• BRAF mutation
• Colorectal cancer
• Diabetes mellitus
• Hypertension
• Risk factors
• Sessile serrated lesion

• Adenoma
• Chromoendoscopy
• Colonoscopy
• Narrow band imaging
• Quality
• Sessile serrated lesion

• Serrated pathway
• Serrated polyposis syndrome
• Somatic pathogenic variant

• Humans
• Proto-Oncogene Proteins B-raf/genetics
• Research
• Syndrome
• Intestinal Polyposis

• 22K08053 Japan Society for the Promotion of Science
• Takeda Science Foundation

• CpG island methylator phenotype
• colorectal cancer
• colorectal serrated lesions
• microsatellite instability
• molecular pathways
• serrated pathway
• sessile serrated lesions

• Adenoma/genetics
• Adenoma/pathology
• Colonic Polyps/genetics
• Colonic Polyps/pathology
• Colorectal Neoplasms/genetics
• Colorectal Neoplasms/pathology
• Humans
• Microsatellite Instability
• Mutation
• Proto-Oncogene Proteins B-raf/genetics

• Dysplasia
• Large
• Prevalence
• Proximal
• Sessile serrated lesion

• adenoma
• colorectal cancer screening
• polyp

• Cryptal dysplasia
• Cytological dysplasia
• Hyperplastic polyp
• Sessile serrated adenoma/polyp
• Sessile serrated lesion
• Traditional serrated adenoma

• Adenoma/diagnosis
• Adenoma/pathology
• Adenoma/surgery
• Clinical Decision-Making
• Colectomy/standards
• Colon/diagnostic imaging
• Colon/pathology
• Colon/surgery
• Colonic Polyps/diagnosis
• Colonic Polyps/pathology
• Colonic Polyps/surgery
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Humans
• Hyperplasia/diagnosis
• Hyperplasia/pathology
• Hyperplasia/surgery
• Intestinal Mucosa/diagnostic imaging
• Intestinal Mucosa/pathology
• Intestinal Mucosa/surgery
• Narrow Band Imaging
• Practice Guidelines as Topic
• Precancerous Conditions/diagnosis
• Precancerous Conditions/pathology
• Precancerous Conditions/surgery
• Proctectomy/standards
• Rectum/diagnostic imaging
• Rectum/pathology
• Rectum/surgery
• Treatment Outcome

Left-sided colonic serrated adenomas (L-SAs) were evaluated for aneuploidy using automated imaging cytometry to quantify DNA content and compared with normal colonic tissues (NCT), tubular adenomas (TA), left-sided hyperplastic polyps (L-HP) and adenocarcinomas.

We used standard paraffin-embedded Feulgen-stained tissue sections.

The mean DNA index (DI) of NCT was 0.95, L-HP was 1.08, TA was 1.22, L-SA was 1.11 and adenocarcinomas was 1.46. DI of L-SA was statistically higher than that of NCT, but not statistically different from L-HP.

This study demonstrates that DIs correlate with the described neoplastic progression of L-SA, TA and L-SA compared with NCT and suggests that L-SA may be involved in a chromosome instability pathway of neoplastic progression.

Colon cancer remains a deadly disease, with a significant burden of illness to patients and healthcare systems. While most precursor lesions will not necessarily produce cancers, they vary in histology and potential for neoplastic progression. Aneuploidy or abnormal chromosomal content of a cell is considered a marker for chromosomal instability and neoplastic progression. However, conventional methods of assessment can be laborious, costly and may even underestimate its malignant potential if the lesion is focal, small and surrounded by normal stromal cells in the sampled tissue. We used a nuclear stain to detect and quantify aneuploidy on conventionally prepared colonic precancerous histological slides and in particular assessed serrated and hyperplastic polyps of the left colon. When compared with normal tissues, we determined that there was aneuploidy in these lesions, which supports the underappreciated assumption that these lesions manifest chromosomal instability.

