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Microvesicular hyperplastic polyp and sessile serrated lesion of the large intestine: a biological continuum or separate entities?
  1. Adrian C Bateman1,
  2. Adam L Booth2,
  3. Raul S Gonzalez3,
  4. Neil A Shepherd4
  1. 1Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  2. 2Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  3. 3Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
  4. 4Gloucestershire Cellular Pathology Laboratory, Cheltenham, UK
  1. Correspondence to Dr Adrian C Bateman, Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; adrian.bateman{at}


The range of lesions with a serrated appearance within the large intestine has expanded and become more complex over the last 30 years. The majority of these were previously known as metaplastic polyps but are today called hyperplastic polyps (HPs). HPs show two main growth patterns: microvesicular and goblet cell-rich. The former type shows morphological and molecular similarities (eg, BRAF mutations) to the more recently described sessile serrated lesion (SSL). In this review, we debate whether these lesions represent a biological spectrum or separate entities. Whichever view is held, microvesicular HPs and SSLs are distinct from the goblet cell-rich HP and the traditional serrated adenoma (TSA), which may themselves share molecular changes (eg, KRAS mutations), with the goblet cell-rich HP representing a precursor to the TSA. Both SSLs and the goblet cell-rich HP-TSA pathway are routes to colorectal cancer within the serrated pathway and overlaps between them can occur, for example, a (BRAF-mutated) TSA may arise from an SSL.

  • Gastrointestinal Neoplasms
  • Colorectal Neoplasms

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  • Handling editor Deepa Patil.

  • Twitter @ALBoothMD

  • Contributors ACB created the original concept for the script, prepared the first draft and incorporated comments from the coauthors to create a final draft. AB, RG and NS commented on the first draft and approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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