Batts Kenneth P
Virginia Piper Cancer Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Mod Pathol. 2015 Jan;28 Suppl 1:S80-7. doi: 10.1038/modpathol.2014.130.
In the past 10-15 years, recognition and considerable understanding of much of the so-called 'serrated pathway' of colorectal neoplasia has emerged, although much remains to be discovered. Key elements appear to be a propensity for the elderly, females more than males, and right colon; precursor lesions with serrations; and frequent BRAF mutations, hypermethylation (particularly involving the MHL1 promoter), and resultant dysfunctional DNA mismatch repair and microsatellite instability (MSI) of the colorectal adenocarcinomas. For the anatomic pathologist, this has created challenges in sometimes having to morphologically subdivide once-comfortable hyperplastic polyps into hyperplastic polyps and 'sessile serrated adenoma/polyps' (SSA/Ps), learn to distinguish these from 'traditional' serrated adenomas, and learn to recognize biologically progressing forms of SSA/Ps known as 'sessile serrated adenoma with cytological dysplasia'. The goal of this article is to highlight for the practicing anatomic pathologist the current status of our understanding of serrated colorectal neoplasms from a practical perspective.
在过去10至15年里，人们对结直肠肿瘤所谓的“锯齿状途径”已有了认识和相当程度的了解，尽管仍有许多有待发现。关键因素似乎包括好发于老年人，女性多于男性，且好发于右半结肠；存在锯齿状的前驱病变；以及结直肠癌中频繁出现的BRAF突变、高甲基化（尤其是涉及MHL1启动子），以及由此导致的功能性DNA错配修复缺陷和微卫星不稳定性（MSI）。对于解剖病理学家而言，这带来了一些挑战，有时必须在形态学上将曾经熟悉的增生性息肉细分为增生性息肉和“无蒂锯齿状腺瘤/息肉”（SSA/P），学会将这些与“传统”锯齿状腺瘤区分开来，并学会识别SSA/P的生物学进展形式，即“伴有细胞学异型增生的无蒂锯齿状腺瘤”。本文的目的是从实际角度向执业解剖病理学家强调我们对锯齿状结直肠肿瘤的当前认识状况。
