This polyp was found in the transverse colon of a 60 year old man.
WHAT IS THE LIKELY HISTOLOGY OF THE LESION?
■ Serrated polyp
Crypt openings look a little serrated but nothing else does!
■ Adenomatous polyp
This is not an adenomatous crypt pattern!
■ Hamartomatous polyp
When in doubt, it's hamartomatous !
■ Malignant polyp
The crypt pattern is too organised and regular for cancer!
Sadly, an intimate knowledge of the Kudo crypt patterns doesn't help you here! Adenomatous polyps should be covered with one of the following;
In this case, the closest match is of a serrated polyp, which have wide open crypts with a somewhat jagged outline. However, apart from the crypt openings, there is nothing on this which looks like a serrated polyp!
If you can't see a crypt pattern, the lesion is likely to be malignant. Conversely, if the lesion does have crypts but still doesn't look familiar, its either a hamartomatous polyp or, perhaps less likely, a 'Traditional Serrated Adenoma'.
This lesion turned out to be a hamartomatous polyp. Why a 60 year old man would grow a hamartomatous colonic polyp remains a mystery !