Rashtak Shahrooz, Rego Rafaela, Sweetser Seth R, Sinicrope Frank A
Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
Cancer Prev Res (Phila). 2017 May;10(5):270-278. doi: 10.1158/1940-6207.CAPR-16-0264. Epub 2017 Mar 21.
Evidence suggests that up to one fifth of colorectal carcinomas develop from serrated polyps, named for their pattern of colonic crypts, and include the sessile serrated adenoma/polyp (SSA/P) that has malignant potential. SSA/Ps are typically located in the proximal colon and have molecular features of hypermethylation of CpG islands in gene promoters and activating point mutations (V600E) in the oncogene. Both of these features are seen in sporadic colorectal carcinomas with microsatellite instability (MSI) which is potentially consistent with an origin of these cancers from precursor SSA/Ps. Dysplasia is detected in a subset of SSA/Ps with a high risk of progression to carcinoma. An uncommon serrated polyp is the traditional serrated adenoma that is typically found in the left colon, has a tubulovillous architecture, and frequently harbors mutant To date, the epidemiology of these serrated lesions is poorly understood, and limited observational data suggest a potential chemopreventive benefit of nonsteroidal anti-inflammatory drugs. The current primary strategy to reduce the risk of colorectal carcinoma from serrated polyps is to enhance their detection at colonoscopy and to ensure their complete removal. This review provides insight into the epidemiologic, clinical, histopathologic, and molecular features of serrated polyps and includes data on their endoscopic detection and chemoprevention. .
有证据表明，高达五分之一的结直肠癌由锯齿状息肉发展而来，因其结肠隐窝模式而得名，其中包括具有恶性潜能的无蒂锯齿状腺瘤/息肉（SSA/P）。SSA/P通常位于近端结肠，具有基因启动子中CpG岛高甲基化和癌基因激活点突变（V600E）的分子特征。这两种特征在具有微卫星不稳定性（MSI）的散发性结直肠癌中均可见，这可能与这些癌症起源于前体SSA/P一致。在一部分有进展为癌高风险的SSA/P中可检测到发育异常。一种不常见的锯齿状息肉是传统锯齿状腺瘤，通常位于左半结肠，具有绒毛管状结构，且常含有突变体。迄今为止，对这些锯齿状病变的流行病学了解甚少，有限的观察数据表明非甾体抗炎药可能具有化学预防作用。目前降低锯齿状息肉发展为结直肠癌风险的主要策略是在结肠镜检查时提高其检出率并确保将其完整切除。本综述深入探讨了锯齿状息肉的流行病学、临床、组织病理学和分子特征，并包括其内镜检测和化学预防的数据。
