The Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Hum Pathol. 2012 Nov;43(11):1808-14. doi: 10.1016/j.humpath.2012.04.001. Epub 2012 Jul 9.
Sessile serrated adenomas (SSAs) were unrecognized in pathology and gastroenterology practice until about 2005; we have diagnosed them since 2001, allowing up to 10 years of follow-up. We evaluated follow-up of patients with sessile serrated adenoma diagnosed between 2002 and 2004 in our teaching institution and compared it to follow-up of randomly selected tubular adenomas. Materials from patients diagnosed with sessile serrated adenoma from January 2002 to December 2004 were reviewed. A control group of patients with sporadic tubular adenomas was selected. Ninety-nine sessile serrated adenomas from 93 patients were diagnosed between January 2002 and December 2004. Forty three patients (46.2%) had follow-up colonoscopy. One or more lesions were found in 42 (97.6%) of 43 patients. Mucinous adenocarcinoma was diagnosed in 1 (2.3%) of 43 patients, and 1 (2.3%) of 43 patients had high-grade dysplasia in an sessile serrated adenoma. Sessile serrated adenomas were found in 22 (51.2%) of 43 patients, 16 (37.2%) of 43 patients had tubular adenomas, and hyperplastic polyps were diagnosed in 18 (41.9%) of 43. Ninety-two patients with tubular adenomas between January 2002 and December 2004 formed the control group. Sixty-six patients (71.7%) received follow-up colonoscopy. Most (53/66, 80.3%) patients had tubular adenomas on follow-up, 12 (18.2%) of 66 patients had hyperplastic polyps, and 2 (3.0%) of 66 patients had a sessile serrated adenoma. The follow-up of sessile serrated adenomas from the study period (2002 to 2004) was more rigorous than proposed for sporadic tubular adenomas (patients with sporadic tubular adenomas were also followed up more aggressively than suggested by guidelines). Those with follow-up were managed as per advanced adenomas; their clinical outcomes supported this. These results suggest that guidelines for following up patients with sessile serrated adenomas as per advanced adenomas are warranted.
直到 2005 年左右，无蒂锯齿状腺瘤（SSA）在病理学和胃肠病学实践中才未被识别；我们自 2001 年以来已对其进行诊断，随访时间最长可达 10 年。我们评估了在教学机构中诊断为 2002 年至 2004 年之间的无蒂锯齿状腺瘤患者的随访情况，并将其与随机选择的管状腺瘤的随访进行了比较。回顾了 2002 年 1 月至 2004 年 12 月期间在我院诊断为无蒂锯齿状腺瘤的患者的资料。选择了一组偶发性管状腺瘤患者作为对照组。2002 年 1 月至 2004 年 12 月期间共诊断出 93 例患者中的 99 例无蒂锯齿状腺瘤。43 例患者（46.2%）进行了结肠镜随访。在 43 例患者中，42 例（97.6%）发现了 1 个或多个病变。43 例患者中的 1 例（2.3%）被诊断为黏液性腺癌，43 例患者中的 1 例（2.3%）的无蒂锯齿状腺瘤存在高级别异型增生。在 43 例患者中发现了 22 例（51.2%）无蒂锯齿状腺瘤，43 例患者中有 16 例（37.2%）管状腺瘤，43 例患者中有 18 例（41.9%）诊断为增生性息肉。2002 年 1 月至 2004 年 12 月期间，92 例管状腺瘤患者形成对照组。66 例患者（71.7%）接受了结肠镜随访。大多数（53/66，80.3%）患者在随访时发现管状腺瘤，66 例患者中有 12 例（18.2%）为增生性息肉，66 例患者中有 2 例（3.0%）为无蒂锯齿状腺瘤。该研究期间（2002 年至 2004 年）对无蒂锯齿状腺瘤的随访比偶发性管状腺瘤的建议更严格（对偶发性管状腺瘤患者的随访也比指南建议的更积极）。有随访的患者按高级别腺瘤处理；他们的临床结果支持这一点。这些结果表明，有必要根据高级别腺瘤的标准对无蒂锯齿状腺瘤患者进行随访。
