{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T20:35:57Z","timestamp":1764794157880,"version":"3.40.5"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,2,12]],"date-time":"2020-02-12T00:00:00Z","timestamp":1581465600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Precursor colonic polyps of varied subtypes correlate with the known neoplastic pathways. When patients present with synchronous pre\u2010malignant polyps of multiple histologies, multiple genetic mechanisms are likely to be active, potentially resulting in a more unstable, tumourigenic mucosa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We hypothesized that patients with a combination of sessile serrated adenomas\/polyps (SSA\/Ps), hyperplastic (HP) polyps and adenomas would be at highest risk of developing dysplasia\/cancer compared to SSA\/Ps alone, due to the synergistic effect of multiple active carcinogenic pathways. A prospective colonoscopy database was examined for patients with a history of SSA\/P. Patients were placed into four groups based on patterns of polyp histology as follows: (i) only SSA\/Ps; (ii) SSA\/P\u2009+\u2009HP; (iii) SSA\/Ps\u2009+\u2009adenomas; and (iv) SSA\/Ps\u2009+\u2009HP\u2009+\u2009adenomas. These groups were compared in terms of the numbers, size, location and histology of polyps and personal or family history of colorectal cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 374 patients were included. The average age was 70\u2009years (range 21\u201388), and 43% were male. There was a trend towards the most aggressive neoplastic pattern in group 4, associated with a tendency to larger SSA\/Ps, more villous architecture in the adenomas and more high\u2010grade dysplasia in both types of polyps. It was also associated with multiplicity of both SSA\/Ps and adenomas. No SSA\/Ps existing in the absence of adenomas had cytological dysplasia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The combination of SSA\/Ps, HP and adenomas in the colorectal epithelium seems to be a marker for aggressive carcinogenesis and suggests that accurate and effective surveillance is important to manage this risk.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.15662","type":"journal-article","created":{"date-parts":[[2020,2,13]],"date-time":"2020-02-13T03:14:21Z","timestamp":1581563661000},"page":"807-811","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Patterns of polyp histology: predictors of peril in the mucosa"],"prefix":"10.1111","volume":"90","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9025-2591","authenticated-orcid":false,"given":"Meara","family":"Dean","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Plesec","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew F.","family":"Kalady","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Church","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,2,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1508811"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.161"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prp.2011.05.003"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e3181c6b9dd"},{"key":"e_1_2_7_6_1","first-page":"327","article-title":"The adenoma\u2010carcinoma sequence in cancer of the colon","volume":"93","author":"Jackman RJ","year":"1951","journal-title":"Surg. 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