Folker Mille Brunbjerg, Bernstein Inge T, Holck Susanne
H:S Hvidovre Hospital, Patologiafdelingen og HNPCC-Registret, Gastroenheden, Hvidovre.
Ugeskr Laeger. 2006 Nov 13;168(46):4005-9.
The colorectal hyperplastic polyp has generally been considered a finding of no clinical significance. Recent research has, however, called attention to the existence of some variants of hyperplastic polyp which are potentially malignant. The term "advanced serrated polyp" has been coined for such cases, which comprise mixed hyperplastic/adenomatous tissue, serrated adenoma, and sessile serrated polyp, in contrast to the traditional hyperplastic polyp. Since epithelial dysplasia is an integrated component of mixed hyperplastic/adenomatous polyp and of the serrated adenoma, such a diagnosis would dictate control colonoscopy comparable to the guidelines for subjects with conventional adenomas. The cytology of the sessile serrated polyp is, however, closer to that of the traditional hyperplastic polyp, whereas the architecture mimics that of the serrated adenoma. For this reason, a consensus regarding the optimal management of such patients has not been obtained, but if the polyp is sizeable and located in the right colon, control should be considered. The small, usually left-sided traditional polyp as a rule needs no follow-up, but the context in which such a lesion is found and its morphology may influence the clinical decision. Future large-scale investigations of serrated colorectal polyps, including interobserver studies, will be required to identify histological details of clinical utility which can be adopted in daily routine practice.
结直肠增生性息肉一般被认为是无临床意义的发现。然而，最近的研究已使人们注意到一些增生性息肉变体的存在，这些变体具有潜在恶性。对于此类包含混合性增生/腺瘤性组织、锯齿状腺瘤和无蒂锯齿状息肉的病例，与传统增生性息肉不同，已创造出“高级别锯齿状息肉”这一术语。由于上皮发育异常是混合性增生/腺瘤性息肉和锯齿状腺瘤的一个组成部分，这样的诊断将决定结肠镜检查的控制方式应与传统腺瘤患者的指南相当。然而，无蒂锯齿状息肉的细胞学更接近传统增生性息肉，而其结构则模仿锯齿状腺瘤。因此，尚未就此类患者的最佳管理达成共识，但如果息肉较大且位于右半结肠，则应考虑进行控制。通常位于左侧的小的传统息肉一般无需随访，但发现此类病变的背景及其形态可能会影响临床决策。未来需要对锯齿状结直肠息肉进行大规模研究，包括观察者间研究，以确定可应用于日常实践的具有临床实用性的组织学细节。
