Zusammenfassung
Die Adenom-Karzinom-Sequenz im Kolon gilt zwar auch noch für nichtpolypoide Läsionen, ist jedoch um die serratierten Läsionen ergänzt worden. Serratierte Läsionen lassen sich unterteilen in die Gruppe der zumeist harmlosen, im linken Hemikolon vorkommenden hyperplastischen Polypen, die im distalen Kolon bei älteren Patienten vorkommenden traditionellen serratierten Adenome und die Entität der sessilen serratierten Läsionen vor allem im rechten Hemikolon. Der Polypen- und der Adenombegriff sind im Zusammenhang mit diesen Läsionen falsch, da zumeist lediglich eine flache schleimbedeckte Erhabenheit vorliegt, ohne dass zytologisch eine Neoplasie nachgewiesen werden kann. Dies bedeutet nichts anderes, als dass der von einigen gebrauchte Polypenbegriff nicht angebracht und darüber hinaus auch der Begriff des Adenoms in diesem Zusammenhang nicht gerechtfertigt ist. Vielmehr handelt es sich um strukturelle Veränderungen mit einem bis dato noch nicht ganz klaren Entartungsrisiko. Die sessilen serratierten Läsionen machen >10 % aller Kolonläsionen aus, sollen für 50 % der sog. Intervallkarzinome verantwortlich sein und können relativ schnell maligne transformieren. Laut den S3-Leitlinien der DGVS wird die komplette Abtragung empfohlen. Leider besteht in Bezug auf die diagnostische Sicherheit noch erheblicher Nachholbedarf bei vielen Gastroenterologen und Pathologen. Für die Pathologen gilt es, möglichst auf internationaler Ebene Konsensuskonferenzen zu halten, um klinische Fragen, wie die Häufigkeit der Entartung zu beantworten und prädiktive Faktoren zu finden.
Abstract
The emerging role of nonpolypoid precursors of colorectal cancer has challenged the classical adenoma–carcinoma sequence. The group of serrated lesions has been added to the classical sequence. Serrated lesions of the colon can be subdivided into the mostly harmless hyperplastic polyp mainly found in the left hemicolon, the traditional serrated adenoma in the distal colon of elderly patients and the entity of sessile serrated lesions. These lesions are often erroneously referred to as polyps. This is incorrect since these lesions do not represent polyps but flat lesions with a mucous cap. The term “adenoma” is not correct, either, since these sessile serrated lesions show structural abnormalities but no cytological neoplasia and, thus, are not adenomas. The exact risk of malignant transformation is not clear at the moment. Sessile serrated lesions account for >10% of all colon lesions and are believed to be responsible for 50% of so-called interval carcinomas and some seem to show a very fast malignant transformation. According to the S3 DGVS (Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten) guidelines, these lesions should be completely removed. Due to the diagnostic inconsistencies of gastroenterologists and pathologists, international consensus meetings are needed to answer the clinical questions on frequency of malignant transformation and to identify predictive factors.
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Aktualisierung von Vieth M, Langner C (2010) (K)Eine Verwirrung um serratierte Kolonpolypen. J Gastroenterol Hepatol Erkr 8(4):7–12
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Sterlacci, W., Vieth, M. Serratierte Kolonpolypen. J. Gastroenterol. Hepatol. Erkr. 18, 64–71 (2020). https://doi.org/10.1007/s41971-020-00077-3
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DOI: https://doi.org/10.1007/s41971-020-00077-3