Adenomatous cytologic features infrequent, focal at most
Most polyps are adenomatous, either pure or mixed
Most polyps are sessile
Most are polypoid, regardless of histology
Glands are vertically arranged and not complex
Frequently shows features of juvenile polyps: prominent stroma, cystic dilation
Patients with syndrome are considered at risk for development of colorectal carcinoma
Level of risk is unclear because of rarity of syndrome
15-55% incidence of cancer has been reported
Referral bias may affect these numbers
Increased screening of patients and first degree relatives is indicated
Removal of lesions >1 cm is recommended
Total or partial colectomy may be indicated if numerous
Colorectal carcinomas arising in serrated polyposis are diverse in genotype (Rosty 2013)
They are not restricted to microsatellite instability pathway
Rare familial cases have been reported
Pattern of heredity is not consistent
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Rosty C, Buchanan DD, Walsh MD, Pearson SA, Pavluk E, Walters RJ, Clendenning M, Spring KJ, Jenkins MA, Win AK, Hopper JL, Sweet K, Frankel WL, Aronson M, Gallinger S, Goldblatt J, Woodall S, Arnold J, Walker NI, Jass JR, Parry S, Young JP. Phenotype and polyp landscape in serrated polyposis syndrome: a series of 100 patients from genetics clinics. Am J Surg Pathol. 2012 Jun;36(6):876-82.
Rosty C, Walsh MD, Walters RJ, Clendenning M, Pearson SA, Jenkins MA, Win AK, Hopper JL, Sweet K, Frankel WL, Aronson M, Gallinger S, Goldblatt J, Tucker K, Greening S, Gattas MR, Woodall S, Arnold J, Walker NI, Parry S, Young JP, Buchanan DD. Multiplicity and molecular heterogeneity of colorectal carcinomas in individuals with serrated polyposis. Am J Surg Pathol. 2013 Mar;37(3):434-42.