![fragments of tubular adenoma fragments of tubular adenoma](https://gut.bmj.com/content/gutjnl/53/4/573/F1.large.jpg)
Over 75% of volume has tubular appearance. Tubular adenoma with high-grade dysplasia. More "open" appearing nuclei with increasingly prominent nucleoli.In such piles, nuclei show regular polarity with apical mucin, and their nuclei are not markedly enlarged. This should be distinguished from cases where piles of well-differentiated mucin-producing cells appear cribriform. Rarely, they have foci of squamous differentiation (morules). Cribriform architecture, consisting of juxtaposed gland lumens without stroma in between, with loss of cell polarity.Nuclear pleomorphism and atypical mitosesĬrowding, cribriform, or complex architecture Pseudo-stratification to early stratification Prominent nucleoli Typical findings in low-grade versus high-grade tubular and ⁄or villous adenoma The entire specimen is submitted for microscopic examination in one cassette. The fragments measure 0.2-0.3 cm in greatest dimension. The specimen is received in formalin and consists of 4 fragments of pink-tan tissue with a vaguely recognizable mucosal surface, mixed with food-like material. Small fragments are sieved and embedded in a separate box. Polyps that come in parts: Pick out the largest pieces, which are cut as similar as possible to above.Then divide the two remaining portions into equally thick slices, parallel to the previous slice. Polyps >8 mm with short stem or without stem: Identify the excision surface and cut out a 3-4 mm thick disk that extends longitudinally through the center of the excision surface.Then take a 3-4 mm thick slice longitudinally through the polyp and the middle of the stem, after which the two remaining parts on either side are cut into equally thick slices, parallel to the previous slice. Biopsies and polyps of 8 mm with a stem long enough to make it possible to take a transverse, whole slice from the stem closest to the excision surface: First, take a transverse slice through the peripheral portion of the stem, encompassing the entire circumference.There is a separate article for the Grossing of minimally invasive colorectal surgery.