• Feulgen stain
• colon polyps
• dysplasia
• image cytometry
• serrated adenoma

• Colonic neoplasms
• Colonic polyps
• Colonoscopy
• Colorectal cancer
• Health metrics

• colonoscopy
• colorectal cancer
• public health
• screening

• Adenocarcinoma/diagnosis
• Adenocarcinoma/pathology
• Adenoma/diagnosis
• Adenoma/pathology
• Adult
• Aged
• Aged, 80 and over
• Colon/pathology
• Colonic Polyps/diagnosis
• Colonic Polyps/pathology
• Colonoscopy
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/pathology
• Female
• Humans
• Male
• Middle Aged
• Republic of Korea
• Retrospective Studies
• Young Adult

Hodgkin lymphoma (HL) survivors treated with abdominal radiotherapy and/or alkylating chemotherapy have an increased risk of colorectal cancer (CRC). This study was aimed at evaluating the prevalence of colorectal neoplasia in HL survivors.

This multicenter cohort study assessed the diagnostic yield of advanced colorectal neoplasia detected by a first surveillance colonoscopy among HL survivors treated with abdominal radiotherapy and/or procarbazine. Advanced colorectal neoplasia included advanced adenomas (high‐grade dysplasia, ≥25% villous component, or ≥10‐mm diameter), advanced serrated lesions (dysplasia or ≥10‐mm diameter), and CRC. The results were compared with those for a Dutch general population cohort that underwent a primary screening colonoscopy (1426 asymptomatic individuals 50‐75 years old). This study demonstrated the results of a predefined interim analysis.

A colonoscopy was performed in 101 HL survivors, who were significantly younger (median, 51 years; interquartile range [IQR], 45‐57 years) than the general population controls (median, 60 years; IQR, 55‐65 years; P < .001). The prevalence of advanced neoplasia was higher in HL survivors than controls (25 of 101 [25%] vs 171 of 1426 [12%]; P < .001). Advanced adenomas were detected in 14 of 101 HL survivors (14%) and in 124 of 1426 controls (9%; P = .08). The prevalence of advanced serrated lesions was higher in HL survivors than controls (12 of 101 [12%] vs 55 of 1426 [4%]; P < .001). Serrated polyposis syndrome was present in 6% of HL survivors and absent in controls (P < .001).

HL survivors treated with abdominal radiotherapy and/or procarbazine have a high prevalence of advanced colorectal neoplasia. The implementation of a colonoscopy surveillance program should be considered.

Hodgkin lymphoma survivors treated with abdominal radiotherapy and/or procarbazine have a high prevalence of advanced colorectal neoplasia. The implementation of a colonoscopy surveillance program should be considered.

• colorectal cancer (CRC) screening
• epidemiology
• polyps/adenomas

Serrated polyposis syndrome is a disease that is often missed in the clinical setting and is associated with colorectal cancer. We investigated the prevalence of SPS and the association between colorectal or other cancers in a 10-year, retrospective data analysis.

We reviewed complete colonoscopy data obtained from January 2005 through January 2015 at a health-screening centre. Serrated polyposis syndrome was defined on the basis of the criteria established by the 2010 World Health Organization.

Of a total of 53.842 consecutive subjects who underwent complete colonoscopy, 12 (0.022%) patients had serrated polyposis syndrome. All of these cases were under-recognized by the endoscopist or referring physician. The mean patient age was 58.6 years; 67% of the patients were men and 33% were women. No serrated polyposis syndrome patients had a first-degree relative with serrated polyposis syndrome, and no serrated polyposis syndrome patients had colorectal cancer. Two cases (17%) had extra-colonic cancers (prostate cancer and thyroid cancer). Eight cases (67%) had a family history of cancer (stomach, breast, lung, pancreas, prostate and colorectal cancer).

Serrated polyposis syndrome was a rare condition in a 10-year database, and it was diagnosed late in all cases. Serrated polyposis syndrome may be associated with an increased risk of extra-colonic cancer.

