Clinicopathologic and Outcome Analysis of Serrated Polyps in Inflammatory Bowel Disease.
Hema Khurana, Francis A Farraye, Jonathan S Levine, Robert Burakoff, Jennifer Coukos, Sandra Cerda, Robert D Odze. Brigham and Women's Hospital, Boston; Boston Medical Center
Background: Not uncommonly, serrated polyps, which include hyperplastic polyps (HP), sessile serrated polyps (SSP), and traditional serrated adenomas (SA) occur in patients with Inflammatory Bowel Disease (IBD), but the biological significance and neoplastic potential of these polyps in patients with IBD is unknown. The aim of this study was to evaluate the clinicopathologic features and outcome of a cohort of patients with IBD, all of whom had at least one serrated polyp of the colon at index endoscopy.
Design: A search through the pathology files of two major hospitals between the years 1993-2010 detected 16I IBD patients with at least 1 serrated polyp (total # polyps: 188), and these patients formed the study group [ulcerative colitis (UC):109, Crohn's disease (CD):52]. The clinical and pathologic features of the patients and the polyps, and outcome, were evaluated, and also compared between the patient groups.
Results: The IBD patients consisted of 83 males and 78 females of mean age 48 years (range: 8-88 years). Most patients had left (53%) or subtotal colitis (15%), and had inactive (35%) or mildly active (29%) disease. The mean duration of colitis was 18 years (range:1-45 years). Pathologically, of the 188 polyps identified, 182 (97%) were HP (148 microvesicular, 36 goblet cell-type), and 6(3%) were SSP. No SA were identified. 18 patients (11%) had associated neoplastic polyps [sporadic adenoma (12), adenoma-like DALM (6)] at index endoscopy. 4% polyps were identified endoscopically; 60% were identified only by pathologic evaluation of the biopsies. Most polyps occurred in the left colon (63%) and within areas of previous or concurrent colitis. Follow up information was available in 74 patients (mean follow up; 8 years). None of the patients developed adenocarcinoma, adenomas or flat/elevated dysplasia, but 24/72 (33%) of patients developed further polyps (18 HP, 6 inflammatory). There was no association between disease type (UC vs CD), polyp type, or location (within vs outside colitis) and outcome.
Conclusions: Most serrated polyps in IBD represent microvesicular HP and are detected microscopically, not endoscopically. A small percentage are associated with concurrent adenomas or DALMS. Due to the lack of development of neoplasia upon follow up, increased surveillance of these patients is not warranted.
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 26, Wednesday Morning