{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:07:40Z","timestamp":1790633260254,"version":"4.1.0"},"reference-count":10,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>A new subtype of serrated lesions, superficially serrated adenoma (SuSA), has been proposed as a lesion that histopathologically exhibits the morphological features of both conventional adenomas and serrated lesions and is difficult to classify as either one. SuSA has been elucidated to be a precursor lesion of <jats:italic>KRAS\u2010<\/jats:italic>type traditional serrated adenoma. It has also been reported that SuSA may have malignant potential.<\/jats:p><jats:p>We report a case treated with endoscopic submucosal dissection and detailed observation. Endoscopy revealed a raised lesion with a two\u2010tier raised appearance in the sigmoid colon: a tall pinecone\u2010like reddish structure and flattened whitish elevation on white light imaging. Magnifying narrow\u2010band imaging revealed conspicuous blood vessels in the pinecone\u2010like structure and slightly dilated reticular vessels in the flattened area. Crystal violet staining showed that the pinecone\u2010like structure had a type IV<jats:sub>H<\/jats:sub> pit pattern and the flattened area had a stellate to slightly elongated type III<jats:sub>H<\/jats:sub> pit pattern diagnosed based on Kudo's classification and other pit pattern classification systems. Ki67\u2010positive cells were distributed in the basal and middle layers of the gland in the flattened elevated area. Genetic analysis results were positive for <jats:italic>KRAS<\/jats:italic> mutation and negative for <jats:italic>BRAF<\/jats:italic> mutation. Histopathological examination revealed a traditional serrated adenoma in the pinecone\u2010like structure and SuSA in the adjacent flattened elevated area.<\/jats:p>","DOI":"10.1002\/deo2.247","type":"journal-article","created":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T07:33:59Z","timestamp":1685691239000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Traditional serrated adenoma with superficially serrated adenoma: A case treated with endoscopic submucosal dissection with detailed endoscopic observation and pathological study"],"prefix":"10.1002","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1251-8515","authenticated-orcid":false,"given":"Momoka","family":"Sato","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Tokyo Teishin Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoji","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Tokyo Teishin Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Tezen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Tokyo Teishin Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Tokyo Teishin Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Matsui","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Tokyo Teishin Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuya","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Tokyo Teishin Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichiro","family":"Sekigawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Tokyo Teishin Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Tajiri","sequence":"additional","affiliation":[{"name":"Department of Pathology Tokyo Teishin Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Mitsui","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Tokyo Teishin Hospital  Tokyo 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