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World J Gastroenterol. May 28, 2012; 18(20): 2452-2461
Published online May 28, 2012. doi: 10.3748/wjg.v18.i20.2452
Serrated polyposis syndrome: Molecular, pathological and clinical aspects
Carla Guarinos, Cristina Sánchez-Fortún, María Rodríguez-Soler, Cristina Alenda, Artemio Payá, Rodrigo Jover
Carla Guarinos, María Rodríguez-Soler, Research Unit, Hospital General Universitario de Alicante, 03010 Alicante, Spain
Cristina Sánchez-Fortún, María Rodríguez-Soler, Rodrigo Jover, Unidad de Gastroenterología, Hospital General Universitario de Alicante, 03010 Alicante, Spain
Cristina Alenda, Artemio Payá, Department of Pathology, Hospital General Universitario de Alicante, 03010 Alicante, Spain
Author contributions: Guarinos C, Sánchez-Fortún C and Rodríguez-Soler M made substantial contributions to conception, design and drafting of the article and revised it critically for important intellectual content; Alenda C and Payá A critically revised the article and made important contributions to its final format; Jover R designed and conceived the article and also critically revised it; and all authors approved the version to be published.
Supported by Grants from Instituto de Salud Carlos III, INT09/208 and PI08/0726, to Jover R; Fundación de la CV para la Investigación en el Hospital General Universitario de Alicante, to Alenda C, Payá A and Jover R; a predoctoral grant from Conselleria d’Educació de la Generalitat Valenciana, VALi+d. EXP ACIF/2010/018, to Guarinos C; a grant from Fundación de la CV para la Investigación en el Hospital General Universitario de Alicante, to Rodríguez-Soler M
Correspondence to: Dr. Rodrigo Jover, Unidad de Gastroenterología, Hospital General Universitario de Alicante, Pintor Baeza, 12, 03010 Alicante, Spain. jover_rod@gva.es
Telephone: +34-96-5933468 Fax: +34-96-5933468
Received: September 3, 2011
Revised: February 8, 2012
Accepted: February 26, 2012
Published online: May 28, 2012
Abstract

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.

Keywords: Colorectal cancer, Hyperplastic polyps, CpG island methylator phenotype, Serrated polyposis, Serrated pathway