Abstract
Until recently, all serrated polyps were classified simply as hyperplastic polyps and were thought to represent benign lesions with no progression to malignancy. However, the recognition during the last decade that some serrated polyps may progress to colorectal cancer through the “serrated neoplastic pathway” has changed the understanding of the significance of these lesions. Classification of serrated polyps is evolving and underscores the fact that morphological changes in serrated lesions are linked to a preneoplastic behavior. This fact has been observed not only in the hyperplastic polyposis syndrome, characterized by multiple or large serrated polyps, but also in the sporadic setting. These findings are particularly important for colorectal cancer prevention, and adequate surveillance programs tailored for patients with serrated polyps are urgently needed.
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•• O’Brien MJ: Hyperplastic and serrated polyps of the colorectum. Gastroenterol Clin North Am 2007,36:947–968. This article reviews the histological classification of serrated polyps and their molecular associations.
Chow E, Lipton L, Lynch E, et al.: Hyperplastic polyposis syndrome: phenotypic presentations and the role of MBD4 and MYH. Gastroenterology 2006,131:30–39.
• Boparai KS, Mathus-Vliegen EM, Koornstra JJ, et al.: Increased colorectal cancer risk during follow-up in patients with hyperplastic polyposis syndrome: a multicentre cohort study. Gut 2010;59:1094–1100. This article describes the CRC risk in the largest cohort of HPS patients published so far.
Iino H, Jass JR, Simms LA, et al.: DNA microsatellite instability in hyperplastic polyps, serrated adenomas, and mixed polyps: a mild mutator pathway for colorectal cancer? J Clin Pathol 1999,52:5–9.
Hawkins NJ, Ward RL: Sporadic colorectal cancers with microsatellite instability and their possible origin in hyperplastic polyps and serrated adenomas. Journal of the National Cancer Institute 2001,93:1307–1313.
Toyota M, Ahuja N, Ohe-Toyota M, et al.: CpG island methylator phenotype in colorectal cancer. Proceedings of the National Academy of Sciences of the United States of America 1999,96:8681–8686.
Wynter CV, Walsh MD, Higuchi T, et al.: Methylation patterns define two types of hyperplastic polyp associated with colorectal cancer. Gut 2004,53:573–580.
Jones PA, Laird PW: Cancer epigenetics comes of age. Nature genetics 1999,21:163–167.
Chan TL, Zhao W, Leung SY, Yuen ST: BRAF and KRAS mutations in colorectal hyperplastic polyps and serrated adenomas. Cancer research 2003,63:4878–4881.
Kambara T, Simms LA, Whitehall VL, et al.: BRAF mutation is associated with DNA methylation in serrated polyps and cancers of the colorectum. Gut 2004,53:1137–1144.
• Leggett B, Whitehall V: Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology,138:2088–2100. This recent and complete review focuses on the significance of the serrated pathway in colorectal carcinogenesis.
Glazer E, Golla V, Forman R, et al.: Serrated adenoma is a risk factor for subsequent adenomatous polyps. Dig Dis Sci 2008,53:2204–2207.
Laiyemo AO, Murphy G, Sansbury LB, et al.: Hyperplastic polyps and the risk of adenoma recurrence in the polyp prevention trial. Clin Gastroenterol Hepatol 2009,7:192–197.
Lazarus R, Junttila OE, Karttunen TJ, Makinen MJ: The risk of metachronous neoplasia in patients with serrated adenoma. Am J Clin Pathol 2005,123:349–359.
• Hiraoka S, Kato J, Fujiki S, et al.: The Presence of Large Serrated Polyps Increases Risk for Colorectal Cancer. Gastroenterology 2010,139:1503–1510. This article includes a large cohort of patients undergoing colonoscopy and describes that the presence of large serrated polyps in the colon is associated with CRC development.
• Schreiner MA, Weiss DG, Lieberman DA: Proximal and large hyperplastic and non-dysplastic serrated polyps detected by colonoscopy are associated with neoplasia. Gastroenterology 2010,139:1497–1502. This article analyze predictors of advanced colonic neoplasia in a large cohort of patients undergoing colonoscopy, recognizing that the presence of large and proximal serrated polyps are associated with CRC development.
Snover DC, Jass JR, Fenoglio-Preiser C, Batts KP: Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept. Am J Clin Pathol 2005,124:380–391.
Aust DE, Baretton GB: Serrated polyps of the colon and rectum (hyperplastic polyps, sessile serrated adenomas, traditional serrated adenomas, and mixed polyps)-proposal for diagnostic criteria. Virchows Arch 2010,457:291–297.
Longacre TA, Fenoglio-Preiser CM: Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia. The American journal of surgical pathology 1990,14:524–537.
Torlakovic E, Skovlund E, Snover DC, et al.: Morphologic reappraisal of serrated colorectal polyps. The American journal of surgical pathology 2003,27:65–81.
Torlakovic E, Snover DC: Serrated adenomatous polyposis in humans. Gastroenterology 1996,110:748–755.
Torlakovic EE, Gomez JD, Driman DK, et al.: Sessile serrated adenoma (SSA) vs. traditional serrated adenoma (TSA). The American journal of surgical pathology 2008,32:21–29.
Khalid O, Radaideh S, Cummings OW, et al.: Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001. World J Gastroenterol 2009,15:3767–3770.
Farris AB, Misdraji J, Srivastava A, et al.: Sessile serrated adenoma: challenging discrimination from other serrated colonic polyps. The American journal of surgical pathology 2008,32:30–35.
Sandmeier D, Seelentag W, Bouzourene H: Serrated polyps of the colorectum: is sessile serrated adenoma distinguishable from hyperplastic polyp in a daily practice? Virchows Arch 2007,450:613–618.
