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Qualities of sessile serrated adenoma/polyp/lesion and its borderline variant in the context of synchronous colorectal carcinoma
  1. Mahin Mohammadi1,
  2. Michael Holmsgaard Kristensen1,
  3. Hans Jørgen Nielsen2,
  4. Jesper Hansen Bonde3,4,
  5. Susanne Holck3
  1. 1Department of Pathology, Hospital South, Naestved, Denmark
  2. 2Department of Surgical Gastroenterology, Copenhagen University Hospital, Hvidovre, Denmark
  3. 3Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
  4. 4Department of Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
  1. Correspondence to Dr Mahin Mohammadi, Department of Pathology, Hospital South, Naestved 4700, Denmark; mhim{at}


Aims Although much data have accumulated on sessile serrated adenoma/polyp/lesion (SSA/P/L) in general, its characteristics in specified contexts are less well elucidated. This lack of knowledge is even more conspicuous concerning its borderline counterpart, referred to as BSSA/P/L. The previous histological observations of the authors on SSA/P/L and BSSA/P/L in general are here extended to encompass attributes of these polyps in the context of synchronous colorectal carcinoma (SCRC), with a focus on the place of BSSA/P/L in the spectrum of non-dysplastic serrated polyps.

Methods 219 SSA/P/Ls, 206 BSSA/P/Ls and 170 hyperplastic polyps (HPs) were examined for SCRC. Demographics, polyp details (size, site, BRAF (V600E)) and advanced synchronous conventional adenomas were recorded.

Results SCRC was present in 12.3% of SSA/P/Ls, 7.1% of HPs (p=0.09) and 8.3% of BSSA/P/Ls. Patients' ages were comparable. Gender distribution of SSA/P/L and BSSA/P/L was equal, which differed, albeit insignificantly, from a male predominance of HPs. More SSA/P/Ls and BSSA/P/Ls than HPs exceeded 4 mm (p≤0.0001). A proximal site characterised SSA/P/L compared with BBSA/P/L and HP (p<0.0001). BRAF mutation was more prevalent in SSA/P/Ls and BSSA/P/Ls, which further coexisted with advanced synchronous conventional adenomas less commonly than HPs.

Conclusions BSSA/P/L was like SSA/P/L in most respects. The lower SCRC prevalence of BSSA/P/L could fit the idea of BSSA/P/L as a precursor to SSA/P/L, a notion that deserves attention when formulating guidelines for CRC screening.

  • Sessile serrated adenoma
  • borderline sessile serrated adenoma
  • hyperplastic polyp
  • synchronous colorectal cancer
  • colitis
  • colon
  • prostate
  • rectal cancer
  • salivary gland tumours

Statistics from


  • Funding The work was supported by Hospital South, Region Zealand, and an external award from the Danish Medical Association Research Fund.

  • Competing interests None.

  • Ethics approval The project was approved by the Ethics Committee of the Capital Region of Denmark.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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