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Serrated polyps of the colon and rectum (hyperplastic polyps, sessile serrated adenomas, traditional serrated adenomas, and mixed polyps)—proposal for diagnostic criteria

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Abstract

Until recently, two major types of colorectal epithelial polyps were distinguished: the adenoma and the hyperplastic polyp. While adenomas—because of their cytological atypia—were recognized as the precursor lesions for colorectal carcinoma, hyperplastic polyps were perceived as harmless lesions without any potential for malignant progression mainly because hyperplastic polyps are missing cytological atypia. Meanwhile, it is recognized that the lesions, formerly classified as hyperplastic, represent a heterogeneous group of polyps with characteristic serrated morphology some of which exhibit a significant risk of neoplastic progression. These serrated lesions show characteristic epigenetic alterations not commonly seen in colorectal adenomas and progress to colorectal carcinoma via the so-called serrated pathway (CpG-island-methylation-phenotype pathway). This group of polyps is comprised not only of hyperplastic polyps, but also of sessile serrated adenomas, traditional serrated adenomas and mixed polyps, showing serrated and “classical” adenomatous features. Diagnostic criteria and nomenclature for these lesions are not uniform and, therefore, somewhat confusing. In a consensus conference of the Working Group of Gastroenterological Pathology of the German Society of Pathology, standardization of nomenclature and diagnostic criteria as well as recommendations for clinical management of these serrated polyps were formulated and are presented herein.

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Notes

  1. Comment: In a multivariate analysis of 212 serrated lesions the presence of goblet cells at the base of the crypts proved to be an important feature in the discrimination between HP and SSA [34]

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Acknowledgment

We would like to thank M. Muders for his help in the preparation of this manuscript.

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We declare that we have no conflict of interest.

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Correspondence to Daniela E. Aust.

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Members of the consensus conference: F. Autschbach (Heilbronn), S. Baldus (Düsseldorf), Hendrik Bläker (Heidelberg), H. Koch (Bayreuth), C. Langner (Graz), J. Lüttges (Saarbrücken), M. Neid (Bochum), P. Schirrmacher (Heidelberg), A. Tannapfel (Bochum), M. Vieth (Bayreuth).

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Aust, D.E., Baretton, G.B. & Members of the Working Group GI-Pathology of the German Society of Pathology. Serrated polyps of the colon and rectum (hyperplastic polyps, sessile serrated adenomas, traditional serrated adenomas, and mixed polyps)—proposal for diagnostic criteria. Virchows Arch 457, 291–297 (2010). https://doi.org/10.1007/s00428-010-0945-1

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