Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Clin Pathol. 2023 Jul;76(7):429-434. doi: 10.1136/jcp-2023-208783. Epub 2023 Mar 16.
The range of lesions with a serrated appearance within the large intestine has expanded and become more complex over the last 30 years. The majority of these were previously known as metaplastic polyps but are today called hyperplastic polyps (HPs). HPs show two main growth patterns: microvesicular and goblet cell-rich. The former type shows morphological and molecular similarities (eg, mutations) to the more recently described sessile serrated lesion (SSL). In this review, we debate whether these lesions represent a biological spectrum or separate entities. Whichever view is held, microvesicular HPs and SSLs are distinct from the goblet cell-rich HP and the traditional serrated adenoma (TSA), which may themselves share molecular changes (eg, mutations), with the goblet cell-rich HP representing a precursor to the TSA. Both SSLs and the goblet cell-rich HP-TSA pathway are routes to colorectal cancer within the serrated pathway and overlaps between them can occur, for example, a (-mutated) TSA may arise from an SSL.
在过去的 30 年中，大肠中锯齿状外观病变的范围已经扩大并且变得更加复杂。这些病变大多数以前被称为“化生性息肉”，但现在被称为“增生性息肉”（HPs）。HPs 显示两种主要的生长模式：微囊泡型和富含杯状细胞型。前者在形态学和分子上与最近描述的“无蒂锯齿状病变”（SSL）相似（例如，突变）。在这篇综述中，我们争论这些病变是否代表生物学谱或不同的实体。无论哪种观点，微囊泡型 HPs 和 SSL 与富含杯状细胞的 HP 和传统锯齿状腺瘤（TSA）不同，后者本身可能共享分子变化（例如，突变），富含杯状细胞的 HP 是 TSA 的前体。SSL 和富含杯状细胞的 HP-TSA 途径都是锯齿状途径中结直肠癌的途径，它们之间可能会重叠，例如，（突变）的 TSA 可能源自 SSL。
