Sessile serrated lesion and its borderline variant – Variables with impact on recorded data

Mohammadi, Mahin; Garbyal, Rajendra Singh; Kristensen, Michael Holmsgaard; Madsen, Per M.; Nielsen, Hans Jørgen; Holck, Susanne

doi:10.1016/j.prp.2011.05.003

Cited by 16 publications

(31 citation statements)

References 38 publications

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“…In contrast to conventional adenomas, cytological signs of dysplasia are missing in most cases of sessile serrated adenomas/polyps. Therefore, high interand even intraobserver variability among pathologists is evident in the diagnosis of sessile serrated adenomas/polyps, [19][20][21][22] despite the formally clear morphologic criteria. 13,17 The need for a potential marker to identify microvesicular hyperplastic polyps with risk for progression in the serrated neoplasia pathway is also highlighted by our findings.…”

Section: Discussionmentioning

confidence: 99%

“…17,18 Owing to sampling issues, poor specimen orientation and a significant interobserver variation among pathologists, [19][20][21][22] the differential diagnosis of microvesicular hyperplastic polyps vs sessile serrated adenomas/polyps can be very challenging or even impossible. Especially, if we consider that for the differential diagnosis of microvesicular hyperplastic polyp vs sessile serrated adenoma/polyp, the presence of the appropriate morphologic criteria in just one crypt is considered as sufficient.…”

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confidence: 99%

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Improved molecular classification of serrated lesions of the colon by immunohistochemical detection of BRAF V600E

et al. 2014

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BRAF V600E mutation in serrated lesions of the colon has been implicated as an important mutation and as a specific marker for the serrated carcinogenic pathway. Recent findings point to microvesicular hyperplastic polyps that have similar histologic and molecular features to sessile serrated adenomas/polyps, as potential colorectal carcinoma precursors. The aim of this study was to evaluate BRAF V600E mutation status by immunohistochemistry in serrated lesions of the colon with regard to histomorphology. We investigated 194 serrated lesions of the colon, comprising 42 sessile serrated adenomas/polyps, 16 traditional serrated adenomas, 136 hyperplastic polyps and 20 tubular/tubulovillous adenomas (conventional adenomas) with the novel BRAF V600E mutation-specific antibody VE1. In addition, BRAF exon 15 and KRAS exon 2 status was investigated by capillary sequencing in selected cases. All sessile serrated adenomas/polyps (42/42, 100%), 15/ 16 (94%) traditional serrated adenomas and 84/136 (62%) hyperplastic polyps were VE1 þ . None of the VE1 À serrated lesions showed BRAF V600E mutation. Forty out of 42 (95%) sessile serrated adenomas/polyps displayed areas with microvesicular hyperplastic polyp-like features. In microvesicular hyperplastic polyps, VE1 positivity was significantly associated with nuclear atypia (P ¼ 0.003); however, nuclear atypia was also present in VE1 À cases. Immunostaining with VE1 allows not only the detection of BRAF V600E mutation but also the correlation with histomorphology on a cellular level in serrated lesions. VE1 enables a subclassification of microvesicular hyperplastic polyps according to the mutation status. This improved classification of serrated lesions including immunohistochemical evaluation of BRAF V600E mutation may be the key to identify lesions with higher potential to progression into sessile serrated adenoma/polyp, and further to BRAF V600E-mutated colorectal cancer. Modern Pathology (2014) 27, 135-144; doi:10.1038/modpathol.2013; published online 26 July 2013Keywords: BRAF; colon; immunohistochemistry; morphology; serrated polyp Colorectal cancer is one of the leading causes of cancer death worldwide. Although increased use of screening and surveillance, as well as detection and the removal of conventional adenomas, has led to a reduction in the incidence and mortality of this disease, this effect is mainly limited to distal colorectal cancer. 1-5 However, difficulties remain in the prevention of proximal colorectal cancer.A recent study suggested that colorectal cancers of the proximal colon develop in a significantly shorter period of time than those in the distal colon, after a patient has had a negative colonoscopy. 2,3 Thus, there is a need for improved and targeted identification of neoplastic precursor lesions in the proximal colon.Colorectal cancer arises from several different types of precursor lesions. In the conventional pathway, carcinomas develop from adenomas via biallelic APC (adenomatous polyposis coli) mutations 6 and are reinforced by KRAS mutatio...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Improved molecular classification of serrated lesions of the colon by immunohistochemical detection of BRAF V600E

