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Dermatopathology: Practical & Conceptual January - March 2009
4. General Pathology: What is the true nature of colonic adenoma? Part IV: It is carcinoma
—a concept further supported via comparison with carcinoma
of the skin and of the breast
Masoud Asgari, M.D.
Sheng Chen, M.D.
of the skin
of the breast
illustrates colonic adenoma (top,) together with both DCIS of the breast (middle) and SCCIS of the skin (bottom) for comparison. Normal tissue counterparts (
Figs. 14A, E, and I
) are also shown. They are shown in three entirely different epithelia (columnar epithelium of the colon, stratified squamous epithelium of the skin, and ductal epithelium of the breast), and although the growth pattern of colonic adenoma, CIS of the skin, and CIS of the breast may differ, they share many, if not all, of the histopathologic attributes used by microscopists for diagnosis of them. These common histopathologic attributes are as follows: neoplastic proliferation confined in the epithelium of origin; lack or decrease of maturation; increase of nuclear size and increase of nucleus to cytoplasm ratio; hyperchromasia; heterochromasia; increase of mitotic activity; and presence of necrosis.
Comparison between so-called colonic adenoma, ductal carcinoma
of the breast, and squamous cell carcinoma
of the skin. A, E, and I show normal colonic mucosa, breast, and skin, respectively. As it is evident via comparison, the so-called colonic adenoma (B-D) share many, if not all, of the histopathologic attributes—namely, decrease or loss of maturation, nuclear enlargement, hyperchromasia, heterochromasia, increased mitotic activity, and presence of necrosis—commonly used for diagnosis of ductal carcinoma
of the breast (F-H) and squamous cell carcinoma
of the skin (J-L). This comparison further reinforces the notion that the so-called colonic adenoma is not adenoma, but carcinoma
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