Skip to main content
SpringerLink
Log in

Histopathologische Diagnostik und Differenzialdiagnostik serratierter Polypen im Kolorektum

Ergebnisse einer Konsensuskonferenz der AG „Gastroenterologische Pathologie der DGP“

Histopathological diagnosis and differential diagnosis of colorectal serrated polys

Findings of a consensus conference of the working group“Gastroenterological pathology of the German Society of Pathology”

  • Übersichten
  • Published:
Der Pathologe Aims and scope Submit manuscript

Zusammenfassung

Bis in die jüngste Zeit wurden 2 Hauptformen epithelialer Polypen im Kolorektum unterschieden: Adenome und hyperplastische Polypen. Während Adenome aufgrund ihrer zytologischen Dysplasie bzw. intraepithelialen Neoplasie (IEN) als Vorläuferläsionen invasiver Karzinome aufgefasst werden, wurden die hyperplastischen Polypen, bei denen solche zytologischen Atypien fehlen, als nichtneoplastische Veränderungen ohne Malignitätspotenzial angesehen. Mittlerweile ist klar, dass die ehemals als „hyperplastische Polypen“ klassifizierten Läsionen eine heterogene Gruppe darstellen, die z. T. ein signifikantes Risiko zur malignen Transformation aufweisen. Molekular zeigen diese Polypen charakteristische Genpromotormethylierungen (so genannte „CIMP-Pathways“), die bei konventionellen kolorektalen Adenomen nicht üblich sind, und entwickeln sich wahrscheinlich über den neuen serratierten Karzinogeneseweg zum kolorektalen Karzinom. Das Spektrum dieser serratierten Polypen umfasst dabei nicht nur die hyperplastischen Polypen, sondern auch das sessile serratierte Adenom (SSA) und das traditionelle serratierte Adenom (TSA) sowie Mischformen. Auf einer Konsensuskonferenz der AG „Gastroenterologische Pathologie der DGP“ wurde versucht, eine Standardisierung der Nomenklatur und der histologischen Diagnosekriterien zu erarbeiten sowie Empfehlungen für das klinische Management zu formulieren.

Abstract

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 precursor lesions for colorectal carcinoma, hyperplastic polyps were perceived as harmless lesions without any potential for malignant progression, mainly because hyperplastic polyps lack cytological atypia. Meanwhile, it is evident that the lesions formerly classified as hyperplastic represent a heterogeneous group of polyps, some of which exhibit a significant risk of neoplastic progression. These lesions show characteristic epigenetic alterations not commonly seen in colorectal adenomas and progress to colorectal carcinoma via the so-called serrated pathway (CIMP pathway). This group of polyps is comprised not only of hyperplastic polyps, but also of sessile serrated adenomas (SSA), traditional serrated adenomas (TSA) and mixed polyps, showing serrated and “classical” adenomatous features. 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Notes

  1. In einer zwischenzeitlich in Dresden durchgeführten multivariaten Analyse an 212 serratierten Läsionen erwies sich neben den Kriterien 1–3 auch der Nachweis reifer Becherzellen an der Kryptenbasis als signifikanter Diskriminator zwischen HP und SSA [35].

Literatur

  1. Ajioka Y, Watanabe H, Jass JR et al (1998) Infrequent K-ras codon 12 mutation in serrated adenomas of human colorectum. Gut 42:680–684

    Article  CAS  PubMed  Google Scholar 

  2. Azimuddin K, Stasik JJ, Khubchandani IT et al (2000) Hyperplastic polyps: „more than meets the eye“? Report of sixteen cases. Dis Colon Rectum 43:1309–1313

    Article  CAS  PubMed  Google Scholar 

  3. Bartley AN, Thompson PA, Buckmeier JA et al (2010) Expression of gastric pyloric mucin, MUC6, in colorectal serrated polyps. Mod Pathol 23:169–176

    Article  CAS  PubMed  Google Scholar 

  4. Chan TL, Zhao W, Leung SY et al (2003) BRAF and KRAS mutations in colorectal hyperplastic polyps and serrated adenomas. Cancer Res 63:4878–4881

    CAS  PubMed  Google Scholar 

  5. Dong SM, Lee EJ, Jeon ES et al (2005) Progressive methylation during the serrated neoplasia pathway of the colorectum. Mod Pathol 18:170–178

