WordNet

permanently attached to a substrate; not free to move about; "sessile marine animals and plants"
attached directly by the base; not having an intervening stalk; "sessile flowers"; "the shell of a sessile barnacle is attached directly to a substrate" (同)stalkless
make saw-toothed or jag the edge of; "serrate the edges of the teeth"
notched like a saw with teeth pointing toward the apex (同)serrated, saw-toothed, toothed, notched
a benign epithelial tumor of glandular origin

PrepTutorEJDIC

(植物が)無柄(へい)の / (動物が)固着した,定着性の(イソギンチャクなどについていう)
(葉の縁が)のこぎり歯状の
=serrate

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/08/24 11:01:39」(JST)

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In gastroenterology, a sessile serrated adenoma (abbreviated SSA), also known as sessile serrated polyp (abbreviated SSP), is a premalignant flat (or sessile) lesions of the colon, predominantly seen in the cecum and ascending colon.

SSAs are thought to lead to colorectal cancer through the (alternate) serrated pathway.^[1]^[2] This differs from most colorectal cancer, which arises from mutations starting with inactivation of the APC gene.

Multiple SSAs may be part of the serrated polyposis syndrome.^[3]

Symptoms[edit source | edit]

SSAs, generally, are asymptomatic. They are typically identified on a colonoscopy, by a gastroenterologist, and excised for a definitive diagnosis and treatment.

Diagnosis[edit source | edit]

SSAs are diagnosed by their microscopic appearance; histomorphologically, they are characterized by (1) basal dilation of the crypts, (2) basal crypt serration, (3) crypts that run horizontal to the basement membrane (horizontal crypts), and (4) crypt branching. The most common of these features is basal dilation of the crypts.

Unlike traditional colonic adenomas (e.g. tubular adenoma, villous adenoma), they do not (typically) have nuclear changes (nuclear hyperchromatism, nuclear crowding, elliptical/cigar-shaped nuclei).

Treatment[edit source | edit]

Complete removal of a SSA is considered curative.

Several SSAs confer a higher risk of subsequently finding colorectal cancer and warrant more frequently screening. The screening guidelines are the same, as for other colonic adenomas. The screening interval is dependent on (1) the number of adenomas, (2) their size and, (3) whether high-grade microscopic features are present.^[4]

Additional images[edit source | edit]

Low magnification micrograph of a SSA.
Intermediate magnification micrograph of a SSA.
High magnification micrograph of a SSA showing crypt branching.

References[edit source | edit]

^ Rüschoff J, Aust D, Hartmann A (2007). "[Colorectal serrated adenoma: diagnostic criteria and clinical implications]". Verh Dtsch Ges Pathol (in German) 91: 119–25. PMID 18314605.
^ Mäkinen MJ (January 2007). "Colorectal serrated adenocarcinoma". Histopathology 50 (1): 131–50. doi:10.1111/j.1365-2559.2006.02548.x. PMID 17204027.
^ Rosty, C.; Parry, S.; Young, JP. (2011). "Serrated polyposis: an enigmatic model of colorectal cancer predisposition.". Patholog Res Int 2011: 157073. doi:10.4061/2011/157073. PMID 21660283.
^ Levine JS, Ahnen DJ (December 2006). "Clinical practice. Adenomatous polyps of the colon". N. Engl. J. Med. 355 (24): 2551–7. doi:10.1056/NEJMcp063038. PMID 17167138.

External links[edit source | edit]

Intestinal adenomas - halflytely.com.
Pathology of Serrated Colon Adenomas - Medscape

UpToDate Contents

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1. 大腸ポリープ患者に対するアプローチ approach to the patient with colonic polyps
2. MUTYH-associated polyposis
3. 大腸癌の分子遺伝学 molecular genetics of colorectal cancer

English Journal

Microsatellite instability and DNA mismatch repair protein deficiency in Lynch syndrome colorectal polyps.

Yurgelun MB, Goel A, Hornick JL, Sen A, Turgeon DK, Ruffin Iv MT, Marcon NE, Baron JA, Bresalier RS, Syngal S, Brenner DE, Boland CR, Stoffel E.Source1Division of Hematology/Oncology, Beth Israel Deaconess Medical Center.
Cancer prevention research (Philadelphia, Pa.).Cancer Prev Res (Phila).2012 Jan 18. [Epub ahead of print]
Colorectal cancers associated with Lynch syndrome (LS) are characterized by deficient DNA mismatch repair (MMR) function. Our aim was to evaluate the prevalence of microsatellite instability (MSI) and loss of MMR protein expression in LS-associated polyps. Sixty two colorectal polyps - 37 adenomas (
PMID 22262812

A Novel Pit Pattern Identifies the Precursor of Colorectal Cancer Derived From Sessile Serrated Adenoma.

