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. 2011 Jun;178(6):2700-7.
doi: 10.1016/j.ajpath.2011.02.023.

A serrated colorectal cancer pathway predominates over the classic WNT pathway in patients with hyperplastic polyposis syndrome

Karam S Boparai  1 , Evelien Dekker, Mirjam M Polak, Alex R Musler, Susanne van Eeden, Carel J M van Noesel
Affiliations

A serrated colorectal cancer pathway predominates over the classic WNT pathway in patients with hyperplastic polyposis syndrome

Karam S Boparai et al. Am J Pathol. 2011 Jun.

Abstract

Hyperplastic polyposis syndrome (HPS) is characterized by the presence of multiple colorectal serrated polyps and is associated with an increased colorectal cancer (CRC) risk. The mixture of distinct precursor lesion types and malignancies in HPS provides a unique model to study the canonical pathway and a proposed serrated CRC pathway in humans. To establish which CRC pathways play a role in HPS and to obtain new support for the serrated CRC pathway, we assessed the molecular characteristics of polyps (n = 84) and CRCs (n = 19) in 17 patients with HPS versus control groups of various sporadic polyps (n = 59) and sporadic microsatellite-stable CRCs (n = 16). In HPS and sporadic polyps, APC mutations were exclusively identified in adenomas, whereas BRAF mutations were confined to serrated polyps. Six of 19 HPS CRCs (32%) were identified in a serrated polyp. Mutation analysis performed in the CRC and the serrated component of these lesions showed identical BRAF mutations. One HPS CRC was located in an adenoma, both components harboring an identical APC mutation. Overall, 10 of 19 HPS CRCs (53%) carried a BRAF mutation versus none in control group CRCs (P = 0.001). Six BRAF-mutated HPS CRCs (60%) were microsatellite unstable owing to MLH1 methylation. These findings provide novel supporting evidence for the existence of a predominant serrated CRC pathway in HPS, generating microsatellite-stable and microsatellite-instable CRCs.

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Figures

Figure 1
Figure 1
Three CRCs of three HPS patients; two CRCs located within two serrated polyps (A and B), and one CRC within a villous adenoma (C). Original magnification, ×50.
Figure 2
Figure 2
Mutation profiles of HPS polyps/CRCs compared with sporadic control group polyps/CRCs. White bars indicate APC; gray bars, KRAS; black bars, BRAF. SPs, serrated polyps; Ads, conventional adenomas.
Figure 3
Figure 3
Nuclear CTNNB1 expression in the adenocarcinoma (top) and the adjacent adenoma (bottom) of patient 11, both harboring the same APC gene mutation. Original magnification, ×200.
See this image and copyright information in PMC

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