    Article  CAS  PubMed  Google Scholar 

  6. Freeman HJ (2008) Heterogeneity of colorectal adenomas, the serrated adenoma, and implications for screening and surveillance. World J Gastroenterol 14:3461–3463

    Article  PubMed  Google Scholar 

  7. Goldstein NS (2006) Small colonic microsatellite unstable adenocarcinomas and high-grade epithelial dysplasias in sessile serrated adenoma polypectomy specimens: a study of eight cases. Am J Clin Pathol 125:132–145

    PubMed  Google Scholar 

  8. Hamilton SR, Aaltonen LA (Hrsg) (2000) World Health Organization Classification of Tumours. Pathology and genetics of tumours of the digestive system. IARC, Lyon

  9. Iino H, Jass JR, Simms LA et al (1999) DNA microsatellite instability in hyperplastic polyps, serrated adenomas, and mixed polyps: a mild mutator pathway for colorectal cancer? J Clin Pathol 52:5–9

    Article  CAS  PubMed  Google Scholar 

  10. Jass JR, Biden KG, Cummings MC et al (1999) Characterisation of a subtype of colorectal cancer combining features of the suppressor and mild mutator pathways. J Clin Pathol 52:455–460

    Article  CAS  PubMed  Google Scholar 

  11. Jass JR, Whitehall VL, Young J et al (2002) Emerging concepts in colorectal neoplasia. Gastroenterology 123:862–876

    Article  CAS  PubMed  Google Scholar 

  12. Jass JR, Baker K, Zlobec I et al (2006) Advanced colorectal polyps with the molecular and morphological features of serrated polyps and adenomas: concept of a ‚fusion‘ pathway to colorectal cancer. Histopathology 49:121–131

    Article  CAS  PubMed  Google Scholar 

  13. Jass JR (2007) Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology 50:113–130

    Article  CAS  PubMed  Google Scholar 

  14. Jeevaratnam P, Cottier DS, Browett PJ et al (1996) Familial giant hyperplastic polyposis predisposing to colorectal cancer: a new hereditary bowel cancer syndrome. J Pathol 179:20–25

    Article  CAS  PubMed  Google Scholar 

  15. Kambara T, Simms LA, Whitehall VL et al (2004) BRAF mutation is associated with DNA methylation in serrated polyps and cancers of the colorectum. Gut 53:1137–1144

    Article  CAS  PubMed  Google Scholar 

  16. Kudo S, Lambert R, Allen JI et al (2008) Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 68:S3–S47

    Article  PubMed  Google Scholar 

  17. Lazarus R, Junttila OE, Karttunen TJ et al (2005) The risk of metachronous neoplasia in patients with serrated adenoma. Am J Clin Pathol 123:349–359

    Article  PubMed  Google Scholar 

  18. Li D, Jin C, McCulloch C et al (2009) Association of large serrated polyps with synchronous advanced colorectal neoplasia. Am J Gastroenterol 104:695–702

    Article  PubMed  Google Scholar 

  19. Longacre TA, Fenoglio-Preiser CM (1990) Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia. Am J Surg Pathol 14:524–537

    Article  CAS  PubMed  Google Scholar 

  20. Morson BC (1962) Precancerous lesions of the colon and rectum. Classification and controversial issues. JAMA 179:316–321

    CAS  PubMed  Google Scholar 

  21. Noffsinger AE (2009) Serrated polyps and colorectal cancer: new pathway to malignancy. Annu Rev Pathol 4:343–364

    Article  CAS  PubMed  Google Scholar 

  22. Oono Y, Fu K, Nakamura H et al (2009) Progression of a sessile serrated adenoma to an early invasive cancer within 8 months. Dig Dis Sci 54:906–909

    Article  PubMed  Google Scholar 

  23. Otori K, Oda Y, Sugiyama K et al (1997) High frequency of K-ras mutations in human colorectal hyperplastic polyps. Gut 40:660–663

    CAS  PubMed  Google Scholar 

  24. Owens SR, Chiosea SI, Kuan SF (2008) Selective expression of gastric mucin MUC6 in colonic sessile serrated adenoma but not in hyperplastic polyp aids in morphological diagnosis of serrated polyps. Mod Pathol 21:660–669

