Journal of Pathology and Translational Medicine

Case Report

Solitary Peutz-Jeghers type harmartomatous polyp in duodenum with gastric foveolar epithelium: a case report: Eugene Choi, Junghwan Lee, Youngsoo Park; J Pathol Transl Med. 2023;57(2):128-131. Published online January 10, 2023; DOI: https://doi.org/10.4132/jptm.2022.11.07

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Peutz-Jeghers type hamartomatous polyp is known to be associated with Peutz-Jeghers syndrome, which shows characteristic multiple hamartomatous polyp involvement in the gastrointestinal tract, combined with mucocutaneous symptom, familial history of Peutz- Jeghers syndrome or STK11/LTB1 mutation. However, some cases showing histologic appearance of the polyps discovered in Peutz- Jeghers syndrome while lacking other diagnostic criteria of the syndrome have been reported, and these are called solitary Peutz- Jeghers type polyps. Herein, we report a case of solitary Peutz-Jeghers type polyp covered with heterotopic epithelium. The patient was 47-year-old female without any mucocutaneous symptoms nor familial history of Peutz-Jeghers syndrome. Microscopic examination revealed Peutz-Jeghers type hamartomatous polyp in duodenum covered with gastric type foveolar epithelium. Considering the definition of hamartomatous polyp, which is, the abnormal overgrowth of the indigenous epithelial component, the histological feature of current case is noteworthy in a point that it shows proliferation of heterotopic component, rather than the indigenous component.

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A Solitary Peutz-Jeghers Hamartomatous Polyp in the Gastric Body: A Case Report
Noelia Madera, Noemí Acevedo, Carmen González-Peralta, Rafael Castro, Vismelis Mezquita-Luna
Cureus.2024;[Epub] CrossRef

Review

Evolving pathologic concepts of serrated lesions of the colorectum: Jung Ho Kim, Gyeong Hoon Kang; J Pathol Transl Med. 2020;54(4):276-289. Published online June 26, 2020; DOI: https://doi.org/10.4132/jptm.2020.04.15

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Abstract PDF Supplementary Material

Here, we provide an up-to-date review of the histopathology and molecular pathology of serrated colorectal lesions. First, we introduce the updated contents of the 2019 World Health Organization classification for serrated lesions. The sessile serrated lesion (SSL) is a new diagnostic terminology that replaces sessile serrated adenoma and sessile serrated polyp. The diagnostic criteria for SSL were revised to require only one unequivocal distorted serrated crypt, which is sufficient for diagnosis. Unclassified serrated adenomas have been included as a new category of serrated lesions. Second, we review ongoing issues concerning the morphology of serrated lesions. Minor morphologic variants with distinct molecular features were recently defined, including serrated tubulovillous adenoma, mucin-rich variant of traditional serrated adenoma (TSA), and superficially serrated adenoma. In addition to intestinal dysplasia and serrated dysplasia, minimal deviation dysplasia and not otherwise specified dysplasia were newly suggested as dysplasia subtypes of SSLs. Third, we summarize the molecular features of serrated lesions. The critical determinant of CpG island methylation development in SSLs is patient age. Interestingly, there may be ethnic differences in BRAF/KRAS mutation frequencies in SSLs. The molecular pathogenesis of TSAs is divided into KRAS and BRAF mutation pathways. SSLs with MLH1 methylation can progress into favorable prognostic microsatellite instability-positive (MSI+)/CpG island methylator phenotype-positive (CIMP+) carcinomas, whereas MLH1-unmethylated SSLs and BRAF-mutated TSAs can be precursors of poor-prognostic MSI−/CIMP+ carcinomas. Finally, based on our recent data, we propose an algorithm for stratifying risk subgroups of non-dysplastic SSLs.

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Original Article

Colorectal epithelial neoplasm associated with gut-associated lymphoid tissue: Yo Han Jeon, Ji Hyun Ahn, Hee Kyung Chang; J Pathol Transl Med. 2020;54(2):135-145. Published online January 29, 2020; DOI: https://doi.org/10.4132/jptm.2019.11.06

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Abstract PDF: Background
Colorectal epithelial neoplasm extending into the submucosal gut-associated lymphoid tissue (GALT) can cause difficulties in the differential diagnosis. Regarding GALT-associated epithelial neoplasms, a few studies favor the term “GALT carcinoma” while other studies have mentioned the term “GALT-associated pseudoinvasion/epithelial misplacement (PEM)”.
Methods
The clinicopathologic characteristics of 11 cases of colorectal epithelial neoplasm associated with submucosal GALT diagnosed via endoscopic submucosal dissection were studied.
Results
Eight cases (72.7%) were in males. The median age was 59 years, and age ranged from 53 to 73. All cases had a submucosal tumor component more compatible with GALT-associated PEM. Eight cases (72.7%) were located in the right colon. Ten cases (90.9%) had a non-protruding endoscopic appearance. Nine cases (81.8%) showed continuity between the submucosal and surface adenomatous components. Nine cases showed (81.8%) focal defects or discontinuation of the muscularis mucosae adjacent to the submucosal GALT. No case showed hemosiderin deposits in the submucosa or desmoplastic reaction. No case showed single tumor cells or small clusters of tumor cells in the submucosal GALT. Seven cases (63.6%) showed goblet cells in the submucosa. No cases showed oncocytic columnar cells lining submucosal glands.
Conclusions
Our experience suggests that pathologists should be aware of the differential diagnosis of GALT-associated submucosal extension by colorectal adenomatous neoplasm. Further studies are needed to validate classification of GALT-associated epithelial neoplasms.

Case Study

A Case of Giant Colonic Muco-submucosal Elongated Polyps Associated with Intussusception: Joo Heon Kim, Seung Yun Lee, Je Ho Jang, Hyun Young Han, Dong Wook Kang; J Pathol Transl Med. 2016;50(6):474-478. Published online May 23, 2016; DOI: https://doi.org/10.4132/jptm.2016.04.27

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Abstract PDF

Colonic muco-submucosal elongated polyp (CMSEP), a newly categorized non-neoplastic colorectal polyp, is a pedunculated and elongated polyp composed of normal mucosal and submucosal layers without any proper muscle layer. We herein report a giant variant of CMSEP associated with intussusception in the rectosigmoid colon, with a review of the literature. A 48-year-old woman underwent a laparoscopic low anterior resection due to multiple large submucosal polypoid masses associated with intussusception. Grossly, the colonic masses were multiple pedunculated polyps with a long stalk and branches ranging in size from a few millimeters to 14.0 cm in length. Microscopically, there was no evidence of hyperplasia, atypia, or active inflammation in the mucosa. The submucosal layers were composed of edematous and fibrotic stroma with fat tissue, dilated vessels, and lymphoid follicles.

Citations

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Multiple enteric muco-submucosal elongated polyps causing intussusception
Atsuki Taniguchi, Izuru Endo, Takeyoshi Nishiyama, Nobuyuki Watanabe, Osamu Yoshida, Hiroaki Asano, Masatoshi Kubo, Tetsunobu Udaka
Clinical Journal of Gastroenterology.2024; 17(1): 41. CrossRef
Jejunal intussusception and perforation due to enteric muco-submucosal elongated polyp: a case report and literature review
Ryosuke Kikuchi, Shigenobu Emoto, Hiroaki Nozawa, Kazuhito Sasaki, Koji Murono, Shinya Abe, Hirofumi Sonoda, Aya Shinozaki-Ushiku, Soichiro Ishihara
Surgical Case Reports.2023;[Epub] CrossRef
A stalk with no polyp—A muco‐submucosal elongated polyp in the duodenum
Neil O’Morain, Ciaran McCloskey, Sinead Flanagan, Glen Doherty
United European Gastroenterology Journal.2023; 11(4): 392. CrossRef
Duodenal Worm-Like Polyp
Pan Pan, Guoshan Zhang, Xiao Cui, Liang Liu
Digestive Diseases and Sciences.2023; 68(12): 4275. CrossRef
Colonic Mucosubmucosal Elongated Polyp in the Sigmoid Colon on Surveillance Colonoscopy
Xiaowen Fan, Melissa Hershman, Gabriel Levi, Ilan Weisberg
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Original Article

