COLORECTAL POLYPS:PATHOLOGY

POLYP:protuberant growth into lumen of bowel Types : by gross appearance pedunculated (with stalk) sessile(without stalk) Types :by pathogenesis inflammatory (pseudo-)polyp hamartomatous:juvenile polyposis Peutz-Jegher syndrome adenomatous:tubular villous tubulovillous

COLORECTAL POLYPS:PATHOLOGY
INFLAMMATORY(PSEUDO-)POLYP(mainly cellular infiltration,not hyperplasia) Island of hypertrophied mucosa. Delayed shedding of surface epithelia leading to infolding of crowded epithelia ; fusion of crypts. Surrounded by inflammatory cell infiltrate . Submucosal edema. Grossly: small(<5mm),smooth,hemispherical

COLORECTAL POLYPS PATHOLOGY

INFLAMMATORY(PSEUDO-)POLYP Site:majority in rectosigmoid Incidence:50% of people in >60 year age group (autopsy) Causes: longstanding UC,CD diverticular diseas benign lymphomatous chronic dysentrie

COLORECTAL POLYPS PATHOLOGY

HAMARTOMATOUS POLYP(Normal cells with abnormal tissue-architecture) 2 types juvenile polyp bulk of the polyp formed with lamina propria enclosing cystically dilated glands. Large,1-3cm,rounded,smooth,slightly lobulated with upto 2cm stalk.Usually in single.70% in rectosigmoid.

COLORECTAL POLYPS PATHOLOGY

Peutz-jeghers polyp Arborizing network of connective tissue with smooth muscle extending into polyp with surrounding normal glands and normal epithelia. Large, pedunculated. Multiple.ADsyndrome ( with melanotic mucocutaneous pigmentations).No malignant potential.

COLORECTAL POLYPS:PATHOLOGY
ADENOMATOUS POLYP Benign growth with varied malignant potential depending on size,histologic type or dysplastic change. Site:Anywhere from stomach to rectum. Mostly colon(90%).Left colon and rectum >>Right colon >transeverse. 30% of people in 60+ age(autopsy) M/c symptomatic polyp Same dietary and genetic(FAP,HNPCC) factors as colorectal CA

COLORECTAL POLYPS PATHOLOGY

ADENOMATOUS POLYP 3types: TUBULAR(65-80%) closely packed glandlike structure in >75% of the mucosa. mainly pedunculated. Stalk-fibromuscula With prominent blood vassels. Mainly in colon Smaller to villous type. Usu asymptomatic.may present with anaemia, bleeding P/R.

COLORECTAL POLYPS PATHOLOGY

ADENOMATOUS POLYP VILLOUS:(5-10%) confluent growth of frondlike projections in major part of mucosa. mostly rectal,more dysplastic, more malignant potential, larger(upto 10cm),sessile(no stalk as buffer zone- can invade directly into colonic wall). present with taenesmus, mucoid discharge, diarrhoea, dehydration, hypokalemia, acidosis. TUBULOVILLOUS:(10-25%) Both varities in reasonable proportions.

COLORECTAL POLYPS PATHOLOGY

ADENOMATOUS POLYP Adenoma-Carcinoma sequence most colorectal CA develop by malignant transformation of normal epithelia through adenomatous polyp, not de novo. similar risk factors, prognostic improvement with polypectomy, foci of residual benign adenoma in invasive CA, and molecular biologic evidence support this.

THANK YOU