Histopathology

Adenomas in FAP begin as single dys-plastic crypts ('unicryptal' adenomas). In practice, to find more than one of these in a colon is unique to FAP. By excessive and asymmetrical crypt fission {1086; 433; 2062}, probably due to loss of APC-controlled growth and tissue organization, they develop into oligocryptal adenomas, which may not be visible as polyps before further growth into grossly visible adenomatous polyps. Most adenomas in FAP display a tubular architecture; infrequently they are tubulovillous or villous. Non-polypoid, flat adenomas account for approximately 5% of adenomas in the colon of affected family members {1181}. AF denomas and carcinomas in FAP are histologically identical to sporadic lesions.

Fig. 6.55 Adenocarcinoma and innumerable adenomas in a case of FAP.
Fig. 6.57 Intraepithelial neoplasia (dysplasia) of the common bile duct from a patient with FAP.

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