Surgical Pathology Criteria

Mucosal Prolapse / Cloacogenic Polyp

Differential Diagnosis

Mucosal Prolapse / Cloacogenic Polyp Peutz-Jeghers Polyp
Usually solitary polyp Usually multiple
Smooth muscle surrounds individual crypts Prominent arborizing smooth muscle bundles surround groups of crypts
Polyps rare in small intestine Most polyps in small intestine
Not associated with oral pigmentation Associated with oral pigmentation

 

Mucosal Prolapse / Cloacogenic Polyp Colorectal Adenoma
Nuclear atypia most prominent deep in the lesion with surface maturation Nuclear atypia involves surface of polyp
Nuclei usually enlarged but round and not stratified and not densely packed Nuclei elongated, hyperchromatic, densely packed and frequently stratified
Apoptosis not prominent Prominent apoptosis

 

Mucosal Prolapse / Cloacogenic Polyp Sporadic Juvenile Polyp
Surface erosions with granulation tissue frequent Surface erosions infrequent
Irregular glands with scattered dilation Prominent, regularly dilated glands
Smooth muscle extension into lamina propria of polyps No smooth muscle in lamina propria of polyps
Restricted to rectum (rarely in sigmoid) May involve any part of colorectum

 

Mucosal Prolapse / Cloacogenic Polyp Cowden Disease, Colorectal Polyp
Surface erosions with granulation tissue frequent Surface erosions infrequent
Irregular glands with scattered dilation Prominent, regularly dilated glands
Smooth muscle extension into lamina propria of polyps No smooth muscle in lamina propria of polyps
Restricted to rectum (rarely in sigmoid)

May involve any part of colorectum

No associated lesions Most have facial and oral papillomas, fibromas and skin tumors, see description LINK
No genetic abnormality PTEN mutations in 80%

 

Mucosal Prolapse / Cloacogenic Polyp Reactive / Inflammatory Polyp
Smooth muscle extension into lamina propria of polyps No smooth muscle in lamina propria of polyps
Usually localized to rectum Usually multiple, may involve any inflamed area
Not associated with inflammatory bowel disease Usually associated with ulcerative colitis but may be sporadic

 

Mucosal Prolapse / Cloacogenic Polyp GI Perineurioma
Fibrovascular stroma Lacks vascularity
Inflammatory infiltrate Inflammation infrequent
Prominent gland component Mostly a spindled stromal lesion, crypts pushed aside
Villiform eroded surface Surface intact and normal
Smooth muscle extends into lamina propria around crypts Lamina propria spindled lesion is smooth muscle actin negative and positive for perineurial markers

 

Mucosal Prolapse / Cloacogenic Polyp (Localized Colitis Cystica Profunda) Invasive Colorectal Adenocarcinoma
No surface carcinoma component Surface component usually present
No high grade nuclear atypia High grade nuclear atypia usually present
No cribriform glands or complex architecture Complex architecture with cribriform glands frequent
No desmoplastic stromal response Desmoplastic stromal response
Lamina propria may accompany displaced glands No lamina propria accompanying invasive glands
Mean age 35 years Occurs in older patients

 

Mucosal Prolapse / Cloacogenic Polyp (Solitary Rectal Ulcer) Crohn Disease
Shallow ulceration Deep ulcers and fissures
Restricted to rectum (rarely in sigmoid) May involve any part of GI tract

 

Mucosal Prolapse / Cloacogenic Polyp (Solitary Rectal Ulcer) Ulcerative Colitis
Usually a localized lesion Usually a diffuse lesion
Adjacent, intervening mucosa normal Adjacent, intervening mucosa inflamed
Restricted to rectum (rarely in sigmoid) May involve longer segments of colon

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