Colorectal polyp

Background

Most colorectal carcinomas arise from adenomatous polyps. Colonoscopy is a common and effective procedure for the detection of polyps that also allows for their immediate removal. 1-4


Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

Fresh tissue received
  • No
    • Non-routine fixation (not formalin), describe.
  • Yes
    • Special studies required, describe.
    • Ensure samples are taken prior to fixation.
Intraoperative consultation
  • Not performed
  • Performed, describe type and result
    • Frozen section
    • Imprints
    • Other, describe

See general information for more detail on specimen handling procedures.

Inspect the specimen and dictate a macroscopic description.

External InspectionBack to top


Orientate and identify the anatomical features of the specimen.

Photograph the intact specimen if required.

Describe the following features of the specimen: 1,5,6

Procedure

Record as stated by the clinician.
  • Polypectomy
  • Endoscopic mucosal resection (EMR)
  • *Transanal endoscopic microsurgery (TEM)
  • Other procedure(s), specify

*TEM specimens should be pinned out and orientated on receipt, if not already done so by the clinician.

Polyp site

Record as stated by the clinician.
Options
  • Caecum
  • Ascending colon
  • Hepatic flexure
  • Transverse colon
  • Splenic flexure
  • Descending colon
  • Sigmoid colon
  • Rectosigmoid junction
  • Rectum
    • Distance to anal verge (cm) as stated by clinician;
  • Other, specify
  • Not stated

Specimen configuration and size (mm)

  • Intact polyp
    • Diameter
    • Length of stalk, if present
  • EMR/TEMS
    • Size of entire specimen, in three dimensions
    • Size of lesion, in three dimensions
    • Length of stalk, if present
  • Fragments
    • Number of pieces submitted
    • Diameter of largest fragment
    • OR
    • Aggregate measurement of tissue, in three dimensions

Appearance

Colour

  • Describe

Shape

  • Raised
  • Flat
  • Excavated

Surface

  • Smooth
  • Nodular
  • Villiform
  • Granular

Base

  • Sessile
  • Pedunculated

Ulceration

  • Absent
  • Present

The presence of muscularis propria on the deep aspect of a polyp must be reported urgently due to a risk of bowel perforation. 7


DissectionBack to top


Paint the relevant surgical margins with ink i.e. base of stalk or diathermied margin & record the colour applied. Dissect according to illustrations provided.

Sessile polyps
  • <5mm may be submitted whole.
  • >5mm in diameter should be bisected or sectioned at 3-4mm intervals.
Pedunculated polyps
  • <10mm in diameter, bisect through stalk and submit all tissue for processing in one cassette.
  • >10mm in diameter, dissect either side of stalk and section remainder at 3-4mm intervals.

Submit all tissue for processing with stalk in one cassette and sides in another.

TEM specimens

TEMS specimens should be painted with different inks on the circumferential and deep margins to ensure distinction between left and right margins. Serially section as above and submit all for processing.


Internal InspectionBack to top


No internal inspection required.

ProcessingBack to top


Submit all tissue for processing as indicated in the ilustrations provided.1,4,5,6,8,9

Record details of each cassette.

Block allocation key

Cassette id
Site
No. of pieces
A
Polyp
 

Acknowledgements

Dr Ian Brown for his contribution in reviewing and editing this protocol.

ReferencesBack to top


  1. Brown I, Bourke M, Ackland S, Eckstein R, Hawkins N, Hicks S, Hunter A, Kneebone A, Ruszkiewicz A and Yeong ML. Polypectomy and local resections of the colorectum structured reporting protocol, The Royal College of Pathologists of Australasia, Surry Hills, NSW, 2013.
  2. Rex DK, Rahmani EY, Haseman JH, Lemmel GT, Kaster S and Buckley JS. Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology 1997;112(1):17-23.
  3.  Cooper HS, Deppisch LM, Gourley WK, Kahn EI, Lev R, Manley PN, Pascal RR, Qizilbash AH, Rickert RR, Silverman JF et al. Endoscopically removed malignant colorectal polyps: clinicopathologic correlations. Gastroenterology 1995;108(6):1657-1665.
  4.  Netzer P, Forster C, Biral R, Ruchti C, Neuweiler J, Stauffer E, Schonegg R, Maurer C, Husler J, Halter F and Schmassmann A. Risk factor assessment of endoscopically removed malignant colorectal polyps. Gut 1998;43(5):669-674.
  5. Williams GT, Quirke P and Shepherd NA. Dataset for colorectal cancer, The Royal College of Pathologists, London, 2007.
  6. Feakins R, Campbell F, Mears L, Moffat C, Scott N and Allen D. Tissue pathways for gastrointestinal and pancreatobiliary pathology, The Royal College of Pathologists, London, 2009.
  7. Swan MP, Bourke MJ, Moss A, Williams SJ, Hopper A and Metz A. The target sign: an endoscopic marker for the resection of the muscularis propria and potential perforation during colonic endoscopic mucosal resection. Gastrointest Endosc 2011;73(1):79-85.
  8. Allen DC and Cameron RI (eds). Histopathology Specimens: Clinical, pathological and laboratory aspects, Springer-Verlag, London, 2012.
  9. Lester SC. Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010.