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Journal of Gastroenterology
Published in: Journal of Gastroenterology 8/2023

Open Access 23-05-2023 | Colonoscopy | Review

Sessile serrated lesions with dysplasia: is it possible to nip them in the bud?

Authors: Takahiro Utsumi, Yosuke Yamada, Maria Teresa Diaz-Meco, Jorge Moscat, Yuki Nakanishi

Published in: Journal of Gastroenterology | Issue 8/2023

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Abstract

The serrated neoplasia pathway constitutes an “alternative route” to colorectal cancer (CRC), and sessile serrated lesions with dysplasia (SSLDs) are an intermediate step between sessile serrated lesions (SSLs) and invasive CRC in this pathway. While SSLs show indolent growth before becoming dysplastic (> 10–15 years), SSLDs are considered to rapidly progress to either immunogenic microsatellite instable-high (MSI-H) CRC (presumably 75% of cases) or mesenchymal microsatellite stable (MSS) CRC. Their flat shapes and the relatively short window of this intermediate state make it difficult to detect and diagnose SSLDs; thus, these lesions are potent precursors of post-colonoscopy/interval cancers. Confusing terminology and the lack of longitudinal observation data of serrated polyps have hampered the accumulation of knowledge about SSLDs; however, a growing body of evidence has started to clarify their characteristics and biology. Together with recent efforts to incorporate terminology, histological studies of SSLDs have identified distinct dysplastic patterns and revealed alterations in the tumor microenvironment (TME). Molecular studies at the single-cell level have identified distinct gene alterations in both the epithelium and the TME. Mouse serrated tumor models have demonstrated the importance of TME in disease progression. Advances in colonoscopy provide clues to distinguish pre-malignant from non-malignant-SSLs. Recent progress in all aspects of the field has enhanced our understanding of the biology of SSLDs. The aim of this review article was to assess the current knowledge of SSLDs and highlight their clinical implications.
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Metadata
Title
Sessile serrated lesions with dysplasia: is it possible to nip them in the bud?
Authors
Takahiro Utsumi
Yosuke Yamada
Maria Teresa Diaz-Meco
Jorge Moscat
Yuki Nakanishi
Publication date
23-05-2023
Publisher
Springer Nature Singapore
Published in
Journal of Gastroenterology / Issue 8/2023
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-023-02003-9

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