Skip to main content
SpringerLink
Log in

Hyperplastic Polyposis and the Risk of Colorectal Cancer

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

PURPOSE

Hyperplastic polyps are usually considered to be an innocent finding with little or no potential to progress to colorectal cancer. However, recent literature suggests that some of these polyps may be morphologically and genetically distinct and lead to microsatellite unstable colorectal cancers. The purpose of this study was to define the cancer risk associated with hyperplastic polyposis.

METHODS

All patients with hyperplastic polyposis diagnosed by a single colorectal surgeon at a university hospital were followed prospectively. The diagnosis of hyperplastic polyposis was made by the presence of more than 20 hyperplastic polyps distributed throughout the colon and/or a hyperplastic polyp at least 1 cm in size in diameter in the right colon. Patient demographics, family history, size, location, and distribution of polyps and the development of colorectal cancer were noted.

RESULTS

Thirteen patients who met the criteria for hyperplastic polyposis were identified and followed prospectively. All of these patients had at least 30 polyps distributed throughout the colon, often > 100. Nine of 13 also had a hyperplastic polyp at least 1 cm in size, usually in the right colon. Of particular note, 7 of 13 patients (54 percent) were diagnosed with colorectal cancer during the study period. Four had cancer on initial diagnosis and three patients developed cancer despite frequent colonoscopic surveillance. Five of seven colorectal cancers were located in the right colon.

CONCLUSIONS

Patients with hyperplastic polyposis are at high risk for colorectal cancer. Failure to identify this subset of patients could have dire consequences.

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

Similar content being viewed by others

REFERENCES

  1. H Goldman S-C Ming DF Hickok (1970) ArticleTitleNature and significance of hyperplastic polyps of the human colon Arch Pathol 89 349–54 Occurrence Handle1:STN:280:CS%2BC2c7otVw%3D Occurrence Handle5435674

    CAS  PubMed  Google Scholar 

  2. RG Estrada HJ Spjut (1980) ArticleTitleHyperplastic polyps of the large bowel Am J Surg Pathol 4 127–33 Occurrence Handle1:STN:280:Bi%2BC1Mnht1Y%3D Occurrence Handle7377462 Occurrence Handle10.1097/00000478-198004000-00004

    Article  CAS  PubMed  Google Scholar 

  3. JL Achord (1991) ArticleTitleHyperplastic colon polyps do not predict adenomas Gastroenterology 100 1142–3 Occurrence Handle2001817 Occurrence Handle1:STN:280:By6C28%2FptVc%3D

    PubMed  CAS  Google Scholar 

  4. DK Rex JJ Smith TM Ulbright et al. (1992) ArticleTitleDistal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects Gastroenterology 102 317–9 Occurrence Handle1:STN:280:By2D1M%2FmsVc%3D Occurrence Handle1727766

    CAS  PubMed  Google Scholar 

  5. E Torlakovic E Skovlund DC Snover et al. (2003) ArticleTitleMorphologic reappraisal of serrated colorectal polyps Am J Surg Pathol 27 65–81 Occurrence Handle10.1097/00000478-200301000-00008 Occurrence Handle12502929

    Article  PubMed  Google Scholar 

  6. JR Jass DS Cottier V Pokos et al. (1997) ArticleTitleMixed epithelial polyps in association with hereditary non-polyposis colorectal cancer providing an alternative pathway of cancer histogenesis Pathology 29 28–33 Occurrence Handle1:STN:280:ByiB2cfgsFU%3D Occurrence Handle9094174

    CAS  PubMed  Google Scholar 

  7. JR Jass KG Biden MC Cummings et al. (1999) ArticleTitleCharacterisation of a subtype of colorectal cancer combining features of the suppressor and mild mutator pathways J Clin Pathol 52 455–60 Occurrence Handle1:STN:280:DC%2BD3c%2FivVGmtw%3D%3D Occurrence Handle10562815 Occurrence Handle10.1136/jcp.52.6.455

    Article  CAS  PubMed  Google Scholar 

  8. JR Jass J Young BA Leggett (2000) ArticleTitleHyperplastic polyps and DNA microsatellite unstable cancers of the colorectum Histopathology 37 295–301 Occurrence Handle10.1046/j.1365-2559.2000.01028.x Occurrence Handle1:STN:280:DC%2BD3M%2FhvVehsQ%3D%3D Occurrence Handle11012735

    Article  CAS  PubMed  Google Scholar 

  9. JR Jass H Iino A Ruszkiewicz et al. (2000) ArticleTitleNeoplastic progression occurs through mutator pathways in hyperplastic polyposis of the colorectum Gut 47 43–9 Occurrence Handle10.1136/gut.47.1.43 Occurrence Handle1:CAS:528:DC%2BD3cXlsVGjtrY%3D Occurrence Handle10861263

    Article  CAS  PubMed  Google Scholar 

  10. JR Jass IC Talbot (2001) ArticleTitleMolecular and cellular biology of premalignancy in the gastrointestinal tract Best Pract Clin Gastroenterol 15 175–89 Occurrence Handle10.1053/bega.2000.0168 Occurrence Handle1:CAS:528:DC%2BD3sXktlSqsLc%3D

    Article  CAS  Google Scholar 

  11. JR Jass (1999) ArticleTitleSerrated adenoma and colorectal cancer J Pathol 187 499–502 Occurrence Handle10.1002/(SICI)1096-9896(199904)187:5<499::AID-PATH309>3.0.CO;2-B Occurrence Handle1:STN:280:DyaK1MzlvFGnsA%3D%3D Occurrence Handle10398112

    Article  CAS  PubMed  Google Scholar 

  12. JR Jass (2001) ArticleTitleSerrated route to colorectal cancer: back street or super highway? J Pathol 193 283–5 Occurrence Handle10.1002/1096-9896(200103)193:3<283::AID-PATH799>3.0.CO;2-9 Occurrence Handle1:STN:280:DC%2BD3M7osFaisg%3D%3D Occurrence Handle11241405

    Article  CAS  PubMed  Google Scholar 

  13. JR Jass (2001) ArticleTitleHyperplastic polyps of the colorectum—innocent or guilty? Dis Colon Rectum 44 163–6 Occurrence Handle1:STN:280:DC%2BD3M7ot1SlsA%3D%3D Occurrence Handle11227930

    CAS  PubMed  Google Scholar 

  14. NS Goldstein P Bhanot E Odish et al. (2003) ArticleTitleHyperplastic-like colon polyps that preceded microsatellite-unstable adenocarcinomas Am J Clin Pathol 119 778–96 Occurrence Handle10.1309/DRFQ-0WFU-F1G1-3CTK Occurrence Handle12817424

    Article  PubMed  Google Scholar 

  15. P Correa JP Strong A Reif et al. (1977) ArticleTitleThe epidemiology of colorectal polyps. Prevalence in New Orleans and international comparisons. Cancer 39 2258–64 Occurrence Handle1:STN:280:CSiC2MbosVc%3D Occurrence Handle870171

    CAS  PubMed  Google Scholar 

  16. AP Weston DR Campbell (1995) ArticleTitleDiminutive colonic polyps: histopathology, spatial distribution, concomitant significant lesions, and treatment complications Am J Gastroenterol 90 24–8 Occurrence Handle1:STN:280:ByqC3c%2FhvFE%3D Occurrence Handle7801943

    CAS  PubMed  Google Scholar 

  17. D Provenzale JW Garrett SE Condon SE Condon RS Sandler (1990) ArticleTitleRisk for colon adenomas in patients with rectosigmoid hyperplastic polyps Ann Intern Med 113 760–63 Occurrence Handle1:STN:280:By6D2M3ns1E%3D Occurrence Handle2240878

    CAS  PubMed  Google Scholar 

  18. E Torlakovic DC Snover (1996) ArticleTitleSerrated adenomatous polyposis in humans Gastroenterology 110 748–55 Occurrence Handle8608884 Occurrence Handle1:STN:280:BymC2sjnt1w%3D

    PubMed  CAS  Google Scholar 

  19. H Iino JR Jass LA Simms et al. (1999) ArticleTitleDNA microsatellite instability in hyperplastic polyps, serrated adenomas, and mixed polyps: a mild mutator pathway for colorectal cancer? J Clin Pathol 52 5–9 Occurrence Handle1:STN:280:DyaK1M3nsFSksQ%3D%3D Occurrence Handle10343605

    CAS  PubMed  Google Scholar 

  20. S Orii S Nakamura T Sugai et al. (1997) ArticleTitleHyperplastic (metaplastic) polyposis of the colorectum associated with adenomas and an adenocarcinoma J Clin Gastroenterol 25 369–72 Occurrence Handle10.1097/00004836-199707000-00018 Occurrence Handle1:STN:280:DyaK1c%2FnsVCjtw%3D%3D Occurrence Handle9412925

    Article  CAS  PubMed  Google Scholar 

  21. N Koide Y Saito T Fujii H Kondo D Saito T Shimoda (2002) ArticleTitleA case of hyperplastic polyposis of the colon with adenocarcinomas in hyperplastic polyps after long-term follow-up Endoscopy 34 499–502 Occurrence Handle10.1055/s-2002-32008 Occurrence Handle1:STN:280:DC%2BD38zgs1agtw%3D%3D Occurrence Handle12048637

    Article  CAS  PubMed  Google Scholar 

  22. BA Leggett B Devereaux K Biden J Searle J Young J Jass (2001) ArticleTitleHyperplastic polyposis association with colorectal cancer Am J Surg Path 25 177–84 Occurrence Handle10.1097/00000478-200102000-00005 Occurrence Handle1:STN:280:DC%2BD3M7is1OrsA%3D%3D Occurrence Handle11176066

    Article  CAS  PubMed  Google Scholar 

  23. GT Williams JF Arthur HJ Bussey BC Morson (1980) ArticleTitleMetaplastic polyps and polyposis of the colorectum Histopathology 4 155–70 Occurrence Handle1:STN:280:Bi%2BC3srnsFM%3D Occurrence Handle7358345

    CAS  PubMed  Google Scholar 

  24. H Jorgensen AM Mogensen LB Svedsen (1996) ArticleTitleHyperplastic polyposis of the large bowel Scand J Gastroenterol 31 825–30 Occurrence Handle1:STN:280:ByiD3M7ns1c%3D Occurrence Handle8858755

    CAS  PubMed  Google Scholar 

  25. Jass, JR, Burt, R (2000) “Hyperplastic polyposis” In: Hamilton, SR, Aaltonen, LA (eds.), WHO International Classification of Tumors. 3rd ed. Pathology and genetics of tumors of the digestive system, Springer-Verlag, Berlin, pp 135–6

  26. A Rashid PS Houlihan S Booker GM Petersen FM Giardiello SR Hamilton (2000) ArticleTitlePhenotypic and molecular characteristics of hyperplastic polyposis Gastroenterol 119 323–32 Occurrence Handle1:CAS:528:DC%2BD3cXmtVWrtbg%3D

    CAS  Google Scholar 

  27. M Risio A Arrigoni M Pennazio A Agostinucci M Spandre FP Rossini (1995) ArticleTitleMucosal cell proliferation in patients with hyperplastic colorectal cancers Scand J Gastroenterol 30 344–8 Occurrence Handle1:STN:280:ByqA3svmvVA%3D Occurrence Handle7610350

    CAS  PubMed  Google Scholar 

  28. A Rashid ES Pizer M Moga et al. (1997) ArticleTitleElevated expression of fatty acid synthase and fatty acid synthetic activity in colorectal neoplasia Am J Pathol 150 201–8 Occurrence Handle1:STN:280:ByiC2MfpvFE%3D Occurrence Handle9006336

    CAS  PubMed  Google Scholar 

  29. JM Skinner R Whitehead (1981) ArticleTitleTumor-associated antigens in polyps and carcinoma of the human bowel Cancer 47 1241–5 Occurrence Handle1:STN:280:Bi6C1crpsVw%3D Occurrence Handle6164469

    CAS  PubMed  Google Scholar 

  30. RJ Place CL Simmang (1999) ArticleTitleHyperplastic-adenomatous polyposis syndrome J Am Coll Surg 188 503–7 Occurrence Handle10.1016/S1072-7515(99)00019-8 Occurrence Handle1:STN:280:DyaK1M3kvFKmtQ%3D%3D Occurrence Handle10235578

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Vermont, College of Medicine, Burlington, Vermont

    Neil H. Hyman M.D. & P. Anderson M.D.

  2. Department of Pathology, University of Vermont, College of Medicine, Burlington, Vermont

    H. Blasyk M.D.

Authors
  1. Neil H. Hyman M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Anderson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Blasyk M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neil H. Hyman M.D..

Additional information

Reprints are not available.

About this article

Cite this article

Hyman, N., Anderson, P. & Blasyk, H. Hyperplastic Polyposis and the Risk of Colorectal Cancer. Dis Colon Rectum 47, 2101–2104 (2004). https://doi.org/10.1007/s10350-004-0709-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-004-0709-6

Key words

Search

Navigation