Serrated Polyposis Syndrome: Increasing Awareness and Importance

Heeyah Song,Elizabeth Martin,Dorian Willhite,John Erikson L Yap,Eula Tetangco

doi:10.7759/cureus.9198

Abstract

Serrated polyposis syndrome (SPS) was formerly considered a rare condition. In the past decade, it has gained increasing recognition due to its close association with colorectal cancer (CRC). Diagnosis is made based on the updated World Health Organization (WHO) criteria of having serrated polyps (SPs) proximal to the rectum, all being ≥5 mm in size, with at least two being ≥10 mm in size (criterion I), and a more distal phenotype that presents with greater than 20 SPs of any size throughout the large bowel with five being proximal to the rectum (criterion II). There are three subtypes of SP: hyperplastic polyp (HP), sessile serrated lesion (SSL), and traditional serrated adenoma (TSA). We present a 61-year-old Caucasian male who was referred for surveillance colonoscopy due to a history of colon polyps. A total of 28 polyps were completely removed, 21 of which were found to be SPs, three of which were >10 mm in size, meeting the WHO criteria for SPS. A follow-up colonoscopy was recommended in one year. It is now recognized that SPS are significant contributors to the development of CRC. The United States Multi-Society Preventive Task Force recently updated their consensus statement in 2020 with specific guidance for surveillance of SPs. It is important to emphasize that the diagnostic criteria apply to cumulative polyp count over the individual’s lifetime. The optimal surveillance for SPS remains unclear.

Highlights

Serrated polyposis syndrome (SPS), previously known as hyperplastic polyposis syndrome, is a relatively new condition characterized by multiple serrated polyps (SPs) in the colon
Any serrated polyp subtype is included in the polyp count, which is cumulative over multiple colonoscopies
hyperplastic polyp (HP) are deemed benign while sessile serrated lesion (SSL) and traditional serrated adenoma (TSA) carry a higher risk of developing dysplasia and eventually progressing to colorectal cancer (CRC) due to accumulation of molecular alterations [9]

Summary

Introduction

Serrated polyposis syndrome (SPS), previously known as hyperplastic polyposis syndrome, is a relatively new condition characterized by multiple serrated polyps (SPs) in the colon. A 61-year-old Caucasian male with hypertension was referred to open access endoscopy for surveillance colonoscopy due to a history of colon polyps. Complete blood count and chemistries were unremarkable He reported quitting smoking more than 20 years ago and denied any family history of colon cancer and SPS. One polyp was seen in the transverse colon measuring 2 mm in size. All of these were hyperplastic on pathology. Out of the 28 total polyps removed, the patient had 21 SP, three of which were >10 mm in size He was informed about his diagnosis of SPS.

Discussion

Conclusions

Disclosures

Findings

World Health Organization