Serrated Polyposis. Diagnosis and Management

CORAGLIO, M.; COLLIA, KARINA; GUTIERREZ, A.; GUALDRINI, U.; LUMI, C; ALEJO, M; CABANNE, A; SALANOVA, R.; ANTELO M.; MILITO, D.; MASCIANGIOLI, G

San Pablo

Congreso; International Society for Gastrointestinal Hereditary Tumours - 6th Biennial Meeting; 2015

International Society for Gastrointestinal Hereditary Tumours

Purpose: Hyperplastic or serrated polyposis is arare syndrome of colorectal cancer predisposition, three distinct subtypes of serrated lessions are include like hyperplastic (70% ofall serrated polyps), sessile serrated adenoma/polyp (SSA/P) (25%) and traditional serrated adenoma (<2%). Patterns of inheritance ofare not obvious and the clinical definition is relatively arbitrary. Colorectalcancer prevalenece is around 0 a 50%.(1-5)The aim of our study is to analyze prevalence of colorectal cancer, clinicalcharacteristics, motive of diagnosis and management of these patients. Methodology: BetweenJanuary 2009 and November 2014 the Polyposis Registry incorpored 17 affectedpatients with Hyperplastic / Serrated polyposis, all of them index cases,  they belong to 17 families. We analyzedretrospectively their demographic characteristics, age at cancer diagnosis, prospectivepreoperative or retrospective postoperative diagnosis, upper gastrointestinalpolyposis associated as extra-intestinal manifestations, endoscopic and surgerytreatment, pathological Stage (S), and prevalence of high risk adenomas associatedand colorectal adenocarcinomas. Data were obtained from the Registry data base.Descriptive retrospective observational study. Results: We evaluated 17 serrated polyposis patients, all ofthem index cases, nine were male (64,2%), mean age was 48,9 years ranging from28 to 71; one patient (5,88%) had duodenal polyps in assessment by the multidiscplinaryteam. The diagnosis was done inprospective form before surgery in 11 patients (64,7%) through the colonoscopyassessment and in retrospective form after surgery in six (35,2%) by thehistopathologic study of the surgical specimen. The mean age at cancer diagnosis was 60,5 years ranging from 54 to71. The surgical procedures were four total colectomy and ileorectalanastomosis and two proctocolectomy with ileal pouch and ileoanal anastomosis. Wefound four patient with adenocarcinoma (23,52%) two localizated in colon andtwo in rectum. There were two cases Stage I (T1 N0 M0), one Stage II (T3 N0 M0),one Stage III (ypT2 ypN1 ypM0). High risk adenomas were found in two of theadenocarcinoma cases (50%). The management of the non operated 11 patients wasdone through endoscopic polyp resection and they will  stay in a surveillance endoscopic protocol. Conclusion:The patients at polyps or colorectal´s cancerdiagnosis  are older than in classicaladenomatous polyposis. In our Registry the first four patients of this seriewere diagnosed in retrospective postoperative form because they were attendedwith colorectal cancer developed. Only one patient had an extra-intestinal manifestationassociated. The serrated polyposis may be accuracy manage byendoscopic therapy in patients without colorectal cancer.