Pathogenesis and management of serrated polyps: current status and future directions.
Pathogenesis and management of serrated polyps: current status and future directions.
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DOI：
10.5009/gnl14248
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发表时间：
2014-11
期刊：
影响因子：
3.4
通讯作者：
Anderson JC
中科院分区：
文献类型：
--
作者：
Anderson JC
增生性或锯齿状息肉曾经被认为几乎没有临床意义。这些息肉的一个子集现在被认为是锯齿状通路中结直肠癌（CRC）的前体，可能占所有肿瘤的至少15%。锯齿状通路与其他两种CRC通路不同，涉及肿瘤抑制基因启动子区域内CpG岛的表观遗传超甲基化机制。该过程导致CpG岛甲基化表型肿瘤的形成。锯齿状息肉分为增生性息肉、无蒂锯齿状腺瘤/息肉（SSA/Ps）和传统锯齿状腺瘤（TSA）。SSA/P和TSA具有发育异常和随后恶变的可能性。SSA/Ps比TSA更常见，更可能是平坦的。它们的扁平形态可能使它们难以检测，从而解释了内窥镜医师之间检测率的差异。内窥镜医生面临的挑战还包括难以对这些病变进行病理解释和监测。此外，锯齿状息肉可能不能被内窥镜医生充分切除。因此，锯齿状通路与间隔期癌症有关也就不足为奇了。这篇综述将为医生或临床医生提供管理锯齿状息肉患者的知识。
Hyperplastic or serrated polyps were once believed to have little to no clinical significance. A subset of these polyps are now considered to be precursors to colorectal cancers (CRC) in the serrated pathway that may account for at least 15% of all tumors. The serrated pathway is distinct from the two other CRC pathways and involves an epigenetic hypermethylation mechanism of CpG islands within promoter regions of tumor suppressor genes. This process results in the formation of CpG island methylator phenotype tumors. Serrated polyps are divided into hyperplastic polyps, sessile serrated adenomas/polyps (SSA/Ps), and traditional serrated adenomas (TSAs). The SSA/P and the TSA have the potential for dysplasia and subsequent malignant transformation. The SSA/Ps are more common and are more likely to be flat than TSAs. Their flat morphology may make them difficult to detect and thus explain the variation in detection rates among endoscopists. Challenges for endoscopists also include the difficulty in pathological interpretation as well surveillance of these lesions. Furthermore, serrated polyps may be inadequately resected by endoscopists. Thus, it is not surprising that the serrated pathway has been linked with interval cancers. This review will provide the physician or clinician with the knowledge to manage patients with serrated polyps.
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影响因子：
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