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  • Clinical

    • associations: FAP
    • small intestine adenoma usually periampulla
    • higher risk if: 3+ adenoma, HG dysplasia, villous features or over 1 cm size
  • Gross

    • can be elevated, flat or depressed
    • can be stalked or sessile
    • non-elevated lesions are recognized by erythema
  • Histology

    • hypercellular
    • nuclear atypia: enlarged, hyperchromatic, stratification, polarity loss
    • dysplastic glands in at least 80% of luminal surface
    • HG dysplasia if: severe atypia in the context of cribriform, polarity loss, or stratification
    • pseudoinvasion = prolapse of neoplastic glands into submucosa (have rounded contours)
    • sporadic = lots of apoptosis
    • Lynch syndrome = intraepithelial lymphs
    • look for invasion: angulated glands, single cells, desmoplasia
  • Types