Ulcerative Colitis With Concomitant Serrated Polyposis Syndrome: A Case Report and Literature Review

Abstract

Serrated polyposis syndrome (SPS) is a pre-cancerous condition associated with increased risk of developing colorectal cancer (CRC). Its role in inflammatory bowel disease (IBD)-associated CRC remains unknown. Despite the growing understanding and recognition of SPS, there is limited literature about its impact on the colon in individuals with IBD. Herein, we report a case of a 45-year-old female who was diagnosed with ulcerative colitis (UC) and SPS. We also reviewed the literature surrounding this association and highlighted the intricacies in managing this unique patient population. At present, there are no screening guidelines for CRC in SPS patients with IBD. However, given the potential synergistic risk for CRC, a close surveillance approach may be utilized. Tracking lifetime cumulative features of SPS and endoscopic clearance of adenomas and serrated polyps are the mainstays of management.

Keywords: colorectal cancer (crc); inflammatory bowel disease; serrated polyp; serrated polyposis syndrome (sps); sessile serrated adenoma; ulcerative colitis (uc).

Figure 1. Ascending colon sessile serrated adenoma/polyp

A: Endoscopic view showing ascending colon sessile serrated adenomatous polyp B: Hematoxylin-eosin stain of the resected specimen of sessile serrated adenoma without cytologic dysplasia showing the presence of serrated crypts and irregularly dilated and branching crypts.

Figure 2. Proctitis; inflammation of the rectal mucosa

A: Endoscopic view showing moderate rectal erythema and muco-purulent discharge. B: Hematoxylin-eosin stain of the rectal biopsy specimen showing active proctitis. A crypt abscess (arrow) is visible.