Sessile serrated adenoma/polyps(SSA/Ps) are early precursor lesions in the serrated neoplasia pathway, which results in colorectal carcinomas with BRAF mutations, methylation for DNA repair genes, a Cp G island methyl...Sessile serrated adenoma/polyps(SSA/Ps) are early precursor lesions in the serrated neoplasia pathway, which results in colorectal carcinomas with BRAF mutations, methylation for DNA repair genes, a Cp G island methylator phenotype, and high levels of microsatellite instability. Some of these lesions can rapidly become dysplastic or invasive carcinomas that exhibit high lymphatic invasion and lymph node metastasis potentials. Detecting serrated lesions, including SSA/Ps with and without dysplasia/carcinoma, is critical, but SSA/Ps can be difficult to detect, are inconsistently identified by endoscopists and pathologists, and are often incompletely resected. Therefore, SSA/Ps are considered to be major contributors to "interval cancers". If colonoscopists can identify the specific endoscopic characteristics of SSA/Ps, their detection and the effectiveness of colonoscopy may improve. Here, the endoscopic features of SSA/Ps with and without dysplasia/carcinoma, including the characteristics determined using magnifying endoscopy, are reviewed in the context of previous reports. Endoscopically, these subtle polyps are like hyperplastic polyps, because they are slightly elevated and pale. Unlike hyperplastic polyps, SSA/Ps are usually larger than 5 mm, frequently covered by a thin layer called the ‘‘mucus cap'', and are more commonly located in the proximal colon. Magnifying narrow-band imaging findings, which include dark spots inside the crypts and varicose microvascular vessels, in addition to the type II-open pit patterns detected using magnifying chromoendoscopy, effectively differentiate SSA/Ps from hyperplastic polyps. The lesions' endoscopic characteristics, which include their(semi)pedunculated morphologies, double elevations, central depressions, and reddishness, and the use of magnifying endoscopy, might help to detect dysplasia/carcinoma within SSA/Ps. Greater awareness may promote further research into improving the detection, identification, and complete resection rates of SSA/Ps with and without dysp展开更多
It is currently known that colorectal cancers(CRC) arise from 3 different pathways: the adenoma to carcinoma chromosomal instability pathway(50%-70%); the mutator "Lynch syndrome" route(3%-5%); and the serra...It is currently known that colorectal cancers(CRC) arise from 3 different pathways: the adenoma to carcinoma chromosomal instability pathway(50%-70%); the mutator "Lynch syndrome" route(3%-5%); and the serrated pathway(30%-35%). The World Health Organization has classified serrated polyps into three types of lesions: hyperplastic polyps(HP),sessile serrated adenomas/polyps(SSA/P) and traditional serrated adenomas(TSA),the latter two strongly associated with development of CRCs. HPs do not cause cancer and TSAs are rare. SSA/P appear to be the responsible precursor lesion for the development of cancers through the serrated pathway. Both HPs and SSA/Ps appear morphologically similar. SSA/P are difficult to detect. The margins are normally inconspicuous. En bloc resection of these polyps can hence be troublesome. A careful examination of borders,submucosal injection of a dye solution(for larger lesions) and resection of a rim of normal tissue around the lesion may ensure total eradication of these lesions.展开更多
In this review, I outline the characteristic endoscopic findings of serrated lesions of the colorectum based on image enhanced endoscopy(IEE). Histopathologically, lesions with serrated structures are typically classi...In this review, I outline the characteristic endoscopic findings of serrated lesions of the colorectum based on image enhanced endoscopy(IEE). Histopathologically, lesions with serrated structures are typically classified into the following three types based: hyperplastic polyps(HPs), traditional serrated adenomas(TSAs), and sessile serrated adenoma/polyps(SSA/Ps). Both HP and SSA/P often present as dark-green colors on auto fluorescence imaging(AFI) colonoscopy that are similar to the normal surrounding mucosa. In contrast, TSAs often have elevated shapes and present as magenta colors that are similar to the tubular adenomas. The superficial type of TSA also includes many lesions that present as magenta colors. When SSA/Ps are associated with cytological dysplasia, many lesions present with magenta colors, whereas lesions that are not associated with cytological dysplasia present with dark-green colors. When observed via narrow band imaging(NBI), many SSA/P include lesions with strong