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DOI: 10.1055/s-2001-16525
© Georg Thieme Verlag Stuttgart · New York
Evaluation of Endoscopic and Histopathological Features of Serrated Adenoma of the Colon
Publication History
Publication Date:
20 August 2001 (online)
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Background and Study Aims: The aim of this study was to reveal the clinical features of serrated colonic adenoma by investigating its endoscopic features using a magnifying videoscope.
Materials and Methods: 68 colorectal serrated adenomas presented for colonoscopic examination were included in this study. A magnifying videoscope with a zoom ranging from × 1 to × 100 magnification was employed to observe the pit patterns of colonic lesions, and 39 of the serrated adenoma specimens were evaluated using this. Some pit patterns appeared as elongated oval and stellar-like orifices of the crypts; we termed these type which was detected IIISA patterns. Other pit patterns showed a flower petal-like or pineal form, and this was termed a type IVSA pit pattern.
Results: In the entire sample of serrated adenomas, 53 were of the protruded type, and 15 were superficial, for a protruded/superficial ratio of 3.5 : 1. The protruded type of serrated adenoma predominated in the distal portion. The superficial type was preferentially located in the proximal portion of the colon (P < 0.0001). Among the 13 superficial types in which the magnifying videoscope was used, all 13 showed the type IIISA basic pit pattern. In these serrated adenomas of the superficial type, an additional IVSA pit pattern was found in 23.1% (3/13), which was detected in 53.8% (14/26) in the protruded type. Small serrated adenomas measuring less than 10 mm in diameter were preferentially mild to moderate atypia (odd's ratio = 15.9, P = 0.0216).
Conclusion: The pit pattern may prove useful for the endoscopic diagnosis of serrated adenoma. Furthermore, endoscopic treatment is indicated for serrated adenoma; in particular those of 10 mm or more in diameter should be treated because of the possibility of high-grade glandular intraepithelial neoplasia.
References
- 1 Longacre T A, Fenoglio-Preiser C M. Mixed hyperplastic adenomatous polyps/serrated adenomas: a distinct form of colorectal neoplasia. Am J Surg Pathol. 1990; 14 524-537
- 2 Kudo S, Tamura S, Nakajima T, et al. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc. 1996; 44 8-14
-
3 Hamilton S R, Vogelstein B, Kudo S, et al. Tumours of the colon and rectum. In: Hamilton SR, Aaltonen LA (eds).
World Health Organization Classification of Tumours, Pathology and Genetics of Tumours of the Digestive System. IARC Press, 2000 - 4 Rubio C A, Kato Y, Hirota T, et al. Histological classification of endoscopically removed flat colorectal polyps: a multicentric study. Jpn J Cancer Res. 1996; 87 849-855
- 5 Urbanski S J, Marcon N, Kossakowska A, et al. Mixed hyperplastic adenomatous polyps: an underdiagnosed entity. Am J Surg Pathol. 1984; 8 551-556
- 6 Jass J R. Nature and clinical significance of colorectal polyp. Semin Colon Rectal Surg. 1991; 2 246-252
- 7 Fenoglio-Preiser C M. Definition of the histological features of colorectal epithelial polyps including serrated adenomas. Stomach and Intestine. 1998; 33 817-823
- 8 Hayashi T, Yatani R, Apostol J, et al. Pathogenesis of hyperplastic polyps of the colon: in vitro cell kinetics. Gastroenterology. 1974; 66 347-356
- 9 Fenoglio-Preiser C M, Pascal R R, Perzin K H. Tumors of the intestine. Washington DC; Armed Forces Institute of Pathology, 2nd edn. 1988: 108-112
- 10 Rubio C A, Kato Y, Hirota T, et al. Flat serrated adenomas of the colorectal mucosa in Japanese patients. In Vivo. 1996; 10 339-344
- 11 Rubio C A, Rodensjo M. Flat adenomas and flat serrated adenomas of colorectal mucosa: differences in the pattern of cell proliferation. Jpn J Cancer Res. 1995; 86 756-760
- 12 Cooper H S, Patchefsky A S, Marks G. Adenomatous and carcinomatous changes within hyperplastic colonic epithelium. Dis Colon Rectum. 1979; 22 152-156
S. Tamura,M.D.
First Department of Internal Medicine
Kochi Medical School
Kohasu, Okoh-cho
Nankoku, Kochi 783-8505, Japan
Fax: + 81-088-8802338
Email: tamuras@hi-ho.ne.jp