Serrated polyposis syndrome: Molecular, pathological and clinical aspects
Serrated polyposis syndrome: Molecular, pathological and clinical aspects
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DOI：
10.3748/wjg.v18.i20.2452
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发表时间：
2012-05-28
影响因子：
4.3
通讯作者：
Jover, Rodrigo
中科院分区：
文献类型：
--
作者：
Guarinos, Carla;Sanchez-Fortun, Cristina;Jover, Rodrigo
增生性息肉传统上被认为没有恶性潜力。锯齿状息肉的新病理分类和锯齿状癌变途径的发现，使这一领域的研究发生了革命性的变化。直到最近，人们一直认为大多数结直肠癌是通过APC基因突变启动的传统肿瘤抑制途径由传统腺瘤引起的，但已经发现该途径仅占结直肠癌（CRC）病例的约70%-80%。大多数剩余的结直肠癌病例遵循导致具有BRAF突变的CpG岛甲基化表型癌的替代途径，并且具有或不具有微卫星不稳定性。从这种替代途径产生的癌的机制似乎开始与BRAF癌基因的激活突变。锯齿状息肉综合征是一种相对罕见的疾病，其特征是结肠多发性和/或大的锯齿状息肉。锯齿状息肉病综合征的临床特点、病因及与结直肠癌的关系尚不清楚。患有这种综合征的患者显示出CRC的高风险，并且已经描述了散发性和遗传性病例。临床标准已被用于诊断和频繁的结肠镜监测，应进行，以防止结直肠癌。本文就锯齿状息肉的分子发病机制作一综述，以了解其可能的临床意义，并探讨锯齿状息肉的治疗方法。(C)2012年百世登。All rights reserved.
Hyperplastic polyps have traditionally been considered not to have malignant potential. New pathological classification of serrated polyps and recent discoveries about the serrated pathway of carcinogenesis have revolutionized the concepts and revitalized the research in this area. Until recently, it has been thought that most colorectal cancers arise from conventional adenomas via the traditional tumor suppressor pathway initiated by a mutation of the APC gene, but it has been found that this pathway accounts for only approximately 70%-80% of colorectal cancer (CRC) cases. The majority of the remaining colorectal cancer cases follow an alternative pathway leading to CpG island methylator phenotype carcinoma with BRAF mutation and with or without microsatellite instability. The mechanism of carcinomas arising from this alternative pathway seems to begin with an activating mutation of the BRAF oncogene. Serrated polyposis syndrome is a relatively rare condition characterized by multiple and/or large serrated polyps of the colon. Clinical characteristics, etiology and relationship of serrated polyposis syndrome to CRC have not been clarified yet. Patients with this syndrome show a high risk of CRC and both sporadic and hereditary cases have been described. Clinical criteria have been used for diagnosis and frequent colonoscopy surveillance should be performed in order to prevent colorectal cancer. In this review, we try to gather new insights into the molecular pathogenesis of serrated polyps in order to understand their possible clinical implications and to make an approach to the management of this syndrome. (C) 2012 Baishideng. All rights reserved.