Intest Res.  2017 Jul;15(3):402-410. 10.5217/ir.2017.15.3.402.

Clinical characteristics of patients with serrated polyposis syndrome in Korea: comparison with Western patients

• Kim ER
• Jeon J
• Lee JH
• Lee YJ
• Hong SN
• Chang DK
• Kim YH

• KMID: 2382385
• DOI: http://doi.org/10.5217/ir.2017.15.3.402

Abstract

BACKGROUND/AIMS
Serrated polyposis syndrome (SPS) has been shown to increase the risk of colorectal cancer (CRC). However, little is known about the characteristics of Asian patients with SPS. This study aimed to identify the clinicopathological features and risk of CRC in Korean patients with SPS as well as the differences between Korean and Western patients based on a literature review.
METHODS
This retrospective study included 30 patients with SPS as defined by World Health Organization classification treated at Samsung Medical Center, Korea, between March 1999 and May 2011.
RESULTS
Twenty patients (67%) were male. The median patient age at diagnosis was 56 years (range, 39-76 years). A total of 702 polyps were identified during a median follow-up of 43 months (range, 0-149 months). Serrated polyps were noted more frequently in the distal colon (298/702, 55%). However, large serrated polyps and serrated adenomas were mainly distributed throughout the proximal colon (75% vs. 25% and 81% vs. 19%, respectively); 73.3% had synchronous adenomatous polyps. The incidence of CRC was 10% (3/30 patients), but no interval CRC was detected. A total of 87% of the patients underwent esophagogastroduodenoscopy and 19.2% had significant lesions.
CONCLUSIONS
The phenotype of SPS in Korean patients is different from that of Western patients. In Korean patients, SPS is more common in men, there were fewer total numbers of serrated adenoma/polyps, and the incidence of CRC was lower than that in Western patients. Korean patients tend to more frequently have abnormal gastric lesions. However, the prevalence of synchronous adenomatous polyps is high in both Western and Korean patients.

Keyword

Serrated polyposis syndrome; Serrated adenoma/polyp; Colorectal neoplasms

MeSH Terms

Adenoma
Adenomatous Polyps
Asian Continental Ancestry Group
Classification
Colon
Colorectal Neoplasms
Diagnosis
Endoscopy, Digestive System
Follow-Up Studies
Humans
Incidence
Korea*
Male
Phenotype
Polyps
Prevalence
Retrospective Studies
World Health Organization

Figure

• 

  Fig. 1 Examples of the spectrum of lesions found in the colon. (A) Endoscopic finding of hyperplastic polyp (HP): a 6-mm transverse colon polyp with a smooth and pale appearance. (B) Endoscopic finding of sessile serrated adenoma (SSA): a 12-mm ascending colon polyp with a flat or sessile appearance and indistinct borders. It also has a characteristic rim of debris. (C) Endoscopic finding of traditional serrated adenoma (TSA): a 15-mm descending colon polyp showing a granulonodular and lobular appearance. (D) Histopathologic finding of HP: serrated crypts are confined to the upper crypt. (E) Histopathologic finding of SSA: serrated surfaces are enlarged and epithelial serration extends to the crypt bases. (F) Histopathologic finding of TSA: serrated crypt with pseudostratified, elongated nuclei and abundant eosinophilic cytoplasm is characteristic (D–F, H&E stain).

• 

  Fig. 2 Distribution of serrated polyps (SPs) according to location. SPs ≥10 mm were found more frequently in the proximal colon, with the majority usually found in the distal colon. Similar to the distribution of SPs ≥10 mm, most serrated adenomas (SAs) were distributed throughout the proximal colon.

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