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Polypectomies

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IntroductionEdit

Most polypectomy specimens received in the surgical pathology laboratory are adenomas (colon) or fundic gland polyps (stomach).

Fresh HandlingEdit

Fix the specimen intact at least several hours prior to sectioning, and possibly overnight if needed to avoid crumbling (if more than 1.5 or 2 cm and received late); these specimens can be friable.

Grossing InEdit

  • Measure the dimensions of the polyp, diameter of the head and the length of the stalk (if present).
  • Description: Sessile or pedunculated? Ulcerated? Smooth surface or papillary? Cysts on cross section? Appearance of stalk?
  • Mode of Sectioning:
    • Short stalk (less than 1 cm) or sessile:
      • Ink surgical resection margin. Allow to dry.
      • Serially section at 3-5 mm intervals perpendicular to surgical margin if visible and submit entire specimen.
    • Long stalk (greater than 1 cm):
      • Ink stalk resection margin and allow to dry.
      • Serially section the polyp at 3-5 mm intervals paying particular attention to the central section containing the stalk.
      • The stalk margin is of prime importance! Precise orientation of the sections are crucial for interpretation of muscularis mucosa and/or stalk invasion!
      • Submit entire specimen.

Sample DictationEdit

The specimen is designated "sigmoid colon polyp" and consists of a single soft, red-brown polypoid portion of tissue measuring 0.5 x 0.4 x 0.2 cm. The specimen is inked black and serially sectioned. Sections are submitted in toto in one cassette labeled 1 A.

Review and SignoutEdit

If you receive a specimen labeled "polyp" and you see no evidence of either an adenoma or a hyperplastic polyp, the attending most likely will order levels to make sure the underlying cause of the polyp is not still in the block.

Colonic adenomasEdit

The report should include:

  • Type (tubular, villous, tubulovillous) - Criteria here are somewhat arbitrary, but less than 20%, greater than 50%, and 20-50% villous component, respectively, appear reasonable.
  • Degree of Dysplasia - As low grade dysplasia is considered part of the definition of adenoma, one should only mention the presence of high grade dysplasia.
  • Foci of invasive carcinoma
    • Degree of differentiation.
    • Location: Confined to lamina propria - intramucosal carcinoma; invasion beyond muscularis mucosa implies potential to metastasize.
    • Presence of lymphatic (unlikely in colon where lamina propria lacks lymphatics) or vascular Invasion.
  • Surgical Margins - Presence of dysplasia or carcinoma. Cautery artifact is usually at the surgical margin of endoscopically removed polypectomy specimens.


1. Left colon, polyp, cold forceps polypectomy:

-Hyperplastic polyp.
-Adenomatous polyp, completely excised.
-Adenomatous colonic epithelium, present at tissue edges.
-Colonic mucosa with hyperplastic changes.
-Colonic mucosa with (focal) adenomatous changes.
-Intramucosal carcinoma, arising in adenomatous polyp, present (or not) at cauterized tissue edges.

Return to Gastrointestinal Grossing

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