Hyperplastic polyp or sessile serrated lesion? The contribution of serial sections to reclassification
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RESEARCH
Open Access
Hyperplastic polyp or sessile serrated lesion? The contribution of serial sections to reclassification Diana R. Jaravaza1*
and Jonathan M. Rigby1,2
Abstract Background: The histological discrimination of hyperplastic polyps from sessile serrated lesions can be difficult. Sessile serrated lesions and hyperplastic polyps are types of serrated polyps which confer different malignancy risks, and surveillance intervals, and are sometimes difficult to discriminate. Our aim was to reclassify previously diagnosed hyperplastic polyps as sessile serrated lesions or confirmed hyperplastic polyps, using additional serial sections. Methods: Clinicopathological data for all colorectal hyperplastic polyps diagnosed in 2016 and 2017 was collected. The slides were reviewed and classified as hyperplastic polyps, sessile serrated lesion, or other, using current World Health Organization criteria. Eight additional serial sections were performed for the confirmed hyperplastic polyp group and reviewed. Results: Of an initial 147 hyperplastic polyps from 93 patients, 9 (6.1%) were classified as sessile serrated lesions, 103 as hyperplastic polyps, and 35 as other. Of the 103 confirmed hyperplastic polyps, 7 (6.8%) were proximal, and 8 (7.8%) had a largest fragment size of ≥5 mm and < 10 mm. After 8 additional serial sections, 11 (10.7%) were reclassified as sessile serrated lesions. They were all less than 5 mm and represented 14.3% of proximal polyps and 10.4% of distal polyps. An average of 3.6 serial sections were required for a change in diagnosis. Conclusion: Histopathological distinction between hyperplastic polyps and sessile serrated lesions remains a challenge. This study has uncovered a potential role for the use of additional serial sections in the morphological reappraisal of small hyperplastic polyps, especially when proximally located. Keywords: Sessile serrated lesion, Sessile serrated adenoma/polyp, Hyperplastic polyp, Levels, Serial sections
Introduction Although serrated polyps have in common a saw-tooth morphology of crypts, it is important to distinguish between hyperplastic polyps (HPs) and sessile serrated lesions (SSLs) because of the inherent difference in risk of malignant transformation [1]. This risk in turn informs colonoscopic surveillance intervals [1–7]. * Correspondence: [email protected] 1 Division of Anatomical Pathology, National Health Laboratory Service, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa Full list of author information is available at the end of the article
Historically, colorectal polyps were classified as conventional adenomas (adenomatous polyps) and hyperplastic (metaplastic) polyps, with only the former being recognised as having a risk of malignant transformation [2, 6, 8, 9]. In a landmark study published in 2003, Torlakovic et al. proposed that not all hyperplastic polyps were equal, and that there was a subgroup of serrated/ hyperplastic polyps with morphological and genetic features distinct from “benign” hyperplastic polyps, th
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