Flat elevated lesions of the colon and rectum: a spectrum of neoplastic and nonneoplastic entities.


:The aim of this prospective study is to establish the frequency and the type (neoplastic and nonneoplastic) lesions defined endoscopically as flat elevated lesion (FEL) in the colon and rectum, as well as to compare flat adenomas (FAs) to polypoid lesions of the same size with morphometric and immunohistochemical analysis. One hundred nineteen patients were studied through fibrocolonoscopy with chromoscopy (indigo carmine spray). All detected lesions (total of 195) were removed, and FELs measuring 10 mm or smaller were also selected. Using histopathologic criteria, they were divided in neoplastic (adenomas and carcinomas) and nonneoplastic ones. In neoplastic lesions, the following parameters were evaluated to compare FAs with polypoid lesions: morphometric studies with Index of Structural Atypia (ISA) and Stratification Index (SI), evaluation of cellular proliferation with label index of Ki-67, and expression of p53 protein. Of 195 lesions resected, only 33 (17%) met the endoscopic requirements for FELs. Twelve (36.4%) were neoplastic and 21 (63.6%) considered nonneoplastic. Among the FAs, there were a percentage of high-grade (severe dysplasia) significantly more frequent than observed in polypoid lesions (16.7% vs 2.6%). In addition, the SI, Ki-67 label index and p53 positivity were significantly higher in FAs. The ISA also reached significant differences between both groups of adenomas. Non-neoplastic FELs included different entities such as hyperplasic polyps, focuses of colitis, normal mucosa, and scars. The endoscopic elements analyzed were shared between nonneoplastic FELs and FAs. A central depression, when air was properly insufflated, considered typical in neoplastic lesions, was frequently observed in nonneoplastic lesions. Following the endoscopic criteria of FELs, nonneoplastic lesions predominated over the adenomatous lesions, demonstrating that FELs and FAs are not homologous terms. The frequency of high-grade dysplasia was significantly more elevated in the adenomatous FELs than in polypoid adenomas. The ISA, SI, p53 expression, and Ki-67 label index were helpful in differentiating adenomatous FELs from polypoid lesions. Flat elevated lesions selected by endoscopic criteria are, in fact, a heterogeneous population of lesions.


Ann Diagn Pathol


Gualco G,Reissenweber N,Cliché I,Bacchi CE




Has Abstract


2006-12-01 00:00:00














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  • Expression of dog1 in low-grade fibromyxoid sarcoma: A study of 19 cases and review of the literature.

    abstract::DOG1 is a highly-sensitive marker often included in the immunohistochemical panel for the diagnosis of gastrointestinal stromal tumors (GISTs). Recent research has shown that DOG1 may also be expressed by low-grade fibromyxoid sarcomas (LGFMSs); this may give rise to diagnostic error when the sarcoma is located in the...

    journal_title:Annals of diagnostic pathology

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    authors: Vallejo-Benítez A,Rodríguez-Zarco E,Carrasco SP,Pereira-Gallardo S,Brugal Molina J,García-Escudero A,Robles Frías A,Marcilla D,González-Cámpora R

    更新日期:2017-10-01 00:00:00

  • Clear cell renal cell carcinoma with focal renal angiomyoadenomatous tumor-like area.

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    journal_title:Annals of diagnostic pathology

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    authors: Fernandez-Flores A,Cassarino DS

    更新日期:2017-02-01 00:00:00

  • Adenocarcinoma arising in an ectopic mediastinal pancreas.

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    authors: St Romain P,Muehlebach G,Damjanov I,Fan F

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    更新日期:2013-02-01 00:00:00

  • Aggressive B-cell lymphomas: frequency, immunophenotype, and genetics in a reference laboratory population.

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  • Clinical and pathologic predictors of lymph node metastasis in papillary thyroid microcarcinomas.

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  • Myospherulosis.

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    authors: Phillip V,Becker K,Bajbouj M,Schmid RM

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  • Bilateral renal tumors; conventional clear cell carcinoma and contralateral t(6;11)/t(X;17)-like tumor Histomorphologic, immunohistochemical, ultrastructural and molecular genetic studies including the report of a novel mutation in the VHL gene.

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    journal_title:Annals of diagnostic pathology

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  • Parosteal lipoma of the thigh with cartilaginous and osseous differentiation: an osteochondrolipoma.

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  • Utility of thin-layer preparations in the endometrial cytology: evaluation of benign endometrial lesions.

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    authors: Norimatsu Y,Kouda H,Kobayashi TK,Moriya T,Yanoh K,Tsukayama C,Miyake Y,Ohno E

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    pub_type: 杂志文章,评审


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    authors: O'Malley DP,Kim YS,Weiss LM

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  • FTO mRNA expression in the lower quartile is associated with bad prognosis in clear cell renal cell carcinoma based on TCGA data mining.

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    pub_type: 杂志文章


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  • Breast carcinoma with osteoclast-like giant cells: A cytological-pathological correlation with a literature review.

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    journal_title:Annals of diagnostic pathology

    pub_type: 杂志文章,评审


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    更新日期:2018-04-01 00:00:00