A set of polyps that superficially resemble ordinary hyperplastic polyps of the left colon but with divergent morphology and probably divergent biology has become apparent. Such polyps differ from typical small left-sided hyperplasic polyps by the large sizes they may attain, their tendency to be right-sided, and subtle morphologic differences. It is important to separate these polyps, which some have called "sessile serrated polyps" from hyperplastic polyps as they are associated with progression to carcinoma probably through mismatch repair defects.