Hyperplastic Polyposis of the Large Bowel Three Cases and a Review of the Literature

Abstract

Small hyperplastic polyps of the large bowel constitute a frequent non-neoplastic lesion, whereas large or multiple hyperplastic polyps are rare. Here we report three cases of multiple small polyps together with some large hyperplastic ones. Two of the cases had a primary carcinoma in the bowel before onset of the polyps. The neoplastic potential of the hyperplastic polyp is discussed on the basis of the most recent investigations and the three presented cases. The hyperplastic polyp does not seem to be directly involved in the adenoma-carcinoma sequence, but dysplastic changes can be found in large hyperplastic polyps. In cases of multiple hyperplastic polyps a tendency towards a more uniform distribution of the polyps throughout the large bowel is observed. Hyperplastic colonic polyps may exist as a clinical entity, and a definition based on distribution, multiplicity, size, and symptoms is proposed. Patients with multiple or large hyperplastic polyps should have colonoscopy performed at short intervals, with removal of all lesions larger than 5 mm for histologic examination.

Colorectal Carcinomas Arising in the Hyperplastic Polyposis Syndrome Progress through the Chromosomal Instability Pathway

“…3 Although most of the polyps in this case were hyperplastic in nature, one showed serrated adenomatous change, typified by a serrated architecture, with cells showing abundant eosinophilic cytoplasm, goblet cell depletion, and oval vesicular nuclei with prominent nucleoli and nuclear stratification ( Figure 2B). No areas of moderate or severe dysplasia were seen in this lesion, and no adenomatous polyps of the usual type were seen within the colectomy specimen.…”

“…It has been suggested that the formation of an adenoma, with its disordered crypt architecture, allows the exposure of proliferating cells to fecal carcinogens. 3 This leads in some cases to p53 mutations and subsequent neoplastic progression via impaired apoptosis and chromosomal instability. It is plausible that a similar mechanism may be at work in the hyperplastic polyp/serrated adenoma lesions typical of the hyperplastic polyposis syndrome.…”

“…It was first described as a discrete entity in 1980, 2 and some 49 cases have been reported in the literature to date. This includes those cases reviewed by Jorgensen et al in 1996, 3 together with more recent reports by others. 4 -9 Torlakovic and Snover have also described a potential variant of HPS, which they have termed the serrated adenomatous polyposis syndrome.…”

Hyperplastic polyposis coli associated with dysplasia

“…They frequently arise at the crest of a mucosal fold where they present as small, sessile polyps usually measuring less than 5 mm in diameter with a smooth convex surface 1. Although traditionally regarded as non-neoplastic, recent evidence has shown hyperplastic polyps to have molecular features of neoplasia 2…”

Prevalence of serrated polyposis syndrome and its association with synchronous advanced adenoma and lifestyle

“…These criteria were recently redefined and this condition is currently referred to as serrated polyposis syndrome (SPS). A number of patients have been reported as having CRC and concurrent SPS (10)(11)(12)(13)(14)(15)(16), suggesting that SPS may be an alternative pathway for the development of CRC. However, SPS has not yet been extensively investigated in Japan and its clinical characteristics, causes and association of SPS to CRC have not been adequately evaluated.…”