et al. 2014

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“…Even in research settings with the participation of experienced gastrointestinal pathologists, inter-observer variability is common 11. Our recent demonstration of a large group of ND-SPs6 that fulfilled neither the criteria for SSA/P/L1 2 nor those of traditional HP can at least in part explain the reported discrepancies. We proposed the preliminary name borderline sessile serrated adenoma/polyp/lesion (BSSA/P/L) for these equivocal lesions,6 which have been the focus of attention in only one other study 3…”

Section: Introductionmentioning

confidence: 88%

“…Non-dysplastic serrated polyps (ND-SPs) represent a heterogeneous group of polyps that comprise hyperplastic polyp (HP) and non-dysplastic sessile serrated adenomas,1 2 also known as sessile serrated polyps,3 4 and sessile serrated lesions5 (here referred to as sessile serrated adenoma/polyp/lesion, SSA/P/L) 6. Although extensively studied,7 8 our knowledge on the differential diagnosis of ND-SPs and their proper classification is still incomplete.…”

Section: Introductionmentioning

confidence: 99%

“…HPs and SSA/P/Ls share some histological and molecular features; yet, their cancer risk is probably different9 underlining the importance of reliable diagnostic criteria and tools of clinical relevance for patient management. The morphological characterisation is still based solely on general histological attributes, specifically structural qualities, which are often a daunting challenge for practicing pathologists,3 10 though structural aberration of SSA/P/L, to a lesser extent of BSSA/P/L, is more conspicuous than that of HPs 6. Even in research settings with the participation of experienced gastrointestinal pathologists, inter-observer variability is common 11.…”

Section: Introductionmentioning

confidence: 99%

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The stem cell marker CD133 is highly expressed in sessile serrated adenoma and its borderline variant compared with hyperplastic polyp

et al. 2013

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Non-dysplastic serrated polyps (ND-SP) represent a heterogeneous group of colorectal lesions that comprise hyperplastic polyp (HP) and the non-dysplastic subset of sessile serrated adenoma/polyp/lesion (SSA/P/L) and its borderline variant (BSSA/P/L). Given the observer variation in their histological typing, the identification of reliable markers that assist in the characterisation is warranted. Most important is the identification of polyp qualities that may reflect the patients' risk of developing colorectal cancer. To address these issues, CD133 may represent a potential adjunct. Here we studied the discriminatory value of CD133 expression in the classification of ND-SPs and its distribution pattern in relation to synchronous colorectal carcinoma (SCRC). 39 SSA/P/Ls, 27 BSSA/P/Ls and 21 matched HPs were immunostained for CD133. The data were further correlated to the presence of SCRC and to polyp site and size. Ignoring SCRC status, CD133 was expressed more prominently in SSA/P/Ls than in HPs. The values for BSSA/P/Ls fell in between, yet closer to the SSA/P/L scorings. This observation was retained in the context of SCRC and for SSA/P/Ls not associated with SCRC. Right-sidedness and large size of the polyps more commonly associated with increased CD133 expression. CD133 expression was not a significant discriminator as to the SCRC status. BSSA/P/Ls are more closely aligned to SSA/P/L and further that SSA/P/L and BSSA/P/Ls fundamentally differ from HP by their CD133 immunoprofile, a notion that can be exploited in the diagnostic routine practice. Recorded data further indirectly support the idea that SSA/P/Ls are more prone to neoplastic progression than are HPs.

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Serrated Polyps of Colon and Rectum: a Clinicopathologic Review

Geramizadeh

Robertson

2017

J Gastrointest Canc

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Sessile serrated lesion and its borderline variant – Variables with impact on recorded data

Cited by 16 publications

References 38 publications

Improved molecular classification of serrated lesions of the colon by immunohistochemical detection of BRAF V600E

Improved molecular classification of serrated lesions of the colon by immunohistochemical detection of BRAF V600E

The stem cell marker CD133 is highly expressed in sessile serrated adenoma and its borderline variant compared with hyperplastic polyp

Serrated Polyps of Colon and Rectum: a Clinicopathologic Review

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