Grades of atypia in tubular and villous adenomas of the human colon. An electron microscopic study.

Of a total of 544 tubular, villous and tubulo-villous adenomas of the human colon which were investigated by light microscopy, six tubular and six villous adenomas were examined under the electron microscope. It was shown that the two types of adenoma differ in their tissue architecture, but not in their cytological appearance. Different grades of epithelial atypia occur in both types of adenoma. These are designated as grades I to III, correspond to mild, moderate and severe atypia respectively. Whereas adenoma cells with atypia grade I clearly show a cytological relationship with crypt epithelia of the normal colonic mucosa under the electron microscope, adenoma cells with atypia grade III have largely lost the differentiation characteristics of the parent cells and there is no longer intracytoplasmic organization. In the cytoplasm of adenoma cells with atypia grade II, glycogen storage is found as a special feature which does not occur in normal colonic epithelium. A similar finding has been described in the course of malignant transformation of the liver and kidney and thus can be regarded as a further indication of the precancerous nature of the adenomas.