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Updated: Jan 2, 2026

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Colorectal Serrated Polyp With Stromal Changes: An Interobserver Agreement Study.

Daniela S Allende¹, Rish K Pai², Hao Xie³

¹Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA.

Gastroenterology Research

|December 6, 2019

Summary

Sessile serrated polyps (SSPs) with stromal changes can be misdiagnosed. Prolapse changes suggest hyperplastic polyps (HPs), while basal crypt distortion indicates SSPs, aiding classification.

Keywords:

Colorectum Hyperplastