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Traditional serrated adenomas (TSAs) admixed with other serrated (so-called precursor) polyps and conventional adenomas: a frequent occurrence
  1. Runjan Chetty1,
  2. Sara Hafezi-Bakhtiari1,
  3. Stefano Serra1,
  4. Richard Colling2,
  5. Lai Mun Wang1
  1. 1Department of Pathology, Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Cellular Pathology, Oxford University Hospitals, Oxford, UK
  1. Correspondence to Professor Runjan Chetty, Department of Pathology, Toronto General Hospital, 11th floor, Eaton wing, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4; runjan.chetty{at}uhn.ca

Abstract

Background Traditional serrated adenoma (TSA) is a very characteristic type of serrated polyp that has a predilection for the left colon. Recent molecular advances have shown two molecular phenotypes of TSA: one associated with BRAF mutations and the other with KRAS mutations. The former is associated with hyperplastic polyps (HPs) and sessile serrated adenomas (SSAs), while the latter is associated with more conventional adenomatous dysplasia.

Aims The association of TSAs with so-called precursor lesions (HPs and SSAs) is not well recognised and the purpose of this study was to explore the coexistent presence of HPs, SSAs and adenomatous polyps within a large cohort of TSAs.

Methods In total 149 TSAs were examined for the presence of HP, SSA and adenomatous polyps.

Results Seen in 83 men and 65 women ranging in age from 32 to 89 years and 127 were left sided with 22 in the right colon. Seventy-eight of the 149 TSAs showed evidence of another polyp (52.34%): 32 were low-grade tubular/tubulovillous adenomas (TAs/TVAs; 41%), 28 were HPs (36%) and 18 were SSAs (23%). Eleven of the 22 right-sided TSAs were associated with a precursor lesion (1 HP and 7 SSA). In addition, five TSAs showed more than one polyp type: TSA with TA/TVA and HP (3); TSA with TA/TVA and SSA (2). The TAs/TVAs were adjacent to the TSA but occurred as a separate discrete polyp, while HPs and SSAs were intermingled with the TSA and present at the base and surface of the lesion.

Conclusions More than 50% of TSAs are associated with a precursor lesion or adjacent TA/TVA. Their recognition is important as this may have surveillance and management ramifications.

  • GUT PATHOLOGY
  • COLON
  • GASTROINTESTINAL DISEASE

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