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Perez D, Wu T, Bhalla R, Fu Z, Centeno BA, Ghayouri M, Jiang K, Lauwers G, Nakanishi Y. Clinicopathological study of squamoid morules in nineteen conventional colorectal adenomas. Pathol Int 2025; 75:145-150. [PMID: 39898603 DOI: 10.1111/pin.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 12/20/2024] [Accepted: 01/10/2025] [Indexed: 02/04/2025]
Abstract
Squamoid morules are an intriguing finding rarely seen in colorectal adenomas, mimicking foci of microinvasion or neuroendocrine differentiation. We identified nineteen colorectal adenomas with squamoid morules and collected clinicopathological data. A representative block was chosen for immunohistochemistry. The expression of p40, p63, CK5/6, beta-catenin, synaptophysin, chromogranin, and Ki-67 in squamoid morules were examined immunohistochemically. The nineteen patients comprised fifteen males (79%) and four females (21%) ranging in age from 45 to 85 years (average: 59.4 years old). Fourteen adenomas were tubulovillous adenomas (average: 3.4 cm, ranging 1.0 to 6.0 cm) and five were tubular adenomas (average: 2.6 cm, ranging 1.6 to 3.0 cm). All foci of squamoid morules showed beta-catenin nuclear positivity and CK5/6 expression. Squamoid morules were focally positive for p63 in four adenomas and focally positive for p40 in two adenomas. In two adenomas squamoid morules are focally positive for synaptophysin, and in one adenoma chromogranin was focally positive. In all nineteen adenomas squamoid morules were negative for Ki-67. Squamoid morules are characterized by strong male predominance, large adenoma size, beta-catenin nuclear positivity, CK5/6 expression, and no Ki-67 expression. Beta-catenin nuclear expression is helpful in distinguishing squamoid morules from foci of microinvasion and neuroendocrine differentiation.
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Affiliation(s)
- Dana Perez
- Department of Pathology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Tong Wu
- Department of Pathology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ritu Bhalla
- Department of Pathology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Zhiyan Fu
- Department of Pathology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | | | | | - Kun Jiang
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Gregory Lauwers
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Yukihiro Nakanishi
- Department of Pathology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida, USA
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Rubio CA, Vieth M, Lang-Schwarz C. Dysplastic crypts with lateral buddings in tubular adenomas. Pathol Res Pract 2024; 264:155704. [PMID: 39522316 DOI: 10.1016/j.prp.2024.155704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 09/08/2024] [Accepted: 11/03/2024] [Indexed: 11/16/2024]
Abstract
Tubular adenomas (TA) are the most frequent of all colorectal adenomas. Current definitions of TA do not include the phenotype of the dysplastic crypts. We report a novel crypt phenotype characterized by dysplastic crypts with lateral buddings (DCLB). Out of the 309 TA, 25.9 % (n=80) exhibited DCLBs: 12.5 % (n=10) had one DCLB focus/TA, 15.0 % (n=12) had two DCLB foci/TA, 27.5 % (n=22) three had three DCLB foci/TA, 30.0 % (n=24) had four DCLB foci/TA, 12.5 % (n=10) had five DCLB foci/TA, and in the remaining 2.5 %n (n=2) most fields of view at x4 showed DCLB foci. DCLB in TA were generated independently of TA size or degree of dysplasia. The presence of DCLB was not influenced by age, gender or localization. In conclusion, a novel histologic phenotype of TA is showcased. DCLBs are integral components in some of the TA. Recently, another novel dysplastic crypt phenotype in TA characterized by dysplastic crypts in tandem was reported. The awareness that different dysplastic crypt phenotypes thrive in TA might open a new vista on research aimed to learn more about why the most prevalent of all colorectal adenomas thrive with a low capacity to invade the host.
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Affiliation(s)
- Carlos A Rubio
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden.
