Features of a traditional serrated adenoma (TSA) and an example of a ‘mixed polyp’. Features of a traditional serrated adenoma (TSA) and an example of.

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Features of a traditional serrated adenoma (TSA) and an example of a ‘mixed polyp’. Features of a traditional serrated adenoma (TSA) and an example of a ‘mixed polyp’. (A–D) A TSA showing a pronounced villous growth pattern in areas (A), pencillate nuclei (especially in A—left side), eosinophilic cytoplasm and ectopic crypt foci (especially in C). Foci of subtle dysplasia that is characteristic of the areas with eosinophilic cytoplasm and pencillate nuclei are mixed with classical low-grade dysplasia (especially in B and C) and with classical high-grade dysplasia (D). The cut-off between the areas of subtle and classical dysplasia is often abrupt. (E–H) A ‘mixed’ polyp, containing SSL-like areas (E and F), TSA-like areas with subtle dysplasia (G) and classical low-grade dysplasia (H). G also shows TSA-like undulation of the crypt epithelium, imparting a gentler variant of serration to the architecture than is usually seen in SSLs. Other mixed polyps may comprise hyperplastic polyp (HP) and classical adenoma areas, arranged in such a way so as to give the impression of a ‘collision’ tumour (all magnification ×200). Adrian C Bateman, and Neil A Shepherd J Clin Pathol 2015;68:585-591 Copyright © by the BMJ Publishing Group Ltd & Association of Clinical Pathologists. All rights reserved.