课件：结直肠锯齿状息肉最新报道.pptx

结直肠锯齿状息肉最新报道Update on serrated polyps of the colorectum2014-03-19简要介绍锯齿状病变专家共识推荐规范增生性息肉(MVHP)与SSA/P的新认知传统型锯齿状腺瘤(TSA)伴异型增生简要介绍锯齿状病变专家共识推荐规范2010年在Cleveland举行，由美国胃肠病学会(ACG)支持、美国国立卫生研究院(NIH)赞助专家组成员：endoscopy, surgery, pathology, epidemiology, and/or molecular aspects ofserrated lesions and/or serrated polyposis.经与会专家组讨论15年MEDLIAN文献，形成共识报告，目的是总结锯齿状息肉病理、分子病理和内镜特征，提高这种疾病威胁的意识，描述内镜特征，强调该疾病精确探查和完全切除的重要性，提供有关该病切除后处理的推荐规范。Key conclusions and recommendations of the consensus groupPathology1 Serrated lesions of the colorectum should be classified histologically as hyperplastic polyp (HP), sessile serrated adenoma/polyp(SSA/P) with or without cytologic dysplasia, or traditional serrated adenoma (TSA). Exceptions and subcategories are discussed in the text. Clinicians and pathologists within institutions should work collaboratively to achieve a common usage and understanding of terminology of serrated lesions.2 SSA/P and TSA are pre-cancerous lesions. SSA/P is the principal precursor of hypermethylated colorectal cancers (cancers with the CpG Island Methylator Phenotype – CIMP). This pathway occurs primarily in the proximal colon.3 SSA/P is distinguished from HP pathologically by findings of crypt distortion, particularly in the crypt base, in SSA/P. We recommend that a single unequivocal architecturally distorted, dilated, and/or horizontally branched crypt, particularly if it is associated with inverted maturation, is sufficient for a diagnosis of SSA/P. Most large serrated lesions in the proximal colon are SSA/Ps.4 SSA/P with cytological dysplasia is a more advanced lesion in the progression to cancer compared to SSA/P without cytologicaldysplasia.Endoscopy5 SSA/P and hyperplastic polyps in the proximal colon have a distinct endoscopic appearance, which includes a “mucus cap”, color usually similar to normal mucosa, and indistinct edges. All colonoscopists should be able to recognize serrated lesions.6 Detection of proximal colon serrated lesions by individual endoscopists is h