• Serrated polyposis syndrome
• cancer colonoscopy.
• prevalence

• Carcinogenesis
• Colorectal neoplasm
• Hyperplastic polyp
• Serrated neoplasia

Serrated polyps are important contributors to the burden of colorectal cancers (CRC). These lesions were once considered to have no malignant potential, but currently up to 30% of all CRC are recognized to arise from the serrated neoplasia pathway. The primary premalignant lesions are sessile serrated adenomas/polyps (SSA/Ps), although traditional serrated adenomas are relatively uncommon. Compared to conventional adenomas, SSA/Ps are morphologically subtle with indistinct borders, may be difficult to detect endoscopically, are more prevalent than previously thought, are associated with synchronous and metachronous advanced neoplasia, and have a higher risk of incomplete resection. Although many lesions remain “dormant,” progressive disease is associated with the development of dysplasia and more rapid progression to CRC. As a result, SSA/Ps are strongly implicated in the development of interval cancers. These factors represent unique challenges that require a meticulous approach to their management. In this review, we summarize the contemporary literature on the characterization, detection and resection of SSA/Ps.

• Detection
• Endoscopic imaging
• Endoscopic resection
• Histology
• Sessile serrated adenoma

• Adenoma detection rate
• Colorectal cancer
• Health economic modeling
• Proximal serrated polyp detection rate
• Screening

• Adenoma/epidemiology
• Adenoma/mortality
• Adenoma/pathology
• Aged
• Colonic Polyps/pathology
• Colonoscopy
• Colorectal Neoplasms/epidemiology
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/pathology
• Early Detection of Cancer
• Female
• Humans
• Incidence
• Male
• Mass Screening
• Middle Aged
• Models, Econometric
• Mortality
• Population Surveillance

• Colorectal cancer
• Serrated polyp
• Sessile serrated adenoma
• Sessile serrated adenoma/polyp
• Sessile serrated polyp
• Surveillance

• Adenoma/etiology
• Colorectal Neoplasms/etiology
• Humans
• Hyperplasia/diagnostic imaging
• Hyperplasia/pathology
• Intestinal Polyps/diagnostic imaging
• Intestinal Polyps/pathology
• Population Surveillance
• Practice Guidelines as Topic

• KL2 TR001109 NCATS NIH HHS

• COLONIC NEOPLASMS
• COLONOSCOPY
• COLORECTAL CANCER
• HISTOPATHOLOGY
• POLYPOSIS

• Adenoma/diagnosis
• Adenoma/genetics
• Adenoma/surgery
• Adenomatous Polyposis Coli/diagnosis
• Benchmarking
• Biomarkers/analysis
• Cell Transformation, Neoplastic
• Colitis/complications
• Colonic Polyps/diagnosis
• Colonic Polyps/genetics
• Colonic Polyps/surgery
• Colonoscopy
• CpG Islands/genetics
• DNA/isolation & purification
• DNA Methylation
• Feces/chemistry
• Humans
• Parasympatholytics/therapeutic use
• Polyps/diagnosis
• Polyps/genetics
• Polyps/surgery
• Precancerous Conditions/diagnosis
• Precancerous Conditions/surgery
• Rectal Diseases/diagnosis
• Rectal Diseases/genetics
• Rectal Diseases/surgery
• Terminology as Topic
• Watchful Waiting

• 16459 Cancer Research UK
• 16894 Cancer Research UK

• Biomarker
• DNA methylation
• Mutation
• Serrated polyp
• Sessile serrated adenoma
• Traditional serrated adenoma

• Adaptor Proteins, Signal Transducing/genetics
• Adenoma/genetics
• Aged
• Aged, 80 and over
• Colorectal Neoplasms/genetics
• DNA Methylation/genetics
• DNA Mutational Analysis/methods
• Female
• Gene Expression Regulation, Neoplastic/genetics
• Humans
• Male
• Microsatellite Instability
• Middle Aged
• Mutation/genetics
• Nuclear Proteins/genetics
• Pilot Projects
• Proto-Oncogene Proteins B-raf/genetics