Investigation of the Roles of Cyclooxygenase-2 and Galectin-3 Expression in the Pathogenesis of Premenopausal Endometrial Polyps: Esin Kasap, Serap Karaarslan, Esra Bahar Gur, Mine Genc, Nur Sahin, Serkan Güclü; J Pathol Transl Med. 2016;50(3):225-230. Published online April 16, 2016; DOI: https://doi.org/10.4132/jptm.2016.03.08

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Abstract PDF

Background
The pathogenesis and etiology of endometrial polyps has not been elucidated. In this study, we aimed to examine the pathogenic mechanisms of endometrial polyp development using immunohistochemistry. We evaluated the expression of galectin-3 and cyclooxgenase-2 (COX-2) during the menstrual cycle in premenopausal women with endometrial polyps or normal endometrium.
Methods
Thirty-one patients with endometrial polyps and 50 healthy control patients were included in this study. The levels of expression of COX-2 and galectin-3 were studied by immunohistochemistry.
Results
The percentage of COX-2–positive cells and the intensity of COX-2 staining in the endometrium did not vary during the menstrual cycle either in the control group or in patients with endometrial polyps. However, expression of galectin-3 was significantly lower in endometrial polyps and during the proliferative phase of the endometrium compared with the secretory phase.
Conclusions
Our data suggests that the pathogenesis of endometrial polyps does not involve expression of COX-2 or galectin-3.

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Research Progress in the Treatment of Endometrial Polyps
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ER and COX2 expression in endometrial hyperplasia processes
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Case Reports

Isolated Polypoid Ganglioneuroma in the Rectum.: Se Hoon Kim, Chang Hwan Choi, Yong Han Paik, Won Ho Kim, Hoguen Kim; Korean J Pathol. 2001;35(4):344-346.

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Abstract PDF: Gastrointestinal ganglioneuroma is a rare benign neoplasm, composed of ganglion cells, nerve fibers, and supporting cells. Ganglioneuromas are presented as isolated polypoid ganglioneuroma, ganglioneuromatous polyposis, and diffuse ganglioneuromas. We have experienced a case of an isolated ganglioneuromatous polyp in the rectum. The patient was a 58-year-old female who had experienced low abdominal discomfort and tenesmus for 6 to 7 months. Colonoscopic examination revealed a polypoid tumor in the rectum. Microscopically, the tumor showed cystic glands, expanded lamina propria, and smooth surface epithelium. Many proliferated ganglion cells with nerve fibers were evident in the lamina propria which was extended to the submucosa.

Multiple Localized Hyperplastic Gastropathy: Report of A Case with A Special Reference to its Growth Pattern.: Jung Ran Kim, Yong Il Kim; Korean J Pathol. 1989;23(1):154-159.

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Abstract PDF: We present a case of localized mucosal hyperplasia of the stomach. The resected stomach contained four large, short stalked polyps, three of which were located in the anterior wall of body and the other in the posterior wall. In addition, numerous small sessile polyps were also scattered in the anterior and posterior fundic walls. Microscopically, the abnormally thick mucosa, carrying with it the muscularis mucosae and a thin core of loose fibrous tissue comprised the polyps by intraluminal infolding of widening of mucosal area. Abundant vasculature of the rugal pattern was prominent in the submucosa. The above findings suggest that the histogenesis of the polyps is related to both hyperplastic thickening and widening of mucosal areas in rugal pattern in the background of inverted distribution pattern of intestinal metaplasia.

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