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Corinna Lang-Schwarz
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
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Rubio CA, Vieth M, Lang-Schwarz C. Dysplastic crypt-rings in tandem: A novel histologic parameter in tubular adenomas. Ann Diagn Pathol 2024; 72:152322. [PMID: 38705087 DOI: 10.1016/j.anndiagpath.2024.152322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
Descriptions of the various dysplastic crypt phenotypes occurring in TA have remained unattended in the literature. Recently, new crypt-phenotypes, characterized by crypt rings in tandem (CRT), and by dysplastic crypt rings in tandem (DCRT) were described in IBD, and in in IBD-associated dysplasia, respectively. Here, we report the occurrence of DCRT in 40.4 % (n = 59) out of 146 consecutive tubular adenomas of the colorectum (TA). The number of DCRT varied: 10 TA had two DCRT, seven TA had three DCRT, two TA, four DCRT and the remaining two TA had ≥ five DCRT. The frequency of DCRT was influenced by TA-size; larger TA (≥ 5 mm) had significantly more DCRT than smaller TA (<5 mm). Conversely, the frequency of TA with DCRT was not influenced by age, gender, or localization. Since only 1 or 2 sections were available per TA, the number of DCRT in the entire TA should be higher than those shown in Results. Historical controls in human and rodent normal colorectum showed no CRT. Moreover, DCRT were not found in 781 historical non-polypoid colorectal adenomas. The present finding might encourage searching for DCRT, the final goal being to achieve a more elaborated microscopic narrative of TA, the most prevalent of all colorectal adenomas.
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Affiliation(s)
- Carlos A Rubio
- Department of Oncology and Pathology, Karolinska Institute, Stockholm 17177, Sweden.
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany.
| | - Corinna Lang-Schwarz
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
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Shi L, Li H, Li S, Lin S, Wu Y. Pseudoinvasion and squamous metaplasia/morules in colorectal adenomatous polyp: a case report and literature review. Diagn Pathol 2024; 19:126. [PMID: 39289686 PMCID: PMC11406912 DOI: 10.1186/s13000-024-01535-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/07/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Submucosal pseudoinvasion and squamous metaplasia (SM) are incidental and special morphological findings in colorectal adenomas, and both can mimic invasive carcinoma. The coexistence of these two findings further increases the risk of misdiagnosis, posing a great diagnostic challenge to pathologists. From 1979 to 2022, only 8 cases have been reported, which was extremely rare. In this report, we presented a case of sigmoid colon adenoma accompanied by pseudoinvasion and SM. Additionally, relevant literature was analyzed to summarize the clinical and pathological characteristics. CASE PRESENTATION A 51-year-old Chinese male patient presented with fresh blood after defecation. Electronic colonoscopy revealed multiple polyps, which were removed using a snare and subjected to high-frequency electrocoagulation resection. The largest polyp, located in the sigmoid colon, was a thick pedunculated and lobulated polyp with a maximum diameter of 2.8 cm. The surface of the polyp showed slight ruggedness and redness, and it was sent for pathological examination. Grossly, the polyp had a lobulated and slightly rough surface. Microscopically, it showed a tubulovillous adenoma with focal high-grade dysplasia and mucosal muscle hyperplasia. Glandular elements were observed in the submucosal layer, forming a well-defined lobular structure. Some of the glands displayed cystic change, and focal SM could be seen within the adenoma. SM could manifest as discrete solid cell nests of varying sizes or cribriform-morular-like structures. Immunohistochemical staining showed that SM cells were diffusely positive for cytokeratin 5/6 (CK5/6); p40, p63, and cytokeratin 20 (CK20) were negative; while caudal type homeobox 2 (CDX2) was weakly positive. β-catenin showed abnormal nuclear expression, and an extremely low Ki67 proliferation index was observed. CONCLUSIONS Coexistence of SM and pseudoinvasion in colorectal adenomas is highly rare. It is more commonly observed in males and tends to occur in the sigmoid colon. It primarily manifests in tubulovillous adenoma and tubular adenoma, with a majority of cases exhibiting a pedicle. Histologically, it is similar to invasive lesions. The cystic dilation of the submucosal glands, hemosiderin deposition, and the presence of a lamina propria around the submucosal glands without adjacent desmoplastic reaction, suggest pseudoinvasion rather than cancer. The bland cytological morphology and Immunohistochemical markers play a crucial role in distinguishing SM from true invasive lesions.
