Traditional serrated adenoma withBRAFmutation is associated with synchronous/metachronousBRAF-mutated serrated lesions

Abstract Introduction Colorectal carcinoma (CRC) is the most common gastrointestinal neoplasm in the world, accounting for 15% of cancer-related deaths. This condition is related to different molecular pathways, among them the recently described serrated pathway, whose characteristic entities, serrated lesions, have undergone important changes in their names and diagnostic criteria in the past thirty years. The multiplicity of denominations and criteria over the last years may be responsible for the low interobserver concordance (IOC) described in the literature. Objectives The present study aims to describe the evolution in classification of serrated lesions, based on the last three publications of the World Health Organization (WHO) and the reproducibility of these criteria by pathologists, based on the evaluation of the IOC. Methods A search was conducted in the PubMed, ResearchGate and Portal Capes databases, with the following terms: sessile serrated lesion; serrated lesions; serrated adenoma; interobserver concordance; and reproducibility. Articles published since 1990 were researched. Results and Discussion The classification of serrated lesions in the past thirty years showed different denominations and diagnostic criteria. The reproducibility and IOC of these criteria in the literature, based on the kappa coefficient, varied in most studies, from very poor to moderate. Conclusions Interobserver concordance and the reproducibility of microscopic criteria may represent a limitation for the diagnosis and appropriate management of these lesions. It is necessary to investigate diagnostic tools to improve the performance of the pathologist's evaluation, for better concordance, and, consequently, adequate diagnosis and treatment.

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Colorectal Serrated Neoplasia: An Institutional 12-Year Review Highlights the Impact of a Screening Programme

Gastroenterology Research and Practice ◽

10.1155/2019/1592306 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

A. J. McCarthy ◽

S. M. O’Reilly ◽

J. Shanley ◽

R. Geraghty ◽

E. J. Ryan ◽

...

Keyword(s):

Screening Programme ◽

Colorectal Polyps ◽

Left Colon ◽

Serrated Adenoma ◽

Serrated Polyps ◽

Cancer Screening Programme ◽

Serrated Lesions ◽

The Right ◽

The Impact

Background. As the malignant potential of sessile serrated lesions/polyps (SSL/Ps) and traditional serrated adenomas (TSAs) has been clearly demonstrated, it is important that serrated polyps are identified and correctly classified histologically. Aim. Our aim was to characterize the clinicopathological features of a series of SSL/Ps & TSAs, to assess the accuracy of the pathological diagnosis, the incidence, and the rate of dysplasia in SSL/Ps & TSAs. Methods. We identified all colorectal serrated polyps between 01/01/2004 and 31/05/2016, by searching the laboratory information system for all cases assigned a “serrated adenoma” SNOMED code. All available and suitable slides were reviewed by one pathologist, who was blinded to the original diagnosis and the site of the polyp. Subsequently discordant cases, SSL/Ps with dysplasia, and all TSAs were reviewed by a second pathologist. Results. Over a 149-month period, 759 “serrated adenoma” polyps were identified, with 664 (from 523 patients) available for review. 41.1% were reviewed by both pathologists; 15.1% (100/664) were reclassified, with the majority being changed from SSL/P to hyperplastic polyp (HYP) (66/664; 9.9%). 80.3% of these HYPs were located in the left colon, and the majority exhibited prolapse effect. There were 520 SSL/Ps (92.2%) & 40 TSAs (7.1%). The majority of SSL/Ps were in the right colon (86.7%) and were small (64.5% <1 cm), while most TSAs were in the left colon (85.7%) and were large (73.1%≥1 cm). 6.7% of SSL/Ps exhibited dysplasia, the majority of which were large (66.7%≥1 cm). Following consensus review, 13/520 (2.5%) SSL/Ps were downgraded from SSL/P with dysplasia to SSL/P without dysplasia. Detection of SSL/Ps peaked in the most recent years reviewed (87.5% reported between 2013 and 2016, inclusive), coinciding with the introduction of “BowelScreen” (the Irish FIT-based colorectal cancer screening programme). Conclusions. Awareness of, and adherence to, diagnostic criteria is essential for accurate classification of colorectal polyps.

