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Pathology and Staging of Colorectal Adenoma and Adenocarcinoma
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Standardisation of definitions with improved diagnostic reproducibility and developing appropriate screening programmes that are evidence based is an immense challenge. Recently, guidelines on the reporting of SLLs have been published in the UK, and the authors recommend the following classification: hyperplastic polyp, sessile serrated lesion (SSL), SSL with dysplasia, traditional serrated adenoma (TSA) and mixed polyp.22
Small sessile serrated polyps might not be at a higher risk for future advanced neoplasia than low-risk adenomas or polyp-free groups
Published in Scandinavian Journal of Gastroenterology, 2022
Eun Hyo Jin, Ji Yeon Seo, Jung Ho Bae, Jooyoung Lee, Ji Min Choi, Yoo Min Han, Joo Hyun Lim
Colorectal cancer (CRC) is the third leading cause of death in the United States [1]. Most cases of CRC develop from pre-existing adenomas through the adenoma-carcinoma sequence [2]. However, 15–30% of CRC cases rise from serrated pathways showing different molecular and genetic alterations from conventional adenomas [3,4]. The mechanism of serrated pathways is associated with the hypermethylation of CpG islands in gene promotor BRAF mutations and microsatellite instability [3–5]. Histologically, a saw-tooth appearance of the crypt epithelium is a common feature of serrated polyps, which are classified by the World Health Organization (WHO) into three categories: hyperplastic polyp (HP), sessile serrated polyp (SSP, with or without cytologic dysplasia), and traditional serrated adenoma (TSA) [5,6]. Unlike HPs, having a minimal risk of malignant transformation, SSPs and TSAs are considered precursors of CRC [7].
Serrated neoplasia in the colorectum: gut microbiota and molecular pathways
Published in Gut Microbes, 2021
Xing Kang, Ru Zhang, Thomas Ny Kwong, Rashid Ns Lui, William Kk Wu, Joseph Jy Sung, Jun Yu, Sunny H Wong
The development of CRC follows several distinct mechanistic pathways, including the adenoma–carcinoma pathway and serrated neoplasia pathway.8 While the conventional adenoma-carcinoma pathway is more common, a small subset of CRC occurs through the serrated pathway. In the past, these serrated lesions were considered as relatively benign lesions;9 however, emerging evidences suggested that certain sessile lesions are non-adenomatous precursors of malignant cancers.10,11 In the fifth edition of the World Health Organization classification of digestive tumors, sessile serrated polyp/adenoma was renamed as sessile-serrated lesion (SSL). In the British pathological classification system, serrated lesions can be classified into several lesion types, including hyperplastic polyp (HP), SSL, SSL with dysplasia, traditional-serrated adenoma (TSA) and mixed polyp.10 SSLs and TSAs have been recognized as important precancerous lesions of CRC.
Potential for prevention: a cohort study of colonoscopies and removal of adenomas in a FIT-based colorectal cancer screening programme
Published in Scandinavian Journal of Gastroenterology, 2019
Mette Bach Larsen, Sisse Helle Njor, Thomas Møller Jensen, Peter Ingeholm, Berit Andersen
Results of colonoscopies were retrieved from the Danish Pathology Register, which holds information from all pathology departments, using the Danish SNOMED coding system for pathology diagnoses [21]. Localisation of adenomas in colon and rectum was defined by the following two SNOMED codes: T67* (colon) and T68* (rectum). Relevant adenomas were identified by the following SNOMED codes: M8213F (flat adenoma), M82110 (tubular adenoma), M82130 (traditional serrated adenoma), M8213M (sessile serrated lesion with dysplasia) and M82630 (tubulovillous adenoma), M82611 (villous adenoma). Adenomas were classified as high-risk adenomas if one of the following three criteria were met: (1) at least one adenoma ≥20 mm, (2) more than five adenomas regardless of their size, or (3) removal of at least one adenoma using the piecemeal technique. Adenomas were classified as intermediate-risk adenomas if one of the following four criteria were met: (1) ≥3 and ≤4 adenomas, (2) at least one adenoma ≥10 mm and <20 mm, (3) at least one tubulovillous or villous adenoma and (4) at least one adenoma with high-grade neoplasia. Adenomas were classified as low-risk adenomas if none of the above criteria were met [17]. In the following, high- and intermediate-risk adenomas are defined as advanced adenomas and low-risk adenomas are classified as non-advanced adenomas. Adenoma was used as a collective name for both advanced and non-advanced adenomas. If more than one specimen was identified in the Danish Pathology Register per individual within the study period, only the one with the more serious result was included.