Regulatory T cells (Tregs), a subset of CD4⁺ or CD8⁺ T cells, play a pivotal role in regulating immune homeostasis. An increase in Tregs was reported in many tumors to be associated with immune suppression and evasion in cancer patients. Despite the importance of Tregs, the molecular signatures that contributed to their pathophysiological relevance remain poorly understood and controversial. In this study, we explored the gene expression profiles in Tregs derived from patients with colorectal cancer [colorectal carcinoma (CRC), n = 15], colorectal polyps (P, n = 15), and in healthy volunteers (N, n = 15). Tregs were analyzed using CD4⁺CD25⁺CD127^lowFoxP3⁺ antibody markers. Gene expression profiling analysis leads to the identification of 61 and 66 immune-related genes in Tregs derived from CRC and P patients, respectively, but not in N-derived Treg samples. Of these, 30 genes were differentially expressed both in CRC- and P-derived Tregs when compared to N-derived Tregs. Most of the identified genes were involved in cytokine/chemokine mediators of inflammation, chemokine receptor, lymphocyte activation, and T cell receptor (TCR) signaling pathways. This study highlights some of the molecular signatures that may affect Tregs’ expansion and possible suppression of function in cancer development. Our findings may provide a better understanding of the immunomodulatory nature of Tregs and could, therefore, open up new avenues in immunotherapy.

• colorectal cancer
• gene expression
• immune suppression
• interleukin
• regulatory T cells

• Adenoma
• Early-onset colorectal cancer
• Sessile serrated adenoma

• Adenoma/diagnosis
• Adenoma/pathology
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Colon/pathology
• Colonic Polyps/diagnosis
• Colonic Polyps/pathology
• Colonoscopy
• Colorectal Neoplasms/pathology
• Cross-Sectional Studies
• Databases, Factual
• Female
• Gastrointestinal Hemorrhage/etiology
• Hospitals, Teaching
• Humans
• Hyperplasia
• Male
• Medical Audit
• Middle Aged
• Precancerous Conditions/diagnosis
• Precancerous Conditions/pathology
• Rectum/pathology
• Risk Factors
• South Australia
• Young Adult

Colorectal serrated polyp is considered as histologically heterogeneous lesions with malignant potential in western countries. However, few Asian studies have investigated the comprehensive clinical features of serrated polyps in symptomatic populations. The aim of the study was to evaluate the features of colorectal serrated polyps in a Chinese symptomatic population.

Data from all consecutive symptomatic patients were documented from a large colonoscopy database and were analyzed. Chi-square test or Fisher's exact test and logistic regression analysis were used for the data processing.

A total of 9191 (31.7%) patients were detected with at least one colorectal polyp. The prevalence of serrated polyps was 0.53% (153/28,981). The proportions of hyperplastic polyp (HP), sessile serrated adenoma/polyp (SSA/P), and traditional serrated adenoma (TSA) of all serrated polyps were 41.2%, 7.2%, and 51.6%, respectively, which showed a lower proportion of HP and SSA/P and a higher proportion of TSA. Serrated polyps appeared more in males and elder patients while there was no significant difference in the subtype distribution in gender and age. The proportions of large and proximal serrated polyps were 13.7% (21/153) and 46.4% (71/153), respectively. In total, 98.9% (89/90) serrated adenomas were found with dysplasia. Moreover, 14 patients with serrated polyps were found with synchronous advanced colorectal neoplasia, and large serrated polyps (LSPs) (odds ratio: 3.446, 95% confidence interval: 1.010–11.750, P < 0.05), especially large HPs, might have an association with synchronous advanced neoplasia (AN).

The overall detection rate of colorectal serrated polyps in Chinese symptomatic patient population was low, and distribution pattern of three subtypes is different from previous reports. Moreover, LSPs, especially large HPs, might be associated with an increased risk of synchronous AN.

• colonoscopy
• epidemiology
• hyperplastic polyp
• serrated polyp
• sessile serrated adenoma
• sessile serrated polyp
• traditional serrated adenoma

To review the evidence on the association between specific colon adenoma features and the risk of future colonic neoplasia [adenomas and colorectal cancer (CRC)].

We performed a literature search using the National Library of Medicine through PubMed from 1/1/2003 to 5/30/2015. Specific Medical Subject Headings terms (colon, colon polyps, adenomatous polyps, epidemiology, natural history, growth, cancer screening, colonoscopy, CRC) were used in conjunction with subject headings/key words (surveillance, adenoma surveillance, polypectomy surveillance, and serrated adenoma). We defined non-advanced adenomas as 1-2 adenomas each < 10 mm in size and advanced adenomas as any adenoma ≥ 10 mm size or with > 25% villous histology or high-grade dysplasia. A combined endpoint of advanced neoplasia included advanced adenomas and invasive CRC.

