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Kwon, Jung, Shim, Chung, Kang, Song, Jun, and Kim: Sessile Serrated Adenoma with High-grade Dysplasia
Case Report
The Ewha Medical Journal

The Ewha Medical Journal 2012; 35(1): 44-48.

Published online: 31 March 2012

DOI: https://doi.org/10.12771/emj.2012.35.1.44

Sessile Serrated Adenoma with High-grade Dysplasia

Kyoung-Joo Kwon, Sung-Ae Jung, Ki-Nam Shim, Jung-Hwa Chung, Seok-Hyung Kang, Do-Kyeung Song, Seung-Jung Jun, Hye-In Kim

Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Sung-Ae Jung, Department of Internal Medicine, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel: 82-2-2650-5053, Fax: 82-2-2655-2076, jassa@ewha.ac.kr

Received 1 August 2011       Accepted 2 September 2011

Copyright © 2012. Ewha Womans University School of Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Until recently, colorectal polyps were classified predominantly as hyperplastic or adenomatous. While adenomatous polyps are well-characterized precursor lesions of adenocarcinomas, hyperplastic polyps have been considered as benign lesion. However, some hyperplastic polyps with serrated morphology of the crypts have been recognized to have distinctive features and these polyps were termed 'serrated adenomas'. Recent data show that sessile serrated adenomas (SSA) might be the precursors of serrated colonic cancers, underlining the necessity of identifying them. SSA is approximately 3% of all polyps, commonly appears as flat or sessile and yellowish due to mucus production. In the pathogenesis of SSA, progression to high grade dysplasia or early invasive carcinoma may be associated with serrated neoplasia pathway different from adenoma-carcinoma sequence. We report a case with a colon polyp diagnosed as sessile serrated adenoma with high grade dysplasia after endoscopic submucosal dissection.

Keywords: Sessile serrated adenoma, Colorectal polyp, Hyperplastic polyp, Dysplasia

Figures and Tables

Fig. 1
The colonoscopy reveals broad-based sessile polyp of 3.3 cm in size on sigmoid colon. Its surface shows large tubular pit pattern. There is a reddish papillomatous polypoid lesion arising from the surface of the polyp.
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Fig. 2
Abdominal computed tomography show no evidence of apparent wall thickening or intraluminal mass-like lesion in the colon.
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Fig. 3
PET findings shows no abnormal hypermetabolic lesion.
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Fig. 4
Endoscopic findings during endoscopic submucosal dissection.
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Fig. 5
Pathologic findings. (A) The polyp is measured 3.4×2.2×2 cm in size. Its surface is granular, villous and focally had polypoid mass with long stalk (H&E stain, ×100). (B) Serrated adenoma with focal high grade dysplasia is noted with clear resection margin (H&E stain, ×200).
emj-35-44-g005

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