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Review
. 2015 Mar 14;21(10):2896-904.
doi: 10.3748/wjg.v21.i10.2896.

Endoscopic and histologic characteristics of serrated lesions

Driffa Moussata  1 , Gilles Boschetti  1 , Marion Chauvenet  1 , Karine Stroeymeyt  1 , Stéphane Nancey  1 , Françoise Berger  1 , Thierry Lecomte  1 , Bernard Flourié  1
Affiliations
Review

Endoscopic and histologic characteristics of serrated lesions

Driffa Moussata et al. World J Gastroenterol. .

Abstract

In recent years, a second pathway for colonic carcinogenesis, distinct from the adenomatous pathway, has been explored. This is referred to as serrated pathway and includes three types of polyp, characterised by a serrated appearance of the crypts: hyperplastic polyps (HP), sessile serrated adenomas (SSA) or lesions, and traditional serrated adenomas. Each lesion has its own genetic, as well as macroscopic and microscopic morphological features. Because of their flat aspect, their detection is easier with chromoendoscopy (carmin indigo or narrow-band imaging). However, as we show in this review, the distinction between SSA and HP is quite difficult. It is now recommended to resect in one piece as it is possible the serrated polyps with a control in a delay depending on the presence or not of dysplasia. These different types of lesion are described in detail in the present review in general population, in polyposis and in inflammatory bowel diseases patients. This review highlights the need to improve characterization and understanding of this way of colorectal cancerogenesis.

Keywords: Endomicroscopy; Endoscopy; Histology; Hyperplastic polyp; Serrated polyposis; Sessile serrated adenoma; Traditional serrated adenoma.

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Figures

Figure 1
Figure 1
Schematic representation of the sessile and traditional serrated pathways[18]. MSI: Microsatellites instability; CIMP-H, CIMP-L: CpG island methylation promotor-high, CIMP-bas; MLH1: MutL homolog 1; MGMT: MethylGuanine DNA methyltransferase; SSA: Sessile serrated adenomas.
Figure 2
Figure 2
Hyperplastic polyp in chromoendoscopy (A), histology (B) and confocal endomicroscopy (C).
Figure 3
Figure 3
Sessile serrated adenoma in chromoendoscopy (A), confocal endomicroscopy (B) and histology (C)
Figure 4
Figure 4
Traditional serrated polyp in chromoendoscopy (A), confocal endomicroscopy (B) and histology (C).
Figure 5
Figure 5
Endoscopic (A), endomicroscopic (B) and histologic (C) characteristics of serrated lesions in patients with inflammatory bowel disease.
See this image and copyright information in PMC

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