OBJECTIVETo investigate clinicopathological characteristics of colorectal sessile serrated adenoma/polyp (SSA/P) and its differential diagnosis from other serrated lesions.

METHODSClinicopathological features of all cases of colorectal serrated lesions from 5 209 colorectal biopsy samples at Shanghai Tongji Hospital from 2008 to 2013 were reviewed. Three hundred and fifty-three cases of serrated lesions were erolled in the study. Morphological features of SSA/P were investigated with an emphasis on histologic criteria for diagnosis and a literature review was performed.

RESULTSThree hundred and fifty-three cases of serrated lesions were identified, including 25 SSA/P (7.1%), 278 hyperplastic polyp (HP, 78.8%), and 44 traditional serrated adenoma (TSA, 12.5%). Twenty-five patients with SSA/P consisted of 16 males and 9 females with a mean age of 62.2 years (aged 34-84 years) and the lesions involved sigmoid colon (14 cases), ascending colon (9 cases), rectum (1 case) and transverse colon (1 case). Grossly, the majority of SSA/P was sessile with an averaged size of 0.73 cm. Histologically, typical SSA/P had elongated crypts with prominent serration and distorted crypts architecture. The detection rates of crypts dilatation and branching in SSA/P and HP were 100% (25/25) and 24% (12/50, P < 0.01), 72% (18/25) and 4% (2/50, P < 0.01), respectively. Morphological features observed only in SSA/P included L-shaped crypts (48%, 12/25), pseudo infiltration of mucosa muscle (16%, 4/25), atypical nuclei (32%, 8/25), and increased mucus secretion (24%, 6/25).

CONCLUSIONSSSA/P microscopically shows prominent serration and abnormal architectures of crypts. Complete tissue sectioning and correct embedding are helpful for the diagnosis. SSA/P without cytological dysplasia should be distinguished from HP, especially those with only a few distorted crypts.

Adenoma ; pathology ; China ; Colonic Polyps ; pathology ; Diagnosis, Differential ; Female ; Humans ; Hyperplasia ; Intestinal Polyps ; pathology ; Male ; Polyps ; pathology ; Rectal Neoplasms ; pathology

No abstract available.
Adenoma/*diagnosis ; Colonic Neoplasms/*diagnosis ; Colonic Polyps/*pathology ; Female ; Humans ; Male

Narrow-band imaging (NBI) is a new imaging technology that was developed in 2006 and has since spread worldwide. Because of its convenience, NBI has been replacing the role of chromoendoscopy. Here we review the efficacy of NBI with/without magnification for detection, characterization, and management of colorectal polyps, and future perspectives for the technology, including education. Recent studies have shown that the next-generation NBI system can detect significantly more colonic polyps than white light imaging, suggesting that NBI may become the modality of choice from the beginning of screening. The capillary pattern revealed by NBI, and the NBI International Colorectal Endoscopic classification are helpful for prediction of histology and for estimating the depth of invasion of colorectal cancer. However, NBI with magnifying colonoscopy is not superior to magnifying chromoendoscopy for estimation of invasion depth. Currently, therefore, chromoendoscopy should also be performed additionally if deep submucosal invasive cancer is suspected. If endoscopists become able to accurately estimate colorectal polyp pathology using NBI, this will allow adenomatous polyps to be resected and discarded; thus, reducing both the risk of polypectomy and costs. In order to achieve this goal, a suitable system for education and training in in vivo diagnostics will be necessary.
Adenomatous Polyps ; Capillaries ; Classification ; Colonic Polyps ; Colonoscopy ; Colorectal Neoplasms ; Diagnosis ; Education ; Mass Screening ; Narrow Band Imaging ; Pathology ; Polyps*

Colon ; pathology ; Colonic Polyps ; pathology ; Diagnosis, Differential ; Female ; Humans ; Intestinal Mucosa ; pathology ; Male ; Middle Aged

A colonic muco-submucosal elongated polyp (CMSEP) was identified at colonoscopy in a 53-year-old male patient with lower gastrointestinal bleeding. Non-polypoid depressed type of early cancer was noted at the tip of the colonic polyp. The CMSEP is very rare and incidentally found in most cases. Moreover, its association with colonic neoplasia is extremely rare. To our knowledge, this is the second case report of CMSEP associated with a cancerous transformation.
Colonic Neoplasms/*diagnosis/pathology ; Colonic Polyps/*pathology ; Colonoscopy ; Gastrointestinal Hemorrhage ; Humans ; Intestinal Mucosa/*pathology ; Male ; Middle Aged

