Surgical Pathology Criteria

Serrated Polyposis of the Colon and Rectum

Differential Diagnosis

Serrated Polyposis (Hyperplastic Polyposis) Familial Adenomatous Polyposis

Multiple serrated polyps with at most focal cytologic dysplasia

Multiple adenomatous polyps, all with cytologic dysplasia


Serrated Polyposis (Hyperplastic Polyposis) Hereditary Nonpolyposis Colorectal Cancer
Multiple serrated polyps (most are SSA) Polyps are not increased
Not associated with extra-GI cancers Associated with carcinomas of the endometrium, small intestine, ureter and renal pelvis
Associated with sporadic, non-familial colorectal adenocarcinoma Familial colorectal adenocarcinoma and other neoplasms
Two different pathways to MSI high colorectal carcinoma


Juvenile Polyposis Serrated Polyposis (Hyperplastic Polyposis)
Polypoid Sessile
Prominent cystically dilated glands Cystic dilation not prominent
Irregular glands Glands are vertically arranged and not complex
Prominent inflamed stroma Stroma is not prominent


Serrated Polyposis (Hyperplastic Polyposis) Hereditary Mixed Polyposis
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

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