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Affiliation(s)
- Li Shi
- Department of Pathology, Mudanjiang Medical University Affiliated Hongqi Hospital, No.5 Tongxiang Road, Aimin District, Mudanjiang, Heilongjiang, 157011, China
| | - Huamin Li
- Department of Pathology, Mudanjiang Medical University Affiliated Hongqi Hospital, No.5 Tongxiang Road, Aimin District, Mudanjiang, Heilongjiang, 157011, China
| | - Shulian Li
- Department of Pathology, Mudanjiang Medical University Affiliated Hongqi Hospital, No.5 Tongxiang Road, Aimin District, Mudanjiang, Heilongjiang, 157011, China
| | - Songyan Lin
- Department of Pathology, Mudanjiang Medical University Affiliated Hongqi Hospital, No.5 Tongxiang Road, Aimin District, Mudanjiang, Heilongjiang, 157011, China
| | - Ying Wu
- Department of Pathology, Mudanjiang Medical University Affiliated Hongqi Hospital, No.5 Tongxiang Road, Aimin District, Mudanjiang, Heilongjiang, 157011, China.
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Al-Janabi MH. Apocrine and clear cell metaplasia in the gallbladder: the first finding in the medical literature. Oxf Med Case Reports 2024; 2024:omae052. [PMID: 38784780 PMCID: PMC11110856 DOI: 10.1093/omcr/omae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/24/2024] [Accepted: 04/10/2024] [Indexed: 05/25/2024] Open
Abstract
Apocrine metaplasia, specifically, involves the development of cells resembling those in apocrine glands, characterized by their distinctive cytoplasmic features. Apocrine metaplasia in the gallbladder represents a new and intriguing discovery, marking a significant milestone in medical literature. Furthermore, clear cell metaplasia is often observed in other organs like the cervix and has never been documented in the gallbladder. The coexistence of apocrine and clear metaplasia challenges existing paradigms surrounding gallbladder pathology, prompting a reevaluation of the underlying mechanisms that drive these cellular transformations.
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Ferenczi Á, Kuthi L, Sejben I, Sejben A. Colonic Tubular Adenoma with Clear Cell Change: Case Report with Whole-Exome Sequencing and Updated Review of the Literature. Pathobiology 2024; 91:375-381. [PMID: 38574478 PMCID: PMC11449193 DOI: 10.1159/000538705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Colorectal tubular adenomas displaying clear cell change are rare entities, with unknown clinical relevance, prognosis, immunohistochemical, and molecular features. CASE PRESENTATION Hereby we report a case of a 43-year-old female patient with a rectosigmoid polyp. Histologically, conventional dysplasia was visible with scattered areas displaying clear cell change. Whole-exome sequencing (WES) was carried out and revealed high tumour mutation burden and 7 pathogenic mutations, including TP53, APC, FGFR4, EHBP1, IL4R, TYR, and ACTN3. CONCLUSION Clear cell change may only be present in less than 0.1% of adenomas. Aetiology is not well understood; additionally, few authors suggest autolysis or fixation problems. Our WES resulted in newly found pathogenic mutations, and high mutation burden, proving the lesion's neoplastic origin. Hitherto, neither special stainings nor immunohistochemical markers proved to be useful in the diagnostic process. From a differential diagnostic perspective, enteroblastic differentiation, primary and secondary clear cell adenocarcinoma has to be excluded.