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Clinical features and molecular alterations of traditional serrated adenoma in sporadic colorectal carcinogenesis

Journal of Digestive Diseases ◽

10.1111/j.1751-2980.2011.00495.x ◽

2011 ◽

Vol 12 (3) ◽

pp. 193-198 ◽

Cited By ~ 8

Author(s):

Ying HAN ◽

Zhi Yong ZHOU

Keyword(s):

Clinical Features ◽

Colorectal Carcinogenesis ◽

Serrated Adenoma ◽

Traditional Serrated Adenoma ◽

Molecular Alterations

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Su1940 Do Traditional Serrated Adenoma Coexist With Other Polyp Types?

Gastroenterology ◽

10.1016/s0016-5085(15)31869-2 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-556

Author(s):

Sara Hafezi-Bakhtiari ◽

Stefano Serra ◽

Richard Colling ◽

Lai Mun Wang ◽

Runjan Chetty

Keyword(s):

Serrated Adenoma ◽

Traditional Serrated Adenoma

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Traditional serrated adenoma: An enigmatic and aggressive polyp?

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2015.07.011 ◽

2015 ◽

Vol 82 (6) ◽

pp. 1094-1096

Author(s):

Rish K. Pai ◽

Carole Macaron ◽

Carol A. Burke

Keyword(s):

Serrated Adenoma ◽

Traditional Serrated Adenoma

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Slow-Growing Early Adenocarcinoma Arising from Traditional Serrated Adenoma in the Duodenum

Case Reports in Gastroenterology ◽

10.1159/000446767 ◽

2016 ◽

Vol 10 (2) ◽

pp. 257-263 ◽

Cited By ~ 1

Author(s):

Yoon Kyoo Park ◽

Woo Jin Jeong ◽

Gab Jin Cheon

Keyword(s):

Resection Margins ◽

Tubular Adenocarcinoma ◽

Solid Organ ◽

Biopsy Result ◽

Serrated Adenoma ◽

Serrated Polyps ◽

Traditional Serrated Adenoma ◽

Serrated Polyp ◽

Type Iv

Serrated polyps are classified into 3 distinct types: hyperplastic polyp, sessile serrated adenoma, or transitional serrated adenoma. A serrated adenoma is a precursor lesion for colorectal carcinoma. Serrated polyps are commonly found in the colorectum but have rarely been described in other parts of the gastrointestinal tract. Serrated adenomas in the small intestine may represent aggressive lesions with high malignant potential, according to some reports. A 66-year-old man with no significant medical history underwent esophagogastroduodenoscopy (EGD) for general examination. He had a 1-cm sized, Yamada type IV polyp, with focal white patch in the second portion of the duodenum. The biopsy result revealed gastric metaplasia and chronic inflammation. He wanted regular follow -up examinations. The follow-up EGDs were done every year. There were no changes in the shape and size of the polyp. The pathologic findings were unchanged. Then, he underwent EGD for general medical check-up again 5 years after the first detection. The size of the polyp was slightly increased. The biopsy result revealed serrated polyp, unclassified. Endoscopic mucosal resection was done. The pathologic result revealed a 0.8 × 0.5-cm sized, well differentiated tubular adenocarcinoma. Carcinomas are multifocally spread on the traditional serrated adenoma, and the proportion of the adenocarcinoma component is approximately 50%. The tumor had invaded the lamina propria but confined to the mucosa. The resection margins were negative, and no lymphovascular invasion or perineural invasion was seen. Abdominal pelvic computed tomography and positron emission tomography showed no other solid organ involvement or metastasis. Surveillance follow-up EGDs were done after 3 months and 1 year. There was no evidence of recurrence.

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