Characteristic of Mixed Hyperplastic-adenomatous Polyps at Ramathibodi Hospital
Keywords:
Mixed hyperplastic-adenomatous polyps, serrated adenomaAbstract
Introduction: Mixed hyperplastic-adenomatous polyps contain foci of hyperplastic change with dysplasticadenomatous change. These polyps are likely to be heterogeneous at a molecular level and may predispose to
sporadic colorectal cancer through a distinct pathway. Aim of this study was to describe characteristics of mixed
hyperplastic-adenomatous polyps in Thai patients.
Methods: A retrospective study included 272 polyps from 201 patients detected by colonoscopy in the
General Surgery Unit at Ramathibodi Hospital during the past one year period (Jan-Dec 2007).
Results: There were 141 mixed hyperplastic-adenomatous polyps from 104 patients. There were 63
(60.5%) male and 41 (39.5%) female. The mean age was 62 (21-87 years). Most polyps (63.8%) were in left colon
especially sigmoid colon (29.2%). Size of polyps was ≤0.5 cm in 69%, 0.6-1 cm in 23.8%, 1.1-2.0 cm in 4.7% and
> 2 cm in 2.4%. Morphology of polyps was sessile in 56.8%, pedunculated polyps in 34% and others were flat
polyps (9.2%). All detected polyps were endoscopically removed, which technically failed in 1 patient.
Polypectomy (53.3%) was performed in medium and large size polyps. Hot biopsy (39%) was the main treatment
in small polyps. Of 141 polyps identified, 54.8% of polyps were serrated adenoma. There were severe dysplasia
in 5.7% and carcinoma in situ in 1.4%. Only 0.7% of removed polyps contain adenocarcinoma.
Conclusion: The majority of colorectal polyps at our hospital are small size sessile mixed hyperplasticadenomatous
polyps mainly located in left-sided colon. These polyps should be recognized and endoscopically
removed to decrease risk of subsequent colorectal cancer.
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adenomatous polyps/serrated adenomas. A distinct form
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colon polyps that preceded microsatellite-unstable
adenocarcinomas. Am J Clin Pathol 2003;119:778-96.
9. Cunningham KS, Riddell RH. Serrated mucosal lesions of the
colorectum. Curr Opin Gastroenterol 2006;22:48-53.
10. Matsumoto T, Mizuno M, Shimizu M, et al. Serrated adenoma
of the colorectum: colonoscopic and histologic features.
Gastrointest Endosc 1999;49:736-42.
11. Song SY, Kim YH, Yu MK, et al. Comparison of malignant
potential between serrated adenomas and traditional
adenomas. J Gastroenterol Hepatol 2007;22:1786-90.
12. William GT, Arthur JF, Bussey HJR, et al. Metaplastic polyps
and polyposis of the colorectum. Histopathology 1980;4:155-
70.
13. O’Brien MJ, Winawer SJ, Zauber AG, et al. The National
Polyp Study. Patient and polyp characteristics associated
with high-grade dysplasia in colorectal adenoma.
Gastroenterol 1990;98:371-9.
14. Wisedopas N, Thirabanjasak D, Taweevisit M. A retrospective
study of colonic polyps in King Chulalongkorn Memorial
Hospital. J Med Assoc Thai 2005;88 Suppl 4: S36-41.
15. Li SC, Burgart L. Histopathology of serrated adenoma, its
variants, and differentiation from conventional adenomatous
and hyperplastic polyps. Arch Pathol Lab Med
2007;131:440-5.
16. Torlakovic E, Skovlund E, Snover DC, et al. Morphologic
Reappraisal of serrated colorectal polyps. Am J Surg Pathol
2003;27:65-81.
17. Higuchi T, Sugihara K, Jass JR. Demographic and
pathological characteristics of serrated polyps of
colorectum. Histopathology 2005;47:32-40.
Digest Liver Dis 2001;33:305-12.
2. Urbanski SJ, Kossakowska AE. Mixed hyperplastic adenomatous
polyps-An underdiagnosed entity. Am J Surg Pathol
1984;8:551-6.
3. Cooper HS, Patchefsky AS, Marks G. Adenomatous and
carcinomatous changes within hyperplastic colonic
epithelium. Dis Colon Rectum 1979;22:152-6.
4. Estrada RG, Spjut HJ. Hyperplastic polyps of the large
bowel. Am J Surg Pathol 1980;4:127-33.
5. Franzin G, Novelli P. Adenocarcinoma occuring in a hyperplastic
(metaplastic) polyp of the colon. Endoscopy 1982;14:
28-30.
6. Jass JR, Lino H, Ruszkiewicz A, et al. Neoplastic progression
occurs through mutator pathways in hyperplastic polyposis
of the colorectum. Gut 2000;47:43-9.
7. Longacre TA, Fenoglio-Preiser CM. Mixed hyperplastic
adenomatous polyps/serrated adenomas. A distinct form
of colorectal neoplasia. Am J Surg Pathol 1990;14:524-37.
8. Goldstein NS, Bhanot P, Odish E, et al. Hyperplastic-like
colon polyps that preceded microsatellite-unstable
adenocarcinomas. Am J Clin Pathol 2003;119:778-96.
9. Cunningham KS, Riddell RH. Serrated mucosal lesions of the
colorectum. Curr Opin Gastroenterol 2006;22:48-53.
10. Matsumoto T, Mizuno M, Shimizu M, et al. Serrated adenoma
of the colorectum: colonoscopic and histologic features.
Gastrointest Endosc 1999;49:736-42.
11. Song SY, Kim YH, Yu MK, et al. Comparison of malignant
potential between serrated adenomas and traditional
adenomas. J Gastroenterol Hepatol 2007;22:1786-90.
12. William GT, Arthur JF, Bussey HJR, et al. Metaplastic polyps
and polyposis of the colorectum. Histopathology 1980;4:155-
70.
13. O’Brien MJ, Winawer SJ, Zauber AG, et al. The National
Polyp Study. Patient and polyp characteristics associated
with high-grade dysplasia in colorectal adenoma.
Gastroenterol 1990;98:371-9.
14. Wisedopas N, Thirabanjasak D, Taweevisit M. A retrospective
study of colonic polyps in King Chulalongkorn Memorial
Hospital. J Med Assoc Thai 2005;88 Suppl 4: S36-41.
15. Li SC, Burgart L. Histopathology of serrated adenoma, its
variants, and differentiation from conventional adenomatous
and hyperplastic polyps. Arch Pathol Lab Med
2007;131:440-5.
16. Torlakovic E, Skovlund E, Snover DC, et al. Morphologic
Reappraisal of serrated colorectal polyps. Am J Surg Pathol
2003;27:65-81.
17. Higuchi T, Sugihara K, Jass JR. Demographic and
pathological characteristics of serrated polyps of
colorectum. Histopathology 2005;47:32-40.
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Published
2009-06-30
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Srichan P, Wasutit Y, Suwanthanma W, Euanorasetr C, Sornmayura P, Puanfoong O, Tinkornrusmee C. Characteristic of Mixed Hyperplastic-adenomatous Polyps at Ramathibodi Hospital. Thai J Surg [Internet]. 2009 Jun. 30 [cited 2024 Apr. 19];30(1-2). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/227660
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