IJCEP Copyright © 2007-All rights reserved.
International Journal of Clinical and
Experimental Pathology
Int J Clin Exp Pathol 1(4):317-324;2008

Review Article
Nomenclature, Molecular Genetics and Clinical Significance of the Precursor Lesions
in the Serrated Polyp Pathway of Colorectal Carcinoma

John J. Liang, Sadir Alrawi and Dongfeng Tan

Department of Pathology, Pennsylvania State University Hershey Medical Center, Hershey, PA, USA and Department of Pathology, The
University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.

Received 18 Sept 2007; accepted and available online 1 January 2008

Abstract: Serrated adenomas (SAs) are part of the distinct serrated polyp pathway of colorectal carcinogenesis characterized by
microsatellite instability and deficiency in DNA mismatch repair. Sessile SA is a recently recognized lesion that typically presents as a
large sessile polyp, but lacks the conventional dysplasia. It is more frequently found on the right side than on the left side of the colon, and
is thought to represent an intermediate form in the hyperplastic polyp to sessile SA, traditional SA, and colon cancer sequence. Many
terms have been used and are still in use in the literature to describe this lesion, such as “hyperplastic polyposis”, “giant hyperplastic
polyposis,” “large hyperplastic polyps,” “hyperplastic-adenomatous polyposis syndrome,” “giant hyperplastic polyp,” and “mixed epithelial
polyp.” The purpose of this paper is to review and clarify the confusing nomenclature, and to provide a framework for understanding the
genetic alterations and clinical significance of these precursor lesions in the serrated polyp pathway of colorectal caner. (IJCEP709010).

Key Words: Polyp, hyperplastic, adenomatous, colon, sessile serrated adenoma, carcinoma

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Address all correspondences to: Dongfeng Tan, M.D., Department of Pathology and Laboratory Medicine, Unit 85, The University of
Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030; phone: (713) 745-4977; fax: (713) 745-1105; Email:
dtan@mdanderson.org.