Hyperplastic-like Colon Polyps That Preceded Microsatellite-Unstable Adenocarcinomas

Abstract

We compared hyperplastic-like polyps that preceded microsatellite-unstable adenocarcinomas to incidental hyperplastic polyps to identify distinguishing morphologic criteria. The study group included 106 hyperplastic-like, nonadenomatous, serrated polyps, most from the ascending colon in 91 patients; the control group included 106 rectosigmoid hyperplastic polyps from 106 patients in whom adenocarcinoma did not develop. Study group polyps had an expanded crypt proliferative zone, a serrated architectural outline that became apparent in the basilar crypt regions, basilar crypt dilation, inverted crypts, and a predominance of dysmaturational crypts (crypts with minimal cell maturation). In contrast, control group polyps had a proliferative zone confined to the basal crypt region, serrated architecture that became apparent in the superficial crypt region, rare to no basilar crypt dilation, and rare or no dysmaturational crypts. Hyperplastic-like polyps that preceded microsatellite-unstable adenocarcinomas had a distinctive constellation of morphologic features related to altered and decreased cell function and control that resulted in dysmaturational crypts. Dysmaturation constitutes a range of morphologic alterations, some of which overlap with incidental-type innocuous hyperplastic polyps. The morphologic features described herein provide initial guidelines to identify this potentially important subset of premalignant serrated-like polyps.

Evaluación de la reproducibilidad del diagnóstico microscópico del adenoma serrado de sésil de colon

“…These lesions might be most clinically relevant because of their greater MSI prevalence and their relationship with sporadic CRC with MSI at the same location (15). However, in spite of being similar to those of other authors, these results must be taken with caution since agreement on the diagnosis of SSA was only achieved for 5 lesions.…”

Selective expression of gastric mucin MUC6 in colonic sessile serrated adenoma but not in hyperplastic polyp aids in morphological diagnosis of serrated polyps

“…Sessile serrated adenoma is one recently described entity that, although lacking in conventional adenomatous cytological dysplasia, is thought to be related to colorectal adenocarcinoma by the so-called 'serrated pathway' of colorectal neoplasia. [1][2][3][4][5] This pathway results in invasive adenocarcinomas that are frequently microsatellite unstable (MSI-high). 3,6 Sessile serrated adenomas occur most commonly on the right side of the colon, but can be found throughout.…”

Polipose hiperplásica: relato de caso

“…Tais lesões adenomatosas associadas podem ser a causa de transformações malignas [4]. Nesse sentido, Goldstein et al [6] ao compararem pólipos hiperplásico-símiles que precederam adenocarcinoma com instabilidade microssatélite aos pólipos hiperplásicos incidentais, desenvolveram os seguintes critérios morfológicos: aumento da zona de proliferação da cripta, organização arquitetural serrada nas regiões basilares da cripta, dilatação basilar da cripta, criptas invertidas e predomínio de criptas com maturação reduzida.…”