Ewha Med J.  2012 Mar;35(1):44-48. 10.12771/emj.2012.35.1.44.

Sessile Serrated Adenoma with High-grade Dysplasia

• Kwon KJ
• Jung SA
• Shim KN
• Chung JH
• Kang SH
• Song DK
• Jun SJ
• Kim HI

• KMID: 2134945
• DOI: http://doi.org/10.12771/emj.2012.35.1.44

Abstract

Until recently, colorectal polyps were classified predominantly as hyperplastic or adenomatous. While adenomatous polyps are well-characterized precursor lesions of adenocarcinomas, hyperplastic polyps have been considered as benign lesion. However, some hyperplastic polyps with serrated morphology of the crypts have been recognized to have distinctive features and these polyps were termed 'serrated adenomas'. Recent data show that sessile serrated adenomas (SSA) might be the precursors of serrated colonic cancers, underlining the necessity of identifying them. SSA is approximately 3% of all polyps, commonly appears as flat or sessile and yellowish due to mucus production. In the pathogenesis of SSA, progression to high grade dysplasia or early invasive carcinoma may be associated with serrated neoplasia pathway different from adenoma-carcinoma sequence. We report a case with a colon polyp diagnosed as sessile serrated adenoma with high grade dysplasia after endoscopic submucosal dissection.

Keyword

Sessile serrated adenoma; Colorectal polyp; Hyperplastic polyp; Dysplasia

MeSH Terms

Adenocarcinoma
Adenoma
Adenomatous Polyps
Colon
Colonic Neoplasms
Mucus
Polyps

Figure

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  Fig. 1 The colonoscopy reveals broad-based sessile polyp of 3.3 cm in size on sigmoid colon. Its surface shows large tubular pit pattern. There is a reddish papillomatous polypoid lesion arising from the surface of the polyp.

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  Fig. 2 Abdominal computed tomography show no evidence of apparent wall thickening or intraluminal mass-like lesion in the colon.

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  Fig. 3 PET findings shows no abnormal hypermetabolic lesion.

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  Fig. 4 Endoscopic findings during endoscopic submucosal dissection.

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  Fig. 5 Pathologic findings. (A) The polyp is measured 3.4×2.2×2 cm in size. Its surface is granular, villous and focally had polypoid mass with long stalk (H&E stain, ×100). (B) Serrated adenoma with focal high grade dysplasia is noted with clear resection margin (H&E stain, ×200).

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