BACKGROUND/AIMS: There have been several studies showing that retroflexion (RF) in the right colon (RC) could reduce the polyp miss rate of proximal colon during colonoscopy. This study was conducted to evaluate the additional benefit of RF technique in the RC. METHODS: Patients who underwent colonoscopy from May 2008 to April 2011 were enrolled in the study. Data were obtained by retrospectively reviewing the medical records. RF was attempted in every patients undergoing colonoscopy since May 2008 except in cases of small RC vault, co-morbidity, severe diverticulosis, failed RF despite two trials, complaints of severe abdominal pain, or time burden. At first, RC was examined under direct vision. It was then examined by RF to detect missed polyps during the initial observation. Finally, the RC was re-examined with direct view. RESULTS: The cumulative RF success rate in the RC was 78.84% (1,805 of 2,319). The RF success rate increased with the number of cases (50% at 160 cases, 70% at 400 cases, and reached near 90% over 1,000 cases). Few polyps (4.88%) were detected only with RF and the additional adenoma detection rate was 3.32%. The additional polyp/adenoma detection rates were higher in the old age group (p<0.01). There were no RF associated perforation or severe complication. CONCLUSIONS: Using RF examination, additional 4.88% of polyps could be detected in the RC. This technique could be a useful and safe method to detect hidden polyp during colonoscopy.
Adenoma/diagnosis/pathology ; Adult ; Aged ; Colon, Descending/pathology ; Colonic Neoplasms/diagnosis/pathology ; Colonic Polyps/*diagnosis ; *Colonoscopy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies

BACKGROUND/AIMS: Surveillance of individuals with colon polyps is important for the prevention of colon cancer, and its interval is based on the clinical status. Our aims were to determine the recurrence rate of advanced polyp after polypectomy and estimate the adequate interval of surveillance colonoscopy as well as the risk factors of recurrence in Korea. METHODS: Ninety-seven patients who underwent follow-up colonoscopy after initial colonoscopic polypectomy were retrospectively studied. All polyps were endoscopically removed with electrocautery. RESUTLS: Mean number of initial polyps were 2.2 and advanced polyps were observed in 40% of the patients. The cumulative recurrence rate of colon polyp was 13.8% within 1 year, and 60% within 3 years, while that of advanced polyps was 2.5% and 31% within 1 and 3 years, respectively. The significant difference was noted according to the initial polyp number in both overall and advanced polyp recurrence rate. The age at the diagnosis of colon polyps was a significant factor only in overall polyp recurrence rate. Patients who initially had one polyp showed 15% of advanced polyp recurrence within 3 years. CONCLUSIONS: Recurrence of advanced polyp is very rare within one year after polypectomy. Patients with single polyp have low risk and thus, their surveillance may be delayed beyond the standard 3 years. When surveillance colonoscopy is to be performed for the patients with 2 or more polyps, initial polyp number and age should be considered.
Aged ; Colonic Polyps/diagnosis/pathology/*surgery ; *Colonoscopy ; Electrocoagulation ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; Recurrence

BACKGROUND/AIMS: It has been reported that the risk of gastric polyp is increased in various colonic polyposis syndromes or in series of patients with sporadic colonic polyps. However, there are only a few large case controlled studies of colon cancer incidence in gastric cancer patients who underwent colonoscopy. The aims of this study were to determine the incidence of colorectal neoplasm and to evaluate the necessity of colonoscopic surveillance in patients with gastric cancer. METHODS: We performed colonoscopy in 105 patients with gastric cancer who agreed to undergo colonoscopy before or after 6 months from gastric resection between January 2002 and December 2004 in Kangbuk Samsung hospital. As a control group, 269 consecutive, age and sex matched patients without gastric neoplasm on gastroscopy who underwent colonoscopy within 6 months for the evaluation of various gastrointestinal symptoms during the year 2004 were included. Endoscopic reports and pathological results were reviewed retrospectively. RESULTS: In the patient group, adenomatous polyps were diagnosed in 24/105 patients (22.9%) and colorectal adenocarcinoma in 10/105 patients (9.5%). In the control group, adenomatous polyps were diagnosed in 78/269 patients (29.0%) and colorectal adenocarcinoma in 2/269 patients (0.7%). The incidence of colorectal adenocarcinoma between the patient group and control group showed significant differences (odds ratio 11.04, p=0.003). CONCLUSIONS: The risk of colorectal adenocarcinoma increases significantly in patients with gastric cancer. We suggest that the patients with gastric cancer might carry a high risk for colorectal cancer whom require surveillance colonoscopy.
Adenocarcinoma/*diagnosis/*secondary ; Adenomatous Polyps/diagnosis ; Colonic Polyps/diagnosis ; *Colonoscopy ; Colorectal Neoplasms/*diagnosis/*secondary ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Multiple Primary/*diagnosis ; Stomach Neoplasms/*pathology

Adolescent ; Colon, Ascending ; pathology ; Colonic Neoplasms ; pathology ; surgery ; Colonic Polyps ; pathology ; surgery ; Diagnosis, Differential ; Follow-Up Studies ; Ganglioneuroma ; pathology ; surgery ; Humans ; Male

Adenomatous Polyps ; pathology ; Colonic Polyps ; pathology ; Colorectal Neoplasms ; pathology ; Diagnosis, Differential ; Hamartoma Syndrome, Multiple ; pathology ; Humans ; Intestinal Polyposis ; pathology ; Intestinal Polyps ; pathology ; Peutz-Jeghers Syndrome ; pathology ; Rectal Diseases ; pathology