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Colonic polyps with subtle histologic features often show recognizable morphologic changes and can harbor KRAS alterations. These findings indicate they are distinct from hyperplastic polyps.

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Area of Science:

  • Gastroenterology
  • Molecular Pathology
  • Colorectal Cancer Screening

Background:

  • Colonic polyps are common findings during colonoscopies.
  • Subtle histologic features can sometimes complicate polyp classification.
  • Accurate polyp characterization is crucial for appropriate patient management and cancer prevention.

Purpose of the Study:

  • To define the morphologic and molecular characteristics of colonic polyps exhibiting subtle histologic features.
  • To differentiate these polyps from other common colorectal lesions.

Main Methods:

  • Review of endoscopic findings from 200 surveillance colonoscopies.
  • Histologic comparison of polyps with adjacent flat mucosa.
  • Next-generation sequencing (NGS) on 30 polyps and 20 control samples to identify molecular alterations.

Main Results:

  • Polyps with subtle changes constituted 12% of all polyps, predominantly sessile and small (<0.5 cm) in the distal colon.
  • Morphologically, 84.5% displayed wide, nonserrated crypts, increased mucus, and patent openings.
  • KRAS alterations were detected in 30% of these polyps, with synchronous lesions including hyperplastic (30%), sessile serrated (7%), and dysplastic (51%) polyps.

Conclusions:

  • Colonic polyps with subtle histologic features possess distinct morphologic changes.
  • The presence of KRAS alterations in a significant subset suggests a potential role in colorectal neoplasia.
  • These polyps should be recognized as distinct entities and not classified as variants of hyperplastic polyps.