传统锯齿状腺瘤诊断经验分享

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(TSA)的病变细胞核位于中央，细长，呈青霉状，染色质(a)分散

与正常小肠黏膜相似的上皮细胞狭窄缝(“缝隙样锯齿”)可能是 TSA (b)最特异的特征

C 异位隐窝灶(ECF)是指隐窝发育异常，并失去对粘膜肌层的定位

D“富含黏液蛋白的TSA”具有50%或以上的杯状/富含黏液蛋白的细胞，杯状细胞嗜酸性，吸收细胞比例至少为1:1

Tsa 上皮内淋巴细胞(箭头)数量相对增加

许多 TSAs (黑圈)包含邻近区域的增生性息肉或无柄锯齿状腺瘤(SSA)(红圈) ，这些后者被认为代表前体息肉(f)。

斯坦福大学的诊断经验分享

Traditional Serrated Adenoma

Definition

• Serrated polyp of the colon and rectum with generalized cytologic dysplasia

Alternate/Historical Names

• Serrated adenoma

• Serrated adenoma type II

Covered separately

• Sessile serrated adenoma / polyp

Diagnostic Criteria

• Prominent serration of glands

• Usually columnar cells with mucin depleted eosinophilic cytoplasm

• Cytologic low grade dysplasia throughout

• Hyperchromatic elongate nuclei

• Frequent nuclear stratification

• Complex architecture

• Ectopic crypt formation

• Short, crypts oriented at right angles ot main crypt

• Unlike normal crypts they do not reach to muscularis mucosae

• Multiple adjacent crypts contribute to serrated appearance

• In SSA and HP, serrations are predominantly formed by apical cytoplasm

• Filiform variant with long thin surface projections

• Complex villi with serrated surface

• Frequent stromal edema producing bulbous ends

• Lined by tall non-mucinous eosinophilic cytoplasm

• Appears to be restricted to the left colon and rectum

• Usually, but not always, pedunculated and left sided

• May be associated with left sided carcinomas

• Development of focal high grade dysplasia may represent an accelerated phase of carcinoma development

• No clear association with sporadic MSI high carcinomas

• Not typically a component of serrated adenomatous polyposis (hyperplastic polyposis)

• It is now apparent that most, if not all, the polyps of that entity are sessile serrated adenoma

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