Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, 85259, USA.
Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4072, Australia.
Mod Pathol. 2019 Oct;32(10):1390-1415. doi: 10.1038/s41379-019-0280-2. Epub 2019 Apr 25.
Our understanding of serrated colorectal polyps has increased dramatically over the past two decades and has led to a modern classification scheme for these lesions. Sessile serrated polyps with dysplasia represent the most clinically significant serrated polyp; however, the morphologic heterogeneity of dysplasia in sessile serrated polyps has only recently been recognized and correlated with MLH1 immunohistochemistry. Detailed morphologic analysis of traditional serrated adenomas has led to the recognition of flat and early forms of this polyp. Robust data on the risk of metachronous lesions in patients with serrated polyps are also beginning to emerge. This review will summarize our current understanding of serrated polyps and associated carcinomas with a focus on diagnostic criteria, morphologic heterogeneity, molecular findings, and natural history. Controversial issues in the diagnosis and classification of these polyps are also discussed.
在过去的二十年中，我们对锯齿状结直肠息肉的认识有了显著提高，并由此产生了一种用于这些病变的现代分类方案。伴异型增生的无蒂锯齿状息肉是最具临床意义的锯齿状息肉；然而，无蒂锯齿状息肉中异型增生的形态异质性最近才被认识到，并与 MLH1 免疫组化相关。对传统锯齿状腺瘤的详细形态学分析导致了对这种息肉的扁平及早期形式的认识。关于锯齿状息肉患者中同时性病变风险的大量数据也开始出现。本综述将总结我们目前对锯齿状息肉及相关癌的认识，重点介绍诊断标准、形态异质性、分子发现和自然史。还讨论了这些息肉诊断和分类中的一些有争议的问题。
