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My approach to serrated polyps of the colorectum
  1. T Higuchi1,
  2. J R Jass2
  1. 1Department of Digestive Surgery, Tokyo Medical and Dental University, Tokyo, Japan
  2. 2Department of Pathology, McGill University, Montreal, Quebec, Canada H3A 2B4
  1. Correspondence to:
 Professor J R Jass
 Department of Pathology, McGill University, Duff Medical Building, 3775 University Street, Montreal, Quebec, Canada H3A 2B4; jeremy.jassmcgill.ca

Abstract

Hyperplastic polyps of the colorectum are heterogeneous lesions, a subset of which is now regarded as the precursor of colorectal cancer with DNA microsatellite instability. Some authors have distinguished this subset from classic hyperplastic polyps and have introduced the term “sessile serrated adenoma”. These lesions frequently show BRAF mutation and DNA methylation. This personal perspective reviews recent insights into serrated polyps and highlights the importance of inhibition of apoptosis as a unifying mechanism. It is estimated that around 25 hyperplastic polyps of the proximal colon exist for every colorectal cancer with DNA microsatellite instability. Further research is required to identify additional risk factors for hyperplastic polyps other than anatomical location. These may be demographic, clinical, morphological, or molecular. It is not recommended that the term sessile serrated adenoma be used in routine reporting, but it is desirable that potentially aggressive hyperplastic polyps should be identified for the purposes of both clinical practice and research.

  • MSI, microsatellite instability
  • MSI-H, high degree of microsatellite instability
  • MUHC, McGill University Health Centre
  • WHO, World Health Organisation
  • polyp
  • hyperplastic
  • colon
  • serrated
  • adenoma
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