mucous adhesions. Because these lesions are observed with reddish mucous adhesions, we refer to them as "red cap sign" and place such signs among the typical findings of SSA/P. Because the dilatation of the pit in SSA/P is observed as a round/oval black dot on magnified observations, we refer to this finding as Ⅱ-dilatation pit(Ⅱ-D pit) and also positioned it as a characteristic finding of SSA/P. In contrast, dilatations of the capillary vessels surrounding the glands, such as those that occur in tubular adenoma, are not considered to be useful for differentiating HPs from SSA/Ps. However, in cases in which SSA/P is associated with cytological dysplasia, the dilatation of capillary vessels is observed in the same area. When submucosal layer invasion occurs in the same area, the blood flow presents with irregularities that are similar to those of common colorectal cancer at an early stage and disappears as the invasion proceeds deeply. The surface pattern of invasive cancer that is observed at the tumor surface is also likely to展开更多
Background：Colorectal serrated polyp is considered as histologically heterogeneous lesions with malignant potential in western countries.However,few Asian studies have investigated the comprehensive clinical features...Background：Colorectal serrated polyp is considered as histologically heterogeneous lesions with malignant potential in western countries.However,few Asian studies have investigated the comprehensive clinical features of serrated polyps in symptomatic populations.The aim of the study was to evaluate the features of colorectal serrated polyps in a Chinese symptomatic population.Methods：Data from all consecutive symptomatic patients were documented from a large colonoscopy database and were analyzed.Chi-square test or Fisher＇s exact test and logistic regression analysis were used for the data processing.Results：A total of 9191 （31.7%） patients were detected with at least one colorectal polyp.The prevalence of serrated polyps was 0.53% （153/28,981）.The proportions of hyperplastic polyp （HP）,sessile serrated adenoma/polyp （SSA/P）,and traditional serrated adenoma （TSA） of all serrated polyps were 41.2%,7.2%,and 51.6%,respectively,which showed a lower proportion of HP and SSA/P and a higher proportion of TSA.Serrated polyps appeared more in males and elder patients while there was no significant difference in the subtype distribution in gender and age.The proportions of large and proximal serrated polyps were 13.7% （21/153） and 46.4% （71/153）,respectively.In total,98.9% （89/90） serrated adenomas were found with dysplasia.Moreover,14 patients with serrated polyps were found with synchronous advanced colorectal neoplasia,and large serrated polyps （LSPs） （odds ratio：3.446,95% confidence interval：1.010-11.750,P 〈 0.05）,especially large HPs,might have an association with synchronous advanced neoplasia （AN）.Conclusions：The overall detection rate ofcolorectal serrated polyps in Chinese symptomatic patient population was low,and distribution pattern of three subtypes is different from previous reports.Moreover,LSPs,especially large HPs,might be associated with an increased risk of synchronous AN.展开更多
目的研究广基无蒂锯齿状(腺瘤/息肉)(SSA/Ps)临床、内镜及病理特征。方法回顾性研究滨州医学院附属医院2017年1月至2018年1月病理诊断为SSA/P的49例患者。结果检出部位:右半结肠20(40.8%)枚,左半结肠29(59.2%)枚;内镜下形态以扁平型31(6...目的研究广基无蒂锯齿状(腺瘤/息肉)(SSA/Ps)临床、内镜及病理特征。方法回顾性研究滨州医学院附属医院2017年1月至2018年1月病理诊断为SSA/P的49例患者。结果检出部位:右半结肠20(40.8%)枚,左半结肠29(59.2%)枚;内镜下形态以扁平型31(63.3%)枚居多;SSA/Ps长径以≤5 mm 34(69.4%)枚居多,长径为≤5 mm的多位于左半结肠,长径为11~30 mm的多位于右半结,不同部位的大小分布差异有统计学意义(P<0.05);病理学特征:无腺上皮细胞异型增生17枚,低级别上皮内瘤变29枚,高级别上皮内瘤变2枚,癌变1枚,不同病理特征的大小差异具有统计学意义(P<0.05)。结论本研究中SSA/Ps以扁平型居多,不同部位腺瘤的大小存在差异,且长径越大越易发生腺上皮异型增生,这些特点可能有助于SSA/Ps的临床诊治。展开更多
目的探討結直腸無蒂鋸齒狀腺瘤/息肉的臨床病理特徵,提出病理診斷標準。方法從中国澳門鏡湖醫院2016年1月~2017年6月結直腸內鏡活檢標本中篩選出35例S S A/P進行回顧性分析;收集相關臨床病理資料,觀察SSA/P病理形態特徵。結果35例SSA/P...目的探討結直腸無蒂鋸齒狀腺瘤/息肉的臨床病理特徵,提出病理診斷標準。方法從中国澳門鏡湖醫院2016年1月~2017年6月結直腸內鏡活檢標本中篩選出35例S S A/P進行回顧性分析;收集相關臨床病理資料,觀察SSA/P病理形態特徵。結果35例SSA/P中男15例,女20例,平均年齡61.5歲(23歲~83歲);發生部位左半結腸9例,右半結腸26例。內鏡描述腫瘤形態多為無蒂息肉。光鏡下S S A/P呈鋸齒狀結構伴隱窩結構異常。隱窩擴張、隱窩分支、“L”形/倒“T”形隱窩在S S A/P的檢出率分別為:100%(35/35);71%(25/35);60%(21/35)。結論SSA/P的組織學特點是鋸齒狀結構和隱窩結構的異常,內鏡下取材的完整性和正確的石蠟包埋有助於診斷。展开更多
