Sessile serrated adenomas strongly predispose to synchronous serrated polyps in non-syndromic patients

Histopathology. 2010 Apr;56(5):581-8. doi: 10.1111/j.1365-2559.2010.03520.x.


Aims: To determine the prevalence of various colonic polyps removed during a recent 8-month period; to determine the interobserver agreement in the diagnosis of serrated polyps; and to determine if harbouring a sessile serrated adenoma (SSA) predisposes to the presence of synchronous polyps with similar histology.

Methods and results: All polyps resected during an 8-month period at a single tertiary medical centre were analysed. We also analysed all polyps in patients with an SSA or SSA with dysplasia since 2003. SSAs accounted for 4.3% of colonic polyps removed during an 8-month period. A review of 276 serrated polyps by two pathologists revealed good interobserver agreement (kappa = 0.66). Patients with one SSA were more likely to harbour additional serrated polyps. After removal of the index SSA, 18% of their remaining polyps were SSAs, SSAs with dysplasia, and traditional serrated adenomas, contrasting with the approximately 5% prevalence of these polyps in the control population. The hyperplastic polyps in the study population were also twice as likely to occur proximal to the splenic flexure.

Conclusions: These data indicate that there is a strong colonic mucosal field defect in patients with sporadic SSAs that predispose them to develop additional serrated polyps.

MeSH terms

  • Adenoma / diagnosis
  • Adenoma / epidemiology*
  • Adenoma / surgery
  • Colonic Polyps / diagnosis
  • Colonic Polyps / epidemiology*
  • Colonic Polyps / surgery
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / epidemiology*
  • Colorectal Neoplasms / surgery
  • Comorbidity
  • Diagnosis, Differential
  • Female
  • Humans
  • Illinois / epidemiology
  • Male
  • Middle Aged
  • Neoplasms, Multiple Primary / diagnosis
  • Neoplasms, Multiple Primary / epidemiology*
  • Neoplasms, Multiple Primary / surgery
  • Observer Variation
  • Prognosis