Our search strategy identified 592 candidate articles of which 8 met inclusion criteria and were relevant for assessment of histology (low grade vs high grade dysplasia, villous features) and adenoma size. Six of these studies met the accepted quality indicator threshold for overall adenoma detection rate > 25% among study patients. We found 254 articles of which 7 met inclusion criteria for the evaluation of multiple adenomas. Lastly, our search revealed 222 candidate articles of which 6 met inclusion criteria for evaluation of serrated polyps. Our review found that villous features, high grade dysplasia, larger adenoma size, and having ≥ 3 adenomas at baseline are associated with an increased risk of future colonic neoplasia in some but not all studies. Serrated polyps in the proximal colon are associated with an increased risk of future colonic neoplasia, comparable to having a baseline advanced adenoma.

Data on adenoma features and risk of future adenomas and CRC are compelling yet modest in absolute effect size. Future research should refine this risk stratification.

• Colon adenoma
• Colorectal cancer screening
• Surveillance
• Colonoscopy

• K08 DK090150 NIDDK NIH HHS
• R01 CA156186 NCI NIH HHS
• R01 CA165309 NCI NIH HHS
• U01 CA111257 NCI NIH HHS

• Cancer derived from sessile serrated adenoma/polyp
• Hyperplastic polyp
• Mixed serrated polyp
• Serrated polyp pathway
• Sessile serrated adenoma/polyp

• Adenoma/classification
• Adenoma/pathology
• Colonic Neoplasms/classification
• Colonic Neoplasms/pathology
• Colonic Polyps/classification
• Colonic Polyps/pathology
• Colonoscopy
• Humans
• Hyperplasia
• Male
• Middle Aged

• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Colectomy/trends
• Colonic Polyps/complications
• Colorectal Neoplasms/epidemiology
• Colorectal Neoplasms/etiology
• Colorectal Neoplasms/therapy
• Humans
• Incidence
• Laparoscopy/methods
• Laparoscopy/trends
• Radiotherapy/trends
• Risk Factors

• P30 CA015704 NCI NIH HHS
• R01 CA194663 NCI NIH HHS

Large colonic polyps are associated with advanced dysplasia, but prevalence and characteristics of synchronous polyps in patients with large flat colonic polyps are poorly investigated. This study aims to characterize clinicopathological features of large flat colonic polyps and their impact on occurrence and characteristics of synchronous polyps.

A total of 802 patients that underwent endoscopic mucosal resection (EMR) of flat colonic polyps >20 mm from 2003 to 2014 in an academic endoscopy unit were retrospectively analyzed for size, location and histology of large polyps and synchronous polyps.

Average size of large polyps was 34.1 mm (range 20–150 mm, standard deviation 16.1 mm). Histology included 52.5 % adenomas with low-grade dysplasia (LGD), 26.7 % with high-grade dysplasia (HGD), 9.6 % serrated polyps and 11.2 % adenocarcinomas. The majority of large polyps were localized in the proximal colon (61 %). 72.2 % of adenocarcinomas were found in the distal colon, while 80.5 % of all serrated polyps were detected in the proximal colon. Increase in polyp size, advanced age and location in the distal colon were associated with presence of HGD/adenocarcinoma in large polyps, as identified by multivariate analysis. Synchronous polyps were detected in 67.2 % of patients undergoing complete colonoscopy during EMR. Presence of HGD/adenocarcinoma in the large polyp, localization of any synchronous polyp in the rectosigmoid colon and occurrence of multiple synchronous polyps were associated with presence of HGD/adenocarcinoma in synchronous polyps.

Synchronous polyps are frequently found in patients with large flat colonic polyps. The prevalence of synchronous polyps with high grade dysplasia is highest in patients with large flat polyps containing HGD/adenocarcinoma.

The online version of this article (doi:10.1186/s12876-015-0312-4) contains supplementary material, which is available to authorized users.