The Histopathologoid

O'Brien M J ,  Zhao Q ,  Yang S  ( 2015 )  Histopathology   66 ,  49 – 65 . DOI:  10.1111/his.12564 Colorectal serrated pathway cancers and precursors Again had another read of a free review article in Histopathology regarding colorectal serrated lesions, because lo and behold I have a diagnostic dilemma between hyperplastic polyp and sessile serrated polyp. To be continued.

... according to RCPA General Module 15-2 is: 15 or more eosinophils in a high power field OR 20-25 eosinophils in any field.

Mention the term 'serrated lesions" (of the colorectum) and immediately I will get a brief panic attack.  Based on my limited knowledge, the lesions sound and look the same.  Even when a senior teacher made a nice diagram of how to differentiate all of these lesions, it still did not hit me how things work... until today. There is a nice review article in Journal of Clinical Pathology regarding pathological diagnosis of serrated lesions by Bateman and Shepherd ( J Clin Pathol   2015 ; 68 : 585 - 591).   I think it very helpful in terms of clearing up the terminologies involved. Basically, the recommended terminology of serrated lesions in the colorectum is as follows: 1. Hyperplastic polyp 2.  Sessile serrated lesion (SSL) 3.  SSL with dysplasia 4. Traditional serrated adenoma 5. Mixed polyp Hyperplastic polyp is easy enough, but what about sessile serrated lesions?  They have listed the key histological features as follows: ...

Just mentioning presence of a Whipple's specimen in the lab would bring throngs of histopathology trainees to observe the grossing of the specimen.  It is associated with intimidating combination of organs, many margins to remember, and last but definitely not least, the lament of a trainee saying: "Where is the tumour??" When I was a second year Pathology Masters student (first year Histopathology trainee), a senior trainee taught us a simplified way to gross a Whipple's specimen.  It is the same as any other textbook, but the lack of wordiness (as compared to the textbook) make it less intimidating.                                                            (Picture from www.pancreapedia.org) 1. Margins Stomach (proximal margin) Duodenum (distal margin) Uncinate (Soft tissue margin) Anterior pancreas Common...