Objectives. The utility of examining specimens from colorectal biopsies of polyps for nonneoplastic diseases is currently unknown. Our objectives were to characterize such additional diagnoses that could be rendered. Methods. We retrospectively and prospectively reviewed specimens from endoscopic biopsies of colorectal polyps obtained during routine screening or surveillance. Results. 17 of 168 specimens (10.1%) contained additional diagnoses, including schistosomiasis, eosinophilic colitis, intestinal spirochetosis, melanosis coli, and other entities. These findings were easily overlooked because they often affected mucosa that was spared by the polyps or were often evident only at high magnification. Schistosomiasis, eosinophilic colitis, and intestinal spirochetosis were clinically occult. Conclusions. Specimens from biopsies of colorectal polyps often harbor other diagnoses, in addition to polyps, and can be simultaneously screened for polyps and examined for nonneoplastic diseases. Detection of other diagnoses in addition to polyps requires awareness, examination at high magnification, and examination of areas spared by the polyps. 1. Introduction Specimens from endoscopic biopsies of putative colorectal lesions usually show traditional nonserrated adenomas, serrated polyps, or variants of normal mucosa. These entities generally are easily and rapidly diagnosed at low magnification. Consequently, pathologists are tempted to examine these specimens quickly and only at low magnification, to assume that these specimens will harbor only polyps or variants of normal mucosa, and to refrain from examining these specimens further at high magnification once polyps are diagnosed. Directed review of these specimens might reveal other diagnoses, in addition to polyps. Pathologists might overlook such second diagnoses for various reasons. However, such second diagnoses might be significant. We reviewed specimens from biopsies of colorectal polyps to characterize second diagnoses that could be rendered in this setting and to demonstrate that these specimens could be examined for nonneoplastic diseases. 2. Materials and Methods The study was approved by the Institutional Review Board of the University of California, Irvine, USA, on November 7, 2005 as protocol HS number: 2005-4646. The study was carried out in 2 phases. The first phase was designed to determine prevalence, and the second phase was designed to determine incidence. During the first phase, consecutive specimens from endoscopic colorectal biopsies of polyps accessioned at our institution during a
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