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Affiliation(s)
- Ádám Ferenczi
- University of Szeged, Department of Pathology, Szeged, Hungary
| | - Levente Kuthi
- Department of Surgical and Molecular Pathology, National Institute of Oncology, Budapest, Hungary
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - István Sejben
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Anita Sejben
- University of Szeged, Department of Pathology, Szeged, Hungary
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El-Hawary AK, Attia S, Aboelamayem R, Ali KM. Osseous Metaplasia in Juvenile Polyps: Report of Four Cases and Review of Literature. Fetal Pediatr Pathol 2023; 42:93-97. [PMID: 35271404 DOI: 10.1080/15513815.2022.2047848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: There are occasional reports of osseous metaplasia (OM) occurring in gastrointestinal polyps. We report 4 cases occurring in juvenile retention polyps. Case reports: Four juvenile retention polyps presented with rectal bleeding. Microscopically there was osseous metaplasia in addition to the typical surface ulceration and granulation tissue appearance. Discussion/conclusion: Osseous metaplasia was only detected on histopathologic examination of the resected polyps. Although the clinical significance is not established, OM suggests that the polyps have been present for a longer period of time.
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Affiliation(s)
| | - Samar Attia
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rowaa Aboelamayem
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khadiga M Ali
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Fu ZY, Kmeid M, Aldyab M, Lagana SM, Lee H. Composite intestinal adenoma-microcarcinoid: An update and literature review. World J Gastrointest Endosc 2021; 13:593-606. [PMID: 35070021 PMCID: PMC8716980 DOI: 10.4253/wjge.v13.i12.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/19/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
Composite intestinal adenoma-microcarcinoid (CIAM) is a rare intestinal lesion consisting of conventional adenoma and small, well differentiated carcinoid [microcarcinoid (MC)] at its base. The incidence of CIAM is 3.8% in surgically resected colorectal polyps. While its pathogenesis is unknown, studies support the role of Wnt/β-catenin pathway in the tumorigenesis of CIAM. CIAMs have been primarily reported in the colon wherein they present as polyps with well-defined margins, similar to conventional adenomatous polyps. MC is usually found in adenomatous polyps with high-risk features such as large size, villous architecture, or high grade dysplasia. Histologically, the MC component is often multifocal and spans 3.9 to 5.8 millimeters in size. MC is usually confined within the mucosa but occasional CIAM cases with MC extending to the submucosa have been reported. MC of CIAM demonstrates bland cytology and inconspicuous proliferative activity. The lesional cells are positive for synaptophysin and 60% to 100% of cases show nuclear β-catenin positivity. MC poses a diagnostic challenge with its morphologic and immunohistochemical resemblance to both benign and malignant lesions, including squamous morules/metaplasia, adenocarcinoma, squamous cell carcinoma, sporadic neuroendocrine tumor and goblet cell adenocarcinoma. CIAM is an indolent lesion with a favorable outcome. Complete removal by polypectomy is considered curative. Awareness and recognition of this rare entity will help arrive at correct diagnosis and improve patient care. Currently, CIAM is not recognized as a subtype of mixed neuroendocrine-non-neuroendocrine neoplasm by WHO.
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Affiliation(s)
- Zhi-Yan Fu
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
| | - Michel Kmeid
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
| | - Mahmoud Aldyab
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
| | - Stephen M Lagana
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Hwajeong Lee
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
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Dabir PD, van der Post RS, Nagtegaal ID. Incidental morphological findings in colorectal adenomas. Histopathology 2020; 78:348-357. [PMID: 32981102 PMCID: PMC7894322 DOI: 10.1111/his.14263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/01/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022]
Abstract
Owing to a sharp increase in the frequency of diagnosis of colorectal adenomas in the current era of population screening, distinctive morphological features are increasingly being observed. These may present diagnostic challenges and cause clinical management issues. Paneth cell metaplasia is a more common occurrence, but the incidence rates of squamous metaplasia, clear cell metaplasia, osseous metaplasia, neuroendocrine differentiation and signet‐ring cell‐like lesion are low, and they can be seen in <1% of colorectal adenomas. Their histomorphological characteristics are quite unique; ancillary studies are not very helpful and often not needed. In this review, we give an overview and describe the potential clinical consequences of such incidental and special morphological findings in colorectal adenomas.
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Affiliation(s)
- Parag D Dabir
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Institute of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Rachel S van der Post
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
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