Faculty Opinions recommendation of Agrin in the Muscularis Mucosa Serves as a Biomarker Distinguishing Hyperplastic Polyps from Sessile Serrated Lesions.

Abstract Context.—Solitary rectal ulcer syndrome (SRUS) is associated with erythema and ulceration of the rectal wall. Serrated lesions of the colon are divided into conventional hyperplastic polyps and a new set of lesions that are variably called sessile serrated polyps (SSPs) and sessile serrated adenomas. The SSPs are epithelial proliferative lesions that appear to act as a unique pathway to colorectal carcinogenesis. No association between SRUS and SSPs has been previously reported. Objective.—To assess a possible association between SRUS and morphologic features that mimic SSPs. Design.—Twenty-six patients with SRUS, who presented to our institution between January 1, 1999, and November 14, 2004, were retrospectively reviewed for SSP-type morphologic features by 3 pathologists. Ki-67 and hMLH1 immunohistochemical stains were used. Control tissues included 10 conventional left-sided hyperplastic polyps, 10 right-sided large SSPs, 7 adenocarcinomas with known loss of hMLH1 gene expression, and 4 normal human tonsil tissues. Results.—Ten (38%) of 26 SRUS specimens demonstrated histologic features consistent with SSPs. These features included exaggerated serration within the lower crypt compartments, crypt branching, hypermucinous appearance of epithelium, and horizontal extension of crypt bases along the muscularis mucosa. All 10 cases of SRUS had positive basal Ki-67 staining in 10% to 20% of cells. Two (20%) of the 10 cases demonstrated focal superficial loss of hMLH1 mismatch repair gene expression within areas of serrated morphologic features. One hyperplastic polyp superimposed on SRUS showed a reduced number of surface epithelial cells that express hMLH1 protein. Conclusions.—Up to 38% of patients with SRUS have histologic changes that mimic SSPs. More importantly, 20% of these serrated lesions were found to have focal loss of hMLH1 gene expression, indicating a potential of preneoplastic change. This phenomenon may reflect an increased propensity for neoplastic progression in response to repeated trauma and repair process in certain cases of SRUS.

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Association between baseline hyperplastic polyps and metachronous serrated lesions

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.11.028 ◽

2020 ◽

Author(s):

Marc Monachese ◽

Gautam Mankaney ◽

Faris El-Khider ◽

Carol Rouphael ◽

Rocio Lopez ◽

...

Keyword(s):

Hyperplastic Polyps ◽

Serrated Lesions

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Patients with small and diminutive proximal hyperplastic polyps have higher rates of synchronous advanced neoplasia compared with patients without serrated lesions

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.12.028 ◽

2018 ◽

Vol 87 (6) ◽

pp. 1518-1526 ◽

Cited By ~ 6

Author(s):

Thayer Hamoudah ◽

Karen Ma ◽

Marcus Esteban ◽

Waqas Hayat ◽

Daniel Berger ◽

...

Keyword(s):

Hyperplastic Polyps ◽

Advanced Neoplasia ◽

Serrated Lesions

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Somatic targeted mutation profiling of colorectal cancer precursor lesions

10.21203/rs.3.rs-428174/v1 ◽

2021 ◽

Author(s):

Wellington dos Santos ◽

Mariana Bisarro dos Reis ◽

Jun Porto ◽

Ana Carolina de Carvalho ◽

Marcus Matsushita ◽

...

Keyword(s):

Driver Mutations ◽

Precursor Lesions ◽

Hyperplastic Polyps ◽

Serrated Polyps ◽

Targeted Mutation ◽

Mutation Profile ◽

Serrated Lesions ◽

Advanced Adenomas ◽

Biological History ◽

High Degree

Abstract Most colorectal cancers (CRC) arise from precursor lesions. We aimed to characterize the mutation profile of CRC precursor lesions in a Brazilian population. In total, 90 FFPE lesions, including 67 adenomas, 7 sessile serrated lesions, and 16 hyperplastic polyps, were analyzed by next-generation sequencing. The genetic ancestry of the patients was estimated. Somatic driver mutations were identified in 66.7% of cases, including alterations in APC (32.2%), TP53 (20.0%), KRAS (18.9%), BRAF (13.3%) and EGFR (7.8%). Adenomas displayed a higher number of mutations, mainly in APC, compared to serrated polyps (73.1% vs. 47.8%, p = 0.039). Advanced adenomas had a higher frequency of mutation in KRAS and GNAS and a high overall mutation rate than early adenomas (92.9% vs. 59%, p = 0.002). Concerning the serrated pathway, a higher frequency of mutations, mainly in BRAF, was observed in sessile serrated lesions (85.7%) compared to hyperplastic polyps (31.3%, p = 0.027). A high degree of ancestry admixture was observed in the population, with a predominance of European followed by African components. The mutation profile of Brazilian colorectal precursor lesions exhibits a similar landscape to other populations. These results bestow the knowledge of CRC's biological history and may contribute to a molecular screening approach.

