IJCEP Copyright © 2007-All rights reserved.
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 correspondence 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: