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Pathology Challenges

Pathology Challenges. Dr F Duthie Consultant Histopathologist WIG/GRI. Predictable Challenges. Laboratory Staffing Transport mechanisms Feedback of reports Unusual findings. Predicted Range of Disease. Hyperplastic polyps Tubular Adenomas Villous Adenomas Adenocarcinoma

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Pathology Challenges

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  1. Pathology Challenges Dr F Duthie Consultant Histopathologist WIG/GRI

  2. Predictable Challenges Laboratory Staffing Transport mechanisms Feedback of reports Unusual findings

  3. Predicted Range of Disease Hyperplastic polyps Tubular Adenomas Villous Adenomas Adenocarcinoma Inflammatory bowel disease

  4. Predicted Range of Disease Hyperplastic polyps Tubular Adenomas Villous Adenomas Adenocarcinoma Inflammatory bowel disease

  5. Predicted Range of Disease Hyperplastic polyps Tubular Adenomas Villous Adenomas Adenocarcinoma Inflammatory bowel disease

  6. Predicted Range of Disease Hyperplastic polyps Tubular Adenomas Villous Adenomas Adenocarcinoma Inflammatory bowel disease

  7. Predicted Range of Disease Hyperplastic polyps Tubular Adenomas Villous Adenomas Adenocarcinoma Inflammatory bowel disease

  8. Unpredicted Challenges Workload - higher number of patients - large number with multiple lesions Complexity - high frequency of “rare” lesions

  9. Flat Adenoma Lacks polypoid architecture Still has classical dysplasia in glandular epithelium

  10. Serrated Adenoma “Serrated” architecture like a hyperplastic polyp Surface epithelial dysplasia

  11. Serrated Adenoma “Serrated” architecture like a hyperplastic polyp Surface epithelial dysplasia

  12. Sessile Serrated Adenoma “Serrated” architecture with “flask-like” widening of deep aspect of glands Lacks traditional epithelial dysplasia Similar risk as traditional adenomas?

  13. Sessile Serrated Adenoma “Serrated” architecture with “flask-like” widening of deep aspect of glands Lacks traditional epithelial dysplasia Similar risk as traditional adenomas?

  14. Displacement of glands Atypical glands in mucosa=dysplasia Extension into submucosa=cancer BUT torsion displaces mucosal elements into submucosa

  15. Displacement of glands Atypical glands in mucosa=dysplasia Extension into submucosa=cancer BUT torsion displaces mucosal elements into submucosa

  16. Polyp cancers – further treatment? Vascular invasion clearly associated with high risk of metastases Incomplete excision needs further follow up

  17. Polyp cancers – further treatment? Because of treatment implications and risk of overcalling displaced high grade dysplasia ALL completely excised polyp cancers are reviewed by at least two members of Scottish BSP quality assurance panel

  18. Variation in Opinions Distinction between displaced high grade glands and true invasion may be subjective

  19. Variation in Opinions Distinction between displaced high grade glands and true invasion may be subjective

  20. Variation in Opinions Distinction between displaced high grade glands and true invasion may be subjective

  21. Conclusions Reports issued electronically instantly Different spectrum of disorders from symptomatic patients Sessile serrated polyp has same risk as adenoma Distinction between high grade dysplasia and invasive carcinoma may be subjective

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