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Differential Diagnosis of Appendiceal Serrated Lesions and Polyps and Low-Grade Appendiceal Mucinous Neoplasm: Analysis Of 88 Cases

10.21203/rs.3.rs-714928/v1 ◽

2021 ◽

Author(s):

Yiyan Lu ◽

Changhai Qi ◽

Hongbin Xu ◽

Mulan Jin

Keyword(s):

Differential Diagnosis ◽

Acute Inflammation ◽

Clinicopathological Features ◽

Low Grade ◽

Muscularis Mucosa ◽

Diagnostic Features ◽

Mucinous Neoplasm ◽

Center Hospital ◽

Epithelial Structure ◽

Serrated Lesions

Abstract Purpose: To identify clinicopathological features for the differential diagnosis of appendiceal serrated lesions and polyps (SPs) and low-grade appendiceal mucinous neoplasm (LAMN) for the purpose of avoiding over‐diagnosis.Methods: Clinical data and pathological features of 66 patients with SPs diagnosed at the Aerospace Center Hospital between January 2013 and January 2021 were collected and compared to 22 cases of LAMN.Results: SPs, compared with LAMN, are likely to be associated with acute inflammation (SPs 53.0% vs. LAMN 18.2%), and may be located in the appendix partly, although with smaller diameter (average 9.6 vs. 27.2 mm); epithelial structures of serrated (100% vs. 22.7%) and filiform villous (47.0% vs. 18.2%) were often found in SPs. SPs occasionally show attenuated or flattened morphology (16.7% vs. 100%) and undulating or scalloped (7.6% vs. 40.9%) structures, and can also be accompanied by diverticulum (18.2% vs. 18.2%) and acellular mucin in the appendiceal wall (16.7% vs. 54.5%), which causes confusion with LAMN. The key point of the differential diagnosis is to observe whether the muscularis mucosa exists (loss, 0% vs. 100%) and fibrosis of the appendiceal wall (0% vs. 100%). SMA immunohistochemistry can assist in the diagnosis. Calcification is also indicative of LAMN.Conclusions: The epithelial structure of SPs can appear flattened and focally scalloped, and can be accompanied by mucin in the appendiceal wall, which may appear as complex lesions, easily over-diagnosed as LAMN. Key differential diagnostic features are identifying the structure of lamina propria, determining whether the muscularis mucosa exists, and whether the appendiceal wall is fibrotic.

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Hyperplastic polyp or sessile serrated lesion? The contribution of serial sections to reclassification

Diagnostic Pathology ◽

10.1186/s13000-020-01057-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Diana R. Jaravaza ◽

Jonathan M. Rigby

Keyword(s):

Potential Role ◽

Hyperplastic Polyp ◽

Fragment Size ◽

World Health ◽

Serial Sections ◽

Hyperplastic Polyps ◽

Serrated Polyps ◽

Serrated Lesions ◽

Serrated Lesion ◽

Health Organization

Abstract Background The histological discrimination of hyperplastic polyps from sessile serrated lesions can be difficult. Sessile serrated lesions and hyperplastic polyps are types of serrated polyps which confer different malignancy risks, and surveillance intervals, and are sometimes difficult to discriminate. Our aim was to reclassify previously diagnosed hyperplastic polyps as sessile serrated lesions or confirmed hyperplastic polyps, using additional serial sections. Methods Clinicopathological data for all colorectal hyperplastic polyps diagnosed in 2016 and 2017 was collected. The slides were reviewed and classified as hyperplastic polyps, sessile serrated lesion, or other, using current World Health Organization criteria. Eight additional serial sections were performed for the confirmed hyperplastic polyp group and reviewed. Results Of an initial 147 hyperplastic polyps from 93 patients, 9 (6.1%) were classified as sessile serrated lesions, 103 as hyperplastic polyps, and 35 as other. Of the 103 confirmed hyperplastic polyps, 7 (6.8%) were proximal, and 8 (7.8%) had a largest fragment size of ≥5 mm and < 10 mm. After 8 additional serial sections, 11 (10.7%) were reclassified as sessile serrated lesions. They were all less than 5 mm and represented 14.3% of proximal polyps and 10.4% of distal polyps. An average of 3.6 serial sections were required for a change in diagnosis. Conclusion Histopathological distinction between hyperplastic polyps and sessile serrated lesions remains a challenge. This study has uncovered a potential role for the use of additional serial sections in the morphological reappraisal of small hyperplastic polyps, especially when proximally located.

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