Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        Haggitt levels within an intrapolypoidal adenocarcinoma
      
 
Intestinal Adenocarcinoma, Intrapolypoid
Occassionally we surgical pathologists are presented with a small colorectal polyp which turns out to have intrapolypoidal adenocarcinoma. What is clinically done following such a diagnosis depends on tumor grade, vascular invasion status, presence or absence of high risk histological features, Haggitt level of polyp invasion, and degree of closeness of the surgical polyp stalk margins (greater than 2mm clear?). Correct embedding can be assuredly maintained with agar pre-embedding (a technique we used for many reasons...predominantly maintaining correct orientation). Some...for example, AFIP3...would consider level 0 to be high grade dysplasia, with WHO ambivalent, and AJCC as pTis3; it is TNM pT1 only after the muscularis mucosae is penetrated. Careful discernment can spare additional surgery [S10-10767] or mitigate concerns about adjuvant therapy (one might need to review & correlate the polypectomy with the segmental resection to show what an "early pT1" case it is with the pN0 [L11-8284].

Reference:

  1. Haggitt RC, et. al. Gastroenterology 89:328-336, 1985
  2. Rex DK, et. al., "Coming to terms with Pathologists Over Colon Polyps with Cancer or High-grade Dysplasia:, J. Clin. Gastroenterol., 39(1):1-3, January 2005.
  3. West AB, et. al., "Cancer or High-grade Dysplasia? The Present Status of the Application of the Terms in Colonis Polyps", J. Clin. Gastroenterol., 39(1):4-6, January 2005.

(posted 30 May 2005; latest addition 29 October 2010)

 
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