serrated adenoma


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  • Names

    • sessile serrated polyp
    • sessile serrated adenoma

  • Clinical

    • right colon
    • > 0.5 cm

  • Histology

    • prominent serration at all levels, including base
    • basal crypts with branching, flask-shape (inverted T)
    • architecture distortions: crypt crowding, horizontal crypts, crypt dilitation
    • mitosis in upper crypts
    • can be with or without dysplasia

  • Types of dysplasia

    • intestinal type dysplasia: most common, stratified, pencil-like nuclei
    • serrated dysplasia: oval nuclei with prominent nuclei, stratification, hypereosinophilic cytoplasm, lacking surface maturation

  • Molecular

    • high rate of CIMP, BRAF
    • Low rate of APC or KRAS or p53
    • dysplasia associated with: MSI, loss of MLH1, MSH2, MGMT

  • Signout

    • if no dysplasia, use the term sessile serrated polyp to avoid confusion
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