Kimura T, Yamamoto E, Yamano HO, Suzuki H, Kamimae S, Nojima M, Sawada T, Ashida M, Yoshikawa K, Takagi R, Kato R, Harada T, Suzuki R, Maruyama R, Kai M, Imai K, Shinomura Y, Sugai T, Toyota M.SourceDepartment of Gastroenterology, Akita Red Cross Hospital, Akita, Japan.
The American journal of gastroenterology.Am J Gastroenterol.2012 Jan 10. doi: 10.1038/ajg.2011.457. [Epub ahead of print]
OBJECTIVES: Sessile serrated adenomas (SSAs) are known to be precursors of sporadic colorectal cancers (CRCs) with microsatellite instability (MSI), and to be tightly associated with BRAF mutation and the CpG island methylator phenotype (CIMP). Consequently, colonoscopic identification of SSAs has i
PMID 22233696

Unexplained polyposis: a challenge for geneticists, pathologists and gastroenterologists.

Mongin C, Coulet F, Lefevre JH, Colas C, Svrcek M, Eyries M, Lahely Y, Fléjou JF, Soubrier F, Parc Y.SourceOncogenetic and Molecular Angiogenetic Laboratory, Hospital Pitié-Salpêtrière AP-HP, Paris, France.
Clinical genetics.Clin Genet.2012 Jan;81(1):38-46. doi: 10.1111/j.1399-0004.2011.01676.x. Epub 2011 May 4.
Two main colorectal polyposis syndromes have been described, familial adenomatous polyposis and MUTYH-associated polyposis syndromes. Some polyposis remains unexplained: 20% of adenomatous polyposis and serrated polyposis. The aim of this study was to evaluate in a cohort of patients with unexplaine
PMID 21476993

Japanese Journal

今月の症例粘膜内癌を合併したSSA/Pに腸管スピロヘータが確認された1例

大森沙織,間部克裕,大野正芳 [他]
日本内科学会雑誌 102(8), 2046-2049, 2013-08-10
NAID 40019787374

Mixed serrated polyp（sessile serrated adenoma/polyp and traditional serrated adenoma）に併存して発生した盲腸SM癌の1例

下立雄一,高梨訓博,和賀永里子,藤田朋紀,勝木伸一,藤田昌宏
日本消化器内視鏡学会雑誌 55(10), 3409-3415, 2013
… 郭不明瞭が見られV<SUB>I</SUB>高度不整と診断した．SM深部浸潤癌と診断して外科的治療を薦めたが，本人の強い希望でESDを施行した．病理組織結果はWell and focal moderately differentiated adenocarcinoma with mixed serrated polyp，SM（1,900μm），ly1，v0，HM0，VM0であり，後日追加腸切除を行ったが腫瘍の残存は認めなかった．癌部および鋸歯状病変部のムチンコア蛋白発現，遺伝子解析の結果から本症例の発育進展過程を考察した …
NAID 130003386580

大腸癌の前癌病変

高山哲治,高岡遠,青木秀俊,岡本耕一
日本消化器内視鏡学会雑誌 55(6), 1787-1795, 2013
… 大腸癌の前病変としては，まず腺腫（adenoma）があげられ，腺腫はadenoma-carcinoma sequenceにより癌に進展する．次いで，traditional serrated adenoma（TSA）やsessile serrated adenoma/polyp（SSA/P）などの鋸歯状ポリープがあげられ，これらの病変はserrated pathwayにより癌に進展する．腺腫，TSA, …
NAID 130003375308

Related Pictures

Sessile serrated adenoma of the colon and rectum - MyPathologyReport.ca Sessile Serrated Adenomas: An Evidence-Based Guide to Management Qiao's Pathology: Sessile Serrated Adenoma of Right Colon - a photo on File:Sessile serrated adenoma 2 low mag.jpg - Wikimedia Commons Sessile serrated adenoma - Libre Pathology Clinicopathological and molecular features of sessile serrated adenomas Colonic Polyps