Virchows Archiv

, Volume 457, Issue 3, pp 291–297

Serrated polyps of the colon and rectum (hyperplastic polyps, sessile serrated adenomas, traditional serrated adenomas, and mixed polyps)—proposal for diagnostic criteria

  • Daniela E. Aust
  • Gustavo B. Baretton
  • Members of the Working Group GI-Pathology of the German Society of Pathology
Review and Perspective


Until recently, two major types of colorectal epithelial polyps were distinguished: the adenoma and the hyperplastic polyp. While adenomas—because of their cytological atypia—were recognized as the precursor lesions for colorectal carcinoma, hyperplastic polyps were perceived as harmless lesions without any potential for malignant progression mainly because hyperplastic polyps are missing cytological atypia. Meanwhile, it is recognized that the lesions, formerly classified as hyperplastic, represent a heterogeneous group of polyps with characteristic serrated morphology some of which exhibit a significant risk of neoplastic progression. These serrated lesions show characteristic epigenetic alterations not commonly seen in colorectal adenomas and progress to colorectal carcinoma via the so-called serrated pathway (CpG-island-methylation-phenotype pathway). This group of polyps is comprised not only of hyperplastic polyps, but also of sessile serrated adenomas, traditional serrated adenomas and mixed polyps, showing serrated and “classical” adenomatous features. Diagnostic criteria and nomenclature for these lesions are not uniform and, therefore, somewhat confusing. In a consensus conference of the Working Group of Gastroenterological Pathology of the German Society of Pathology, standardization of nomenclature and diagnostic criteria as well as recommendations for clinical management of these serrated polyps were formulated and are presented herein.


Hyperplastic polyp Sessile serrated adenoma Traditional serrated adenoma Serrated pathway Precancerous lesion Colorectum 


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Daniela E. Aust
    • 1
  • Gustavo B. Baretton
    • 1
  • Members of the Working Group GI-Pathology of the German Society of Pathology
    • 2
  1. 1.Institute for PathologyUniversity Hospital Carl Gustav Carus, TU DresdenDresdenGermany
  2. 2.Members of the Working Group GI-Pathology of the German Society of PathologyGerman Society for Pathology, Working Group GI-PathologyBerlinGermany

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