Adenomas (serrated, tubular, tubulovillous, villous) and hyperplastic polyps
UNDERSTANDING YOUR PATHOLOGY REPORT: FAQ SHEET
When your colon was
biopsied, the samples taken were studied under the microscope by a
specialized doctor with many years of training called a pathologist.
The pathology report tells your treating doctor the diagnosis in each
of the samples to help manage your care.
This FAQ sheet is designed to help you understand the medical
language used in the pathology report.
What if my report mentions “cecum”, “ascending
colon”, “transverse colon”, “descending colon”, “sigmoid colon”, or “rectum”
The cecum is the beginning of the
colon where the small intestine empties into the large intestine.
The ascending colon, transverse colon, descending colon, sigmoid colon,
and rectum are, in order other parts of the colon beyond the cecum.
The colon ends at the rectum and waste exits through the anus.
2. What is a polyp
in the colon?
A polyp is a projection (growth) of
tissue from the inner lining of the colon into the lumen (hollow center) of the
An adenoma is a polyp that resembles the normal
lining of your colon but differs in several important microscopic aspects.
What are “tubular adenomas”, “tubulovillous adenomas”, and “villous
Adenomas have several different growth patterns
that can be seen by the pathologist under the microscope. There are two major
growth patterns: tubular and villous. Because many adenomas have a mixture of
both growth patterns, some polyps may be called tubulovillous adenomas. Most
adenomas that are small (less than ½ inch) and have a tubular growth pattern.
Larger adenomas may have a villous growth pattern. Larger adenomas are more
often found to have cancers developing in them. Adenomas with a villous growth
pattern are also more likely to have cancers develop in them. As long as your
polyp has been completely removed and does not show cancer, you do not need to
worry about the type of growth pattern seen in your polyp. These growth patterns
are mostly used to try and determine how often you will need to have colonoscopy
to make sure you don’t develop colon cancer in the future (see FAQ#10).
What if my report used the term “sessile”?
Polyps that tend to grow as slightly flattened,
broad-based polyps are referred to as ‘sessile’.
6. What if my report uses
the term “serrated”?
Serrated polyps have a ‘saw tooth’ appearance
under the microscope and that is why they are called ‘serrated’.
What if my report uses the term “traditional serrated”?
The term ‘traditional serrated’ has slightly
different features seen with the microscope than the more recently described
sessile serrated adenoma. Both types
need to be removed from your colon.
What is the significance of the diagnosis of
sessile serrated adenoma or traditional serrated adenoma or adenoma
These types of polyps are not cancer, but are
precancerous and therefore, you have some increased risk of subsequently
developing cancer of the colon. However,
most patients with these polyps never develop cancer.
What if my report mentions “dysplasia”?
“Dysplasia” is a term that describes how much
your polyp looks like cancer under the microscope. Polyps that are only mildly
abnormal are said to have low-grade (mild or moderate) dysplasia, while polyps
that are more abnormal and look more like cancer are said to have high-grade
(severe) dysplasia. As long as your polyp has been completely removed and does
not show cancer, you do not need to worry about dysplasia in your polyp.
How does having the various types of adenoma affect future clinical
Since you had an adenoma, you will need to have a
colonoscopy every so often to make sure that you don’t develop any more
adenomas. The frequency of recommended endoscopy exams depends on a number of
discussed with your treating doctor as it may be individualized to your specific
What if my adenoma was not completely removed?
If your adenoma was biopsied but not completely
removed, you will need talk to your doctor to determine what further treatment
is best for you. In general, all adenomas need to be completely removed. In some
cases, the adenoma may be too large to remove with an endoscope (a tube inserted
through the anus) by the gastroenterologist. In such cases you may be sent to a
surgeon to have the adenoma removed.
What if my report also mentions “hyperplastic polyps”?
“Hyperplastic polyps” are totally benign
(non-cancerous) and have no significance.