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The serrated polyposis syndrome (SPS) is a relatively rare condition characterized by multiple and/or large serrated polyps of the colon. Serrated polyps include SSLs, hyperplastic polyps, and traditional serrated adenomas. Diagnosis of this disease is made by the fulfillment of any of the World Health Organization's (WHO) clinical criteria. [4]
Traditional serrated adenoma seen under microscopy with H&E stain, showing serrated crypts. SPS may occur with one of two phenotypes: distal or proximal. [6] The distal phenotype may demonstrate numerous small polyps in the distal colon and rectum, whereas the proximal phenotype may be characterized by relatively fewer, but larger polyps in the proximal colon (cecum, ascending colon, etc.). [6]
Micrograph of a sessile serrated adenoma. H&E stain. Sessile serrated adenomas are characterized by (1) basal dilation of the crypts, (2) basal crypt serration, (3) crypts that run horizontal to the basement membrane (horizontal crypts), and (4) crypt branching. The most common of these features is basal dilation of the crypts.
As is evident from their name, sessile serrated and traditional serrated adenomas (TSAs) have a serrated appearance and can be difficult to distinguish microscopically from hyperplastic polyps. [18] Making this distinction is important, however, since SSAs and TSAs have the potential to become cancers, [19] while hyperplastic polyps do not. [18]
A sessile serrated adenoma or traditional serrated adenoma is suspected if there is either of the following: [4] Nuclear stratification; Loss of polarity; Dysplasia; A sessile serrated adenoma is suspected in case of any of the following: [4] Size ≥0.5 cm; Location in right colon; If both are present, it is almost always an SSA.
For example, adenomatous polyps in the colon may be pedunculated (lobular head with a long slender stalk) or sessile (broad base). The adenomatous proliferation is characterized by different degrees of cell dysplasia ( atypia or loss of normal differentiation of epithelium) irregular cells with hyperchromatic nuclei, stratified or ...
Sessile polyps larger than 2 cm usually contain villous features, have a higher malignant potential, and tend to recur following colonoscopic polypectomy. [18] Although polyps do not carry significant risk of colon cancer, tubular adenomatous polyps may become cancerous when they grow larger. Larger tubular adenomatous polyps have an increased ...
Traditional serrated adenoma is a premalignant type of polyp found in the colon, often in the distal colon (sigmoid, rectum). Traditional serrated adenomas are a type of serrated polyp, and may occur sporadically or as a part of serrated polyposis syndrome. Traditional serrated adenomas are relatively rare, accounting for less than 1% of all ...