Hyperplastic polyps are regarded as non-neoplastic lesions with no malignant potential. However, several case reports and a clustering phenomenon suggest that they may arise in abnormal colonic that is predisposed to develop neoplastic lesions. The hyperplastic polyp also displays markers associated with colorectal cancer. In addition, several recent articles have addressed the question of hyperplastic polyp in the distal colon as a marker of more proximal adenomatous polyp. Many endoscopists discovering a distal hyperplastic polyp will wish to ensure the absence of a proximal neoplastic lesion.