    Article  CAS  PubMed  Google Scholar 

  25. Preto A, Figueiredo J, Velho S et al (2008) BRAF provides proliferation and survival signals in MSI colorectal carcinoma cells displaying BRAF(V600E) but not KRAS mutations. J Pathol 214:320–327

    Article  CAS  PubMed  Google Scholar 

  26. Renaut AJ, Douglas PR, Newstead GL (2002) Hyperplastic polyposis of the colon and rectum. Colorectal Dis 4:213–215

    Article  PubMed  Google Scholar 

  27. Schmiegel W, Reinacher-Schick A, Arnold D et al (2008) Update S3-guideline „colorectal cancer“ 2008. Z Gastroenterol 46:799–840

    Article  CAS  PubMed  Google Scholar 

  28. Tateyama H, Li W, Takahashi E et al (2002) Apoptosis index and apoptosis-related antigen expression in serrated adenoma of the colorectum: the saw-toothed structure may be related to inhibition of apoptosis. Am J Surg Pathol 26:249–256

    Article  PubMed  Google Scholar 

  29. Torlakovic E, Snover DC (1996) Serrated adenomatous polyposis in humans. Gastroenterology 110:748–755

    Article  CAS  PubMed  Google Scholar 

  30. Torlakovic E, Skovlund E, Snover DC et al (2003) Morphologic reappraisal of serrated colorectal polyps. Am J Surg Pathol 27:65–81

    Article  PubMed  Google Scholar 

  31. Torlakovic EE, Gomez JD, Driman DK et al (2008) Sessile Serrated Adenoma (SSA) vs. Traditional Serrated Adenoma (TSA). Am J Surg Pathol 32:21–29

    Article  PubMed  Google Scholar 

  32. Toyota M, Ahuja N, Ohe-Toyota M et al (1999) CpG island methylator phenotype in colorectal cancer. Proc Natl Acad Sci U S A 96:8681–8686

    Article  CAS  PubMed  Google Scholar 

  33. Velho S, Moutinho C, Cirnes L et al (2008) BRAF, KRAS and PIK3CA mutations in colorectal serrated polyps and cancer: primary or secondary genetic events in colorectal carcinogenesis? BMC Cancer 8:255

    Article  PubMed  Google Scholar 

  34. Warner AS, Glick ME, Fogt F (1994) Multiple large hyperplastic polyps of the colon coincident with adenocarcinoma. Am J Gastroenterol 89:123–125

    CAS  PubMed  Google Scholar 

  35. Wieczorek K, Stolte M, Baretton G et al (2009) Serrated lesions of the colorectum: morphologic characterisation of a large collective. Pathologe (Suppl 1):7

  36. Yantiss RK, Oh KY, Chen YT et al (2007) Filiform serrated adenomas: a clinicopathologic and immunophenotypic study of 18 cases. Am J Surg Pathol 31:1238–1245

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Institut für Pathologie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    G.B. Baretton & D.E. Aust

  2. Institut für Pathologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland

    F. Autschbach

  3. Institut für Pathologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    S. Baldus

  4. Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    H. Bläker & P. Schirmacher

  5. Institut für Pathologie, St. Vincentius-Kliniken gAG Karlsruhe, Karlsruhe, Deutschland

    G. Faller

  6. Institut für Pathologie, Klinikum Bayreuth GmbH, Bayreuth, Deutschland

    H.K. Koch & M. Vieth

  7. Institut für Pathologie, Medizinische Universität Graz, Graz, Österreich

    C. Langner

  8. Institut für Pathologie, Klinikum Saarbrücken, Saarbrücken, Deutschland

    J. Lüttges

  9. Institut für Pathologie, Ruhr-Universität Bochum, Bochum, Deutschland

    M. Neid & A. Tannapfel

Authors
  1. G.B. Baretton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Autschbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Baldus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Bläker
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Faller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H.K. Koch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Langner
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Lüttges
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Neid
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. P. Schirmacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. A. Tannapfel
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M. Vieth
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. D.E. Aust
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G.B. Baretton.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baretton, G., Autschbach, F., Baldus, S. et al. Histopathologische Diagnostik und Differenzialdiagnostik serratierter Polypen im Kolorektum. Pathologe 32, 76–82 (2011). https://doi.org/10.1007/s00292-010-1365-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00292-010-1365-3

Schlüsselwörter

Keywords

Search

Navigation