Serrated Colon Polyps as Precursors to Colorectal Cancer

Slides:



Advertisements
Similar presentations
Management of Gastric Polyps: An Endoscopy-Based Approach
Advertisements

Matthew D. Rutter, Robert H. Riddell 
Sessile Serrated Adenomas: An Evidence-Based Guide to Management
Colorectal Cancers Found After a Complete Colonoscopy
Endoscopic Confocal Imaging
Junya Tsurukiri, Masahito Ueno, Naoyuki Kaneko 
Confocal Endomicroscopy in Ulcerative Colitis: Differentiating Dysplasia-Associated Lesional Mass and Adenoma-Like Mass  David P. Hurlstone, Mike Thomson,
Fay Kastrinos, Elena M. Stoffel 
Hongzhi Zou, Jonathan J. Harrington, Aravind Sugumar, Kristie K
Management of Gastric Polyps: An Endoscopy-Based Approach
Surveillance of Dysplasia in Inflammatory Bowel Disease: The Gastroenterologist- Pathologist Partnership  David T. Rubin, Jerrold R. Turner  Clinical Gastroenterology.
Sessile Serrated Adenomas: An Evidence-Based Guide to Management
Virtual Histology in Everyday Gastrointestinal Endoscopy
Volume 153, Issue 3, Pages (September 2017)
Colonoscopy and Diminutive Polyps: Hot or Cold Biopsy or Snare
Novel Colonoscopic Imaging
Volume 136, Issue 4, Pages (April 2009)
Biliary Stricture and Negative Cytology: What Next?
Banke Agarwal, Olivia J. Ludwig, Brian T. Collins, Cherise Cortese 
Efficacy of Endoscopic Mucosal Resection With Circumferential Incision for Patients With Large Colorectal Tumors  Taku Sakamoto, Takahisa Matsuda, Takeshi.
Katsunori Matsueda, Tatsuya Toyokawa 
Endoscopic Mucosal Resection in the Management of Esophageal Neoplasia: Current Status and Future Directions  Vikneswaran Namasivayam, Kenneth K. Wang,
Clinical Evaluation of Endoscopic Trimodal Imaging for the Detection and Differentiation of Colonic Polyps  Frank J.C. van den Broek, Paul Fockens, Susanne.
When Should We Suspect Hereditary Colorectal Cancer Syndrome?
Todd H. Baron, MD, Thomas C. Smyrk, MD 
Right Upper Quadrant Pain and a Normal Abdominal Ultrasound
Molecular Imaging in Gastrointestinal Endoscopy
Advances in Endoscopic Imaging of Colorectal Neoplasia
Making Sense of HDAC2 Mutations in Colon Cancer
Amit G. Singal, Jasmin A. Tiro, Samir Gupta 
Recommended Intervals Between Screening and Surveillance Colonoscopies
Amnon Sonnenberg, MD, MSc, Brent Y. Lee, MD 
Low Rates of Cancer or High-Grade Dysplasia in Colorectal Polyps Collected From Computed Tomography Colonography Screening  Perry J. Pickhardt, Kendra.
Judy A. Trieu, Mohammad Bilal, Ali Hashmi 
Elizabeth Montgomery, Marcia Irene Canto 
Granular Cell Tumor in Colonic Polyp Found on Screening Colonoscopy
Personalizing Colorectal Cancer Screening: A Systematic Review of Models to Predict Risk of Colorectal Neoplasia  Gene K. Ma, Uri Ladabaum  Clinical Gastroenterology.
Endoscopic Confocal Imaging
Matthew D. Rutter, Robert H. Riddell 
Endoscopy 20 Years Into the Future
Activity-Based Costing and Management in a Hospital-Based GI Unit
Role of the Serrated Pathway in Colorectal Cancer Pathogenesis
Volume 135, Issue 2, Pages (August 2008)
The Serrated Polyp Comes of Age
Endoscopic Therapy for Barrett's Esophagus
When Should Screening Stop for Elderly Individuals at Average and Increased Risk for Colorectal Cancer?  Folasade P. May, Samir Gupta  Clinical Gastroenterology.
Dustin G. James, Gary R. Zuckerman, Gregory S. Sayuk, Hanlin L
Large Sessile Serrated Polyps Can Be Safely and Effectively Removed by Endoscopic Mucosal Resection  Aarti K. Rao, Roy Soetikno, Gottumukkala S. Raju,
New Models of Gastroenterology Practice
Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer  Douglas K. Rex,
Mucosal Prolapse Appearing as a Colonic Polypoid Lesion
Amnon Sonnenberg  Clinical Gastroenterology and Hepatology 
Erratum Gastrointestinal Endoscopy
Endoscopic Mucosal Resection vs Endoscopic Submucosal Dissection For Barrett’s Esophagus and Colorectal Neoplasia  Dennis Yang, Mohamed Othman, Peter.
Yoshihiro Kishida, Kinichi Hotta, Tadakazu Shimoda 
A Young Woman With Gallstone Pancreatitis and Abnormal Liver Tests: When Is Endoscopic Retrograde Cholangiopancreatography Needed?  Andrew D. Rhim, Michael.
Variable Reliability of Endoscopic Findings With White-Light and Narrow-Band Imaging for Patients With Suspected Eosinophilic Esophagitis  Anne F. Peery,
Colorectal Cancer Screening: How to Stop a Moving Target
Heiko Pohl, Douglas J. Robertson 
Junya Tsurukiri, Masahito Ueno, Naoyuki Kaneko 
Endoscopic Ultrasound and Endoscopic Mucosal Resection Features of a Non–Protein Losing Form of Ménétrier's Disease  Ferga C. Gleeson, Thomas F. Mangan,
Nasim Parsa, MD, Douglas K. Rex, MD  VideoGIE 
Colorectal Cancers Found After a Complete Colonoscopy
Minimal-Change Esophagitis on Narrow-Band Imaging
Hyperplastic polyps and colorectal cancer: is there a link?1
In Vivo Diagnosis and Classification of Colorectal Neoplasia by Chromoendoscopy- Guided Confocal Laser Endomicroscopy  Silvia Sanduleanu, Ann Driessen,
A, SSA/P is seen in the right colon (outlined by arrows) at colonoscopy. A, SSA/P is seen in the right colon (outlined by arrows) at colonoscopy. Note.
Kevin P. Quinn, James H. Tabibian, Seth Sweetser 
Detection of Serrated Lesions: We Are Still in the Teething Stage
Klaus Mönkemüller, Helmut Neumann, Lucia C. Fry 
Presentation transcript:

Serrated Colon Polyps as Precursors to Colorectal Cancer Seth Sweetser, Thomas C. Smyrk, Frank A. Sinicrope  Clinical Gastroenterology and Hepatology  Volume 11, Issue 7, Pages 760-767 (July 2013) DOI: 10.1016/j.cgh.2012.12.004 Copyright © 2013 AGA Institute Terms and Conditions

Figure 1 Histomicrographs of serrated polyps. (A) HP (microvesicular subtype) with serrations in upper half of the crypt and no cytologic dysplasia. (B) SSA/P with characteristic branching crypt bases (arrow). (C) SSA/P with dysplasia; arrow indicates dysplastic epithelium with hyperchromatic nuclei and pseudostratification. (D) TSA showing ectopic crypt (circle). Clinical Gastroenterology and Hepatology 2013 11, 760-767DOI: (10.1016/j.cgh.2012.12.004) Copyright © 2013 AGA Institute Terms and Conditions

Figure 2 Diagram of 2 potential molecular pathways of serrated neoplasia. The precursors of the first pathway are the microvesicular HP (MVHP) and/or the SSA/P, with the potential for SSA/P to arise de novo from normal mucosa. This pathway results in cancers that are CIMP-high and carry BRAFV600E mutations with either MSI or MSS status. The second pathway is less defined, with the potential precursor lesion being the goblet cell HP and the TSA. The end result of the second path is MSS and CIMP-low cancers that are associated with KRAS mutations, although this remains speculative. GCHP, goblet cell HP; MSS, microsatellite stable. Clinical Gastroenterology and Hepatology 2013 11, 760-767DOI: (10.1016/j.cgh.2012.12.004) Copyright © 2013 AGA Institute Terms and Conditions

Figure 3 Endoscopic photographs showing the varied morphologic appearances of SSA/Ps. (A) SSA/P with indistinct edges that overlays a mucosal fold that alters its contour. (B) SSA/P in the ascending colon with a rim of debris. The lesion is shown to obscure the course of a submucosal vessel. (C) SSA/P at the hepatic flexure is covered by a debris-stained mucus cap that has the characteristic “egg-drop soup” appearance with arrow indicating blurring of submucosal vessel by polyp. (D) Lesion in (panel C) is shown after washing off the mucus cap. The SSA/P displays a subtle appearance with blurring of submucosal vessel and mucosal irregularity. The arrows indicate the outer margins of the polyp. (E) Large SSA/P is obscured by mucus debris. (F) Lesion in panel E after washing and aspiration of intraluminal air displays more conspicuous nodularity. Clinical Gastroenterology and Hepatology 2013 11, 760-767DOI: (10.1016/j.cgh.2012.12.004) Copyright © 2013 AGA Institute Terms and Conditions

Figure 4 Endoscopic photographs of SSA/P. (A) SSA/P in ascending colon with an adherent mucus cap in white light. (B) Lesion in panel A under narrow-band imaging. Clinical Gastroenterology and Hepatology 2013 11, 760-767DOI: (10.1016/j.cgh.2012.12.004) Copyright © 2013 AGA Institute Terms and Conditions