This polyp is composed of villiform projections of hypereosinophilic cells…
Figure 3Traditional serrated adenoma. This polyp is composed of villiform projections of hypereosinophilic cells with small oval-shaped nuclei oriented basally along the basement membrane. The cells are growing in a hyperserrated luminal contour. Multiple ectopic crypts are present. These are composed of crypts oriented perpendicular to the long axis of the villi. Overall, goblet cells are decreased in number.
Figure 4
A schematic representation of the…
Figure 4
A schematic representation of the putative development of CIMP-high CRCs with microsatellite instability…
Figure 4A schematic representation of the putative development of CIMP-high CRCs with microsatellite instability through a serrated pathway via methylation of the MLH1 gene.
Figure 5
Both sessile serrated adenoma/polyps and…
Figure 5
Both sessile serrated adenoma/polyps and hyperplastic polyps in the proximal colon may demonstrate…
Figure 5Both sessile serrated adenoma/polyps and hyperplastic polyps in the proximal colon may demonstrate a “mucus cap,” which may be yellow, green or rust-colored in white light (a) and red in narrow-band imaging (b).
Figure 5
Both sessile serrated adenoma/polyps and…
Figure 5
Both sessile serrated adenoma/polyps and hyperplastic polyps in the proximal colon may demonstrate…
Figure 5Both sessile serrated adenoma/polyps and hyperplastic polyps in the proximal colon may demonstrate a “mucus cap,” which may be yellow, green or rust-colored in white light (a) and red in narrow-band imaging (b).
Figure 6
Typical serrated lesions in the…
Figure 6
Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in…
Figure 6Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in the cecum. Note the adherent mucus in white light (a) and with narrow-band imaging (b). After removal of the cap by washing the characteristics surface features are seen in white light (c) and narrow-band imaging (d), including indistinct edges, color similar to the surrounding normal mucosa, and a paucity of blood vessels. e–h. A flat sessile serrated adenoma/polyp in the transverse colon, with the mucus cap in white light (e) and narrow-band imaging (f) and with the cap washed off in white light (g) and blue light (h). Note the subtlety of the lesion after the cap is washed off.
Figure 6
Typical serrated lesions in the…
Figure 6
Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in…
Figure 6Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in the cecum. Note the adherent mucus in white light (a) and with narrow-band imaging (b). After removal of the cap by washing the characteristics surface features are seen in white light (c) and narrow-band imaging (d), including indistinct edges, color similar to the surrounding normal mucosa, and a paucity of blood vessels. e–h. A flat sessile serrated adenoma/polyp in the transverse colon, with the mucus cap in white light (e) and narrow-band imaging (f) and with the cap washed off in white light (g) and blue light (h). Note the subtlety of the lesion after the cap is washed off.
Figure 6
Typical serrated lesions in the…
Figure 6
Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in…
Figure 6Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in the cecum. Note the adherent mucus in white light (a) and with narrow-band imaging (b). After removal of the cap by washing the characteristics surface features are seen in white light (c) and narrow-band imaging (d), including indistinct edges, color similar to the surrounding normal mucosa, and a paucity of blood vessels. e–h. A flat sessile serrated adenoma/polyp in the transverse colon, with the mucus cap in white light (e) and narrow-band imaging (f) and with the cap washed off in white light (g) and blue light (h). Note the subtlety of the lesion after the cap is washed off.
Figure 6
Typical serrated lesions in the…
Figure 6
Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in…
Figure 6Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in the cecum. Note the adherent mucus in white light (a) and with narrow-band imaging (b). After removal of the cap by washing the characteristics surface features are seen in white light (c) and narrow-band imaging (d), including indistinct edges, color similar to the surrounding normal mucosa, and a paucity of blood vessels. e–h. A flat sessile serrated adenoma/polyp in the transverse colon, with the mucus cap in white light (e) and narrow-band imaging (f) and with the cap washed off in white light (g) and blue light (h). Note the subtlety of the lesion after the cap is washed off.
Figure 6
Typical serrated lesions in the…
Figure 6
Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in…
Figure 6Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in the cecum. Note the adherent mucus in white light (a) and with narrow-band imaging (b). After removal of the cap by washing the characteristics surface features are seen in white light (c) and narrow-band imaging (d), including indistinct edges, color similar to the surrounding normal mucosa, and a paucity of blood vessels. e–h. A flat sessile serrated adenoma/polyp in the transverse colon, with the mucus cap in white light (e) and narrow-band imaging (f) and with the cap washed off in white light (g) and blue light (h). Note the subtlety of the lesion after the cap is washed off.
Figure 6
Typical serrated lesions in the…
Figure 6
Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in…
Figure 6Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in the cecum. Note the adherent mucus in white light (a) and with narrow-band imaging (b). After removal of the cap by washing the characteristics surface features are seen in white light (c) and narrow-band imaging (d), including indistinct edges, color similar to the surrounding normal mucosa, and a paucity of blood vessels. e–h. A flat sessile serrated adenoma/polyp in the transverse colon, with the mucus cap in white light (e) and narrow-band imaging (f) and with the cap washed off in white light (g) and blue light (h). Note the subtlety of the lesion after the cap is washed off.
Figure 6
Typical serrated lesions in the…
Figure 6
Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in…
Figure 6Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in the cecum. Note the adherent mucus in white light (a) and with narrow-band imaging (b). After removal of the cap by washing the characteristics surface features are seen in white light (c) and narrow-band imaging (d), including indistinct edges, color similar to the surrounding normal mucosa, and a paucity of blood vessels. e–h. A flat sessile serrated adenoma/polyp in the transverse colon, with the mucus cap in white light (e) and narrow-band imaging (f) and with the cap washed off in white light (g) and blue light (h). Note the subtlety of the lesion after the cap is washed off.
Figure 6
Typical serrated lesions in the…
Figure 6
Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in…
Figure 6Typical serrated lesions in the proximal colon. a–d. A sessile serrated adenoma/polyp in the cecum. Note the adherent mucus in white light (a) and with narrow-band imaging (b). After removal of the cap by washing the characteristics surface features are seen in white light (c) and narrow-band imaging (d), including indistinct edges, color similar to the surrounding normal mucosa, and a paucity of blood vessels. e–h. A flat sessile serrated adenoma/polyp in the transverse colon, with the mucus cap in white light (e) and narrow-band imaging (f) and with the cap washed off in white light (g) and blue light (h). Note the subtlety of the lesion after the cap is washed off.
Figure 7
The risk of developing colorectal…
Figure 7
The risk of developing colorectal cancers through the serrated pathway parallels the number,…
Figure 7The risk of developing colorectal cancers through the serrated pathway parallels the number, size, type, and anatomic distribution of the serrated polyps.
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