GASTROINTESTINAL POLYPS

Dr. PRIYANKA MD.,

Associate Professor
Department of Pathology
SSSMC&RI
SPECIFIC LEARNING OBJECTIVES
• Define polyps
• Classify polyps of gastrointestinal tract
• Describe the gross and morphology of each
POLYPS

• NON NEOPLASTIC POLYPS

• NEOPLASTIC POLYP

• POLYPS CAN BE
• SESSILE
• PEDUNCULATED
NON NEOPLASTIC POLPS

• INFLAMMATORY

• HAMARTOMATOUS

• HYPERPLASTIC
INFLAMMATORY POLYP

• Patients presents with a clinical triad of rectal

bleeding, mucus discharge, and an
inflammatory lesion of the anterior rectal wall.

• The underlying cause is impaired relaxation of

the anorectal sphincter
• The distinctive histologic features are

–DILATED GLANDS
–PROLIFERATIVE EPITHELIUM
–INFLAMMATORY INFILTRATE
HYPERPLASTIC POLYP
HYPERPLASTIC POLYP

• Hyperplastic polyps - in the left colon

• They are typically less than 5 mm in diameter

with smooth, nodular protrusions of the
mucosa, often on the crests of mucosal folds.
particularly in the sigmoid colon and rectum.
HYPERPLASTIC POLYP

• Characterized by serrated, convoluted

(sawtooth pattern) luminal border
• Slight expansion of the mitotically active basal
cell zone, limited to the lower half of the crypt
(so-called bottom-up atypia)
• No dysplasia
• Mixture of absorptive cells and goblet cells
HAMARTOMATOUS POLYP
• The glands are supported by broad bands of
smooth muscle fibers, which are thick in the
center of the lesion and thinner on the
periphery
• The intimate intermingling of glands and
smooth muscle fibers may simulate the
appearance of invasion and lead to a mistaken
diagnosis of carcinoma.
JUVENILE POLYP
JUVENILE POLYP
• Children less than 5 years of age

• Majority of juvenile polyps are located in the

rectum .

• They can be sporadic or syndromic

• Sporadic juvenile polyps are usually solitary

lesions and may be referred to as retention polyps
• Individuals with the autosomal dominant syndrome of
juvenile polyposis have from 3 to as many as 100
hamartomatous polyps

• Juvenile polyposis syndrome is associated with an

increased risk of colonic adenocarcinoma

• Pulmonary arteriovenous malformations are a

recognized extra-intestinal manifestation of the
syndrome.
MORPHOLOGY
• Typically pedunculated, smooth-surfaced, reddish
lesions with characteristic cystic spaces apparent
after sectioning.
• Microscopic examination shows these cysts to be
dilated glands filled with mucin and inflammatory
debris . The remainder of the polyp is composed
of lamina propria expanded by mixed
inflammatory infiltrates. The muscularis mucosa
may be normal or attenuated.
PEUTZ JEGHERS SYNDROME
• Autosomal dominant syndrome

• Presents at a median age of 11 years with

multiple GI hamartomatous polyps and
mucocutaneous hyperpigmentation.

• Peutz-Jeghers syndrome is associated with an

increased risk of several malignancies.
• Grossly, the polyps are large and pedunculated
with a lobulated contour.

• Histologic examination demonstrates a

characteristic arborizing network of
connective tissue, smooth muscle, lamina
propria, and glands lined by normal-appearing
intestinal epithelium
COWDEN SYNDROME
• Cowden syndrome is characterized by
macrocephaly, intestinal hamartomatous polyps,
and benign skin tumors, typically trichilemmomas,
papillomatous papules, and acral keratoses.

• Cowden syndrome do not have increased risk of

GI malignancy, they are predisposed to breast
carcinoma, follicular carcinoma of the thyroid, and
endometrial carcinoma
Bannayan-Ruvalcaba-Riley Syndrome
• Mental deficiencies and developmental delays
are only seen with the Bannayan-Ruvalcaba-
Riley syndrome

• GI hamartomatous polyps, lipomas,

macrocephaly, hemangiomas, and, in males,
pigmented macules on the glans penis.
NEOPLASTIC POLYPS
• The most common and clinically important
neoplastic polyps are :

colonic adenomas, benign polyps that are

precursors to the majority of colorectal
adenocarcinomas.
• Typical adenomas range from 0.3 to 10 cm in
diameter and can be pedunculated or sessile,
with the surface of both types having a texture
resembling velvet or a raspberry, due to the
abnormal epithelial growth pattern.
• Adenomas can be classified as tubular,
tubulovillous, or villous based on their
architecture.
• Cancer is extremely rare in adenomas less
than 1 cm in diameter, some studies suggest
that nearly 40% of lesions larger than 4 cm in
diameter contain foci of cancer.
FAMILIAL ADENOMATOUS
POLYPOSIS
• autosomal dominant disorder in which patients
develop numerous colorectal adenomas as
teenagers

• caused by mutations of the adenomatous

polyposis coli, or APC, gene

• At least 100 polyps are necessary for a diagnosis

of classic FAP, and as many as several thousand
may be present
Hereditary non-polyposis colorectal
cancer (HNPCC)
• Hereditary non-polyposis colorectal cancer
(HNPCC), also known as Lynch syndrome
• Colorectum, endometrium, stomach, ovary,
ureters, brain, small bowel, hepatobiliary
tract, and skin.
THANK YOU