Carr NJ, Mahajan H, Tan KL, et al.: Serrated and non-serrated polyps of the colorectum: their prevalence in an unselected case series and correlation of BRAF mutation analysis with the diagnosis of sessile serrated adenoma. J Clin Pathol 2009,62:516–518.
Spring KJ, Zhao ZZ, Karamatic R, et al.: High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology 2006,131:1400–1407.
O’Brien MJ, Yang S, Mack C, et al.: Comparison of microsatellite instability, CpG island methylation phenotype, BRAF and KRAS status in serrated polyps and traditional adenomas indicates separate pathways to distinct colorectal carcinoma end points. The American journal of surgical pathology 2006,30:1491–1501.
Gurudu SR, Heigh RI, De Petris G, et al.: Sessile serrated adenomas: demographic, endoscopic and pathological characteristics. World J Gastroenterol,16:3402–3405.
Higuchi T, Sugihara K, Jass JR: Demographic and pathological characteristics of serrated polyps of colorectum. Histopathology 2005,47:32–40.
Goldstein NS, Bhanot P, Odish E, Hunter S: Hyperplastic-like colon polyps that preceded microsatellite-unstable adenocarcinomas. Am J Clin Pathol 2003,119:778–796.
Jass JR, Baker K, Zlobec I, et al.: Advanced colorectal polyps with the molecular and morphological features of serrated polyps and adenomas: concept of a ‘fusion’ pathway to colorectal cancer. Histopathology 2006,49:121–131.
East JE, Saunders BP, Jass JR: Sporadic and syndromic hyperplastic polyps and serrated adenomas of the colon: classification, molecular genetics, natural history, and clinical management. Gastroenterol Clin North Am 2008,37:25–46.
Ferrandez A, Samowitz W, DiSario JA, Burt RW: Phenotypic characteristics and risk of cancer development in hyperplastic polyposis: case series and literature review. Am J Gastroenterol 2004,99:2012–2018.
Carvajal-Carmona LG, Howarth KM, Lockett M, et al.: Molecular classification and genetic pathways in hyperplastic polyposis syndrome. The Journal of pathology 2007,212:378–385.
Jass JR, Iino H, Ruszkiewicz A, et al.: Neoplastic progression occurs through mutator pathways in hyperplastic polyposis of the colorectum. Gut 2000,47:43–49.
Rashid A, Houlihan PS, Booker S, et al.: Phenotypic and molecular characteristics of hyperplastic polyposis. Gastroenterology 2000,119:323–332.
Rubio CA, Stemme S, Jaramillo E, Lindblom A: Hyperplastic polyposis coli syndrome and colorectal carcinoma. Endoscopy 2006,38:266–270.
Kiesslich R, von Bergh M, Hahn M, et al.: Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon. Endoscopy 2001,33:1001–1006.
Kaltenbach T, Friedland S, Soetikno R: A randomised tandem colonoscopy trial of narrow band imaging versus white light examination to compare neoplasia miss rates. Gut 2008,57:1406–1412.
Boparai KS, Dekker E, Van Eeden S, et al.: Hyperplastic polyps and sessile serrated adenomas as a phenotypic expression of MYH-associated polyposis. Gastroenterology 2008,135:2014–2018.
Jeevaratnam P, Cottier DS, Browett PJ, et al.: Familial giant hyperplastic polyposis predisposing to colorectal cancer: a new hereditary bowel cancer syndrome. The Journal of pathology 1996,179:20–25.
•• Boparai KS, Reitsma JB, Lemmens V, et al.: Increased colorectal cancer risk in first-degree relatives of patients with hyperplastic polyposis syndrome. Gut 2010,59:1222–1225. In this article, using a large cohort of first-degree relatives of HPS patients, the authors show that the risk of both CRC and hyperplastic polyposis phenotype is increased in this population.
Jass JR, Young J, Leggett BA: Hyperplastic polyps and DNA microsatellite unstable cancers of the colorectum. Histopathology 2000,37:295–301.
Sawhney MS, Farrar WD, Gudiseva S, et al.: Microsatellite instability in interval colon cancers. Gastroenterology 2006,131:1700–1705.
Lu FI, van Niekerk de W, Owen D, et al.: Longitudinal outcome study of sessile serrated adenomas of the colorectum: an increased risk for subsequent right-sided colorectal carcinoma. The American journal of surgical pathology 2010,34:927–934.
Li D, Jin C, McCulloch C, et al.: Association of large serrated polyps with synchronous advanced colorectal neoplasia. Am J Gastroenterol 2009,104:695–702.
Bauer VP, Papaconstantinou HT: Management of serrated adenomas and hyperplastic polyps. Clin Colon Rectal Surg 2008,21:273–279.
Rex DK, Smith JJ, Ulbright TM, Lehman GA: Distal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects. Gastroenterology 1992,102:317–319.
Levin B, Lieberman DA, McFarland B, et al.: Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA: a cancer journal for clinicians 2008,58:130–160.
Acknowledgments
This work was supported by grants from the Ministerio de Ciencia e Innovación (SAF2007-64873 and SAF2010-19273), Asociación Española contra el Cáncer (Fundación Científica y Junta de Barcelona), and Agència de Gestió d’Ajuts Universitaris i de Recerca (2009 SGR 849).
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Balaguer, F., Castells, A. Hyperplastic Polyps: Are They Completely Innocent?. Curr Colorectal Cancer Rep 7, 42–49 (2011). https://doi.org/10.1007/s11888-010-0080-z
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DOI: https://doi.org/10.1007/s11888-010-0080-z