Hyperplastic (metaplastic) polyposis associated with adenoma and adenocarcinoma of the colorectum is rare. We describe a 55-year-old man with hyperplastic polyposis associated with multiple adenomas and an adenocarcinoma who underwent total colectomy. We found at least 200 polyps in the surgical specimen. Nearly all of the polyps were hyperplastic, and some were adenomas. Furthermore, some hyperplastic polyps had adenomatous areas. This indicates the transformational sequence of a hyperplastic polyp to adenoma to adenocarcinoma.

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