文摘Sessile serrated adenoma/polyps(SSA/Ps) are early precursor lesions in the serrated neoplasia pathway, which results in colorectal carcinomas with BRAF mutations, methylation for DNA repair genes, a Cp G island methylator phenotype, and high levels of microsatellite instability. Some of these lesions can rapidly become dysplastic or invasive carcinomas that exhibit high lymphatic invasion and lymph node metastasis potentials. Detecting serrated lesions, including SSA/Ps with and without dysplasia/carcinoma, is critical, but SSA/Ps can be difficult to detect, are inconsistently identified by endoscopists and pathologists, and are often incompletely resected. Therefore, SSA/Ps are considered to be major contributors to "interval cancers". If colonoscopists can identify the specific endoscopic characteristics of SSA/Ps, their detection and the effectiveness of colonoscopy may improve. Here, the endoscopic features of SSA/Ps with and without dysplasia/carcinoma, including the characteristics determined using magnifying endoscopy, are reviewed in the context of previous reports. Endoscopically, these subtle polyps are like hyperplastic polyps, because they are slightly elevated and pale. Unlike hyperplastic polyps, SSA/Ps are usually larger than 5 mm, frequently covered by a thin layer called the ‘‘mucus cap'', and are more commonly located in the proximal colon. Magnifying narrow-band imaging findings, which include dark spots inside the crypts and varicose microvascular vessels, in addition to the type II-open pit patterns detected using magnifying chromoendoscopy, effectively differentiate SSA/Ps from hyperplastic polyps. The lesions' endoscopic characteristics, which include their(semi)pedunculated morphologies, double elevations, central depressions, and reddishness, and the use of magnifying endoscopy, might help to detect dysplasia/carcinoma within SSA/Ps. Greater awareness may promote further research into improving the detection, identification, and complete resection rates of SSA/Ps with and without dysp
文摘It is currently known that colorectal cancers(CRC) arise from 3 different pathways: the adenoma to carcinoma chromosomal instability pathway(50%-70%); the mutator "Lynch syndrome" route(3%-5%); and the serrated pathway(30%-35%). The World Health Organization has classified serrated polyps into three types of lesions: hyperplastic polyps(HP),sessile serrated adenomas/polyps(SSA/P) and traditional serrated adenomas(TSA),the latter two strongly associated with development of CRCs. HPs do not cause cancer and TSAs are rare. SSA/P appear to be the responsible precursor lesion for the development of cancers through the serrated pathway. Both HPs and SSA/Ps appear morphologically similar. SSA/P are difficult to detect. The margins are normally inconspicuous. En bloc resection of these polyps can hence be troublesome. A careful examination of borders,submucosal injection of a dye solution(for larger lesions) and resection of a rim of normal tissue around the lesion may ensure total eradication of these lesions.
文摘In this review, I outline the characteristic endoscopic findings of serrated lesions of the colorectum based on image enhanced endoscopy(IEE). Histopathologically, lesions with serrated structures are typically classified into the following three types based: hyperplastic polyps(HPs), traditional serrated adenomas(TSAs), and sessile serrated adenoma/polyps(SSA/Ps). Both HP and SSA/P often present as dark-green colors on auto fluorescence imaging(AFI) colonoscopy that are similar to the normal surrounding mucosa. In contrast, TSAs often have elevated shapes and present as magenta colors that are similar to the tubular adenomas. The superficial type of TSA also includes many lesions that present as magenta colors. When SSA/Ps are associated with cytological dysplasia, many lesions present with magenta colors, whereas lesions that are not associated with cytological dysplasia present with dark-green colors. When observed via narrow band imaging(NBI), many SSA/P include lesions with strong mucous adhesions. Because these lesions are observed with reddish mucous adhesions, we refer to them as "red cap sign" and place such signs among the typical findings of SSA/P. Because the dilatation of the pit in SSA/P is observed as a round/oval black dot on magnified observations, we refer to this finding as Ⅱ-dilatation pit(Ⅱ-D pit) and also positioned it as a characteristic finding of SSA/P. In contrast, dilatations of the capillary vessels surrounding the glands, such as those that occur in tubular adenoma, are not considered to be useful for differentiating HPs from SSA/Ps. However, in cases in which SSA/P is associated with cytological dysplasia, the dilatation of capillary vessels is observed in the same area. When submucosal layer invasion occurs in the same area, the blood flow presents with irregularities that are similar to those of common colorectal cancer at an early stage and disappears as the invasion proceeds deeply. The surface pattern of invasive cancer that is observed at the tumor surface is also likely to
基金This study was supported by the grants from the National Natural Science Foundation of China （No. 81300272, No. 81470796, and No. 81570478）.
文摘Background：Colorectal serrated polyp is considered as histologically heterogeneous lesions with malignant potential in western countries.However,few Asian studies have investigated the comprehensive clinical features of serrated polyps in symptomatic populations.The aim of the study was to evaluate the features of colorectal serrated polyps in a Chinese symptomatic population.Methods：Data from all consecutive symptomatic patients were documented from a large colonoscopy database and were analyzed.Chi-square test or Fisher＇s exact test and logistic regression analysis were used for the data processing.Results：A total of 9191 （31.7%） patients were detected with at least one colorectal polyp.The prevalence of serrated polyps was 0.53% （153/28,981）.The proportions of hyperplastic polyp （HP）,sessile serrated adenoma/polyp （SSA/P）,and traditional serrated adenoma （TSA） of all serrated polyps were 41.2%,7.2%,and 51.6%,respectively,which showed a lower proportion of HP and SSA/P and a higher proportion of TSA.Serrated polyps appeared more in males and elder patients while there was no significant difference in the subtype distribution in gender and age.The proportions of large and proximal serrated polyps were 13.7% （21/153） and 46.4% （71/153）,respectively.In total,98.9% （89/90） serrated adenomas were found with dysplasia.Moreover,14 patients with serrated polyps were found with synchronous advanced colorectal neoplasia,and large serrated polyps （LSPs） （odds ratio：3.446,95% confidence interval：1.010-11.750,P 〈 0.05）,especially large HPs,might have an association with synchronous advanced neoplasia （AN）.Conclusions：The overall detection rate ofcolorectal serrated polyps in Chinese symptomatic patient population was low,and distribution pattern of three subtypes is different from previous reports.Moreover,LSPs,especially large HPs,might be associated with an increased risk of synchronous AN.
文摘目的研究广基无蒂锯齿状(腺瘤/息肉)(SSA/Ps)临床、内镜及病理特征。方法回顾性研究滨州医学院附属医院2017年1月至2018年1月病理诊断为SSA/P的49例患者。结果检出部位:右半结肠20(40.8%)枚,左半结肠29(59.2%)枚;内镜下形态以扁平型31(63.3%)枚居多;SSA/Ps长径以≤5 mm 34(69.4%)枚居多,长径为≤5 mm的多位于左半结肠,长径为11~30 mm的多位于右半结,不同部位的大小分布差异有统计学意义(P<0.05);病理学特征:无腺上皮细胞异型增生17枚,低级别上皮内瘤变29枚,高级别上皮内瘤变2枚,癌变1枚,不同病理特征的大小差异具有统计学意义(P<0.05)。结论本研究中SSA/Ps以扁平型居多,不同部位腺瘤的大小存在差异,且长径越大越易发生腺上皮异型增生,这些特点可能有助于SSA/Ps的临床诊治。
文摘目的探討結直腸無蒂鋸齒狀腺瘤/息肉的臨床病理特徵,提出病理診斷標準。方法從中国澳門鏡湖醫院2016年1月~2017年6月結直腸內鏡活檢標本中篩選出35例S S A/P進行回顧性分析;收集相關臨床病理資料,觀察SSA/P病理形態特徵。結果35例SSA/P中男15例,女20例,平均年齡61.5歲(23歲~83歲);發生部位左半結腸9例,右半結腸26例。內鏡描述腫瘤形態多為無蒂息肉。光鏡下S S A/P呈鋸齒狀結構伴隱窩結構異常。隱窩擴張、隱窩分支、“L”形/倒“T”形隱窩在S S A/P的檢出率分別為:100%(35/35);71%(25/35);60%(21/35)。結論SSA/P的組織學特點是鋸齒狀結構和隱窩結構的異常,內鏡下取材的完整性和正確的石蠟包埋有助於診斷。
