Qualities of sessile serrated adenoma/polyp/lesion and its borderline variant in the context of synchronous colorectal carcinoma

• Published in: Journal of clinical pathology Vol. 65; no. 10; pp. 924 - 927
• Main Authors: Mohammadi, Mahin, Kristensen, Michael Holmsgaard, Nielsen, Hans Jørgen, Bonde, Jesper Hansen, Holck, Susanne
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Association of Clinical Pathologists 01.10.2012; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adenoma - genetics; Adenoma - pathology; Aged; Aged, 80 and over; Biological and medical sciences; borderline sessile serrated adenoma; colitis; colon; Colonic Polyps - genetics; Colonic Polyps - pathology; Colorectal Neoplasms - genetics; Colorectal Neoplasms - pathology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Genes, ras - genetics; Humans; hyperplastic polyp; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Mutation - genetics; Neoplasms, Multiple Primary - genetics; Neoplasms, Multiple Primary - pathology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; prostate; Proto-Oncogene Proteins B-raf - genetics; rectal cancer; salivary gland tumours; Sessile serrated adenoma; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; synchronous colorectal cancer; Tumors; Rectal disease; Adenomatous polyp; Genetic variability; Colorectal carcinoma; Colorectal cancer; Genotype; Malignant tumor; Colonic disease; Variant; Synchronous; Anatomic pathology; Quality; Digestive diseases; Intestinal disease; Lesion; Serrated adenoma; Cancer
• ISSN: 0021-9746; 1472-4146
• DOI: 10.1136/jclinpath-2012-200803

AimsAlthough 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.Methods219 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.ResultsSCRC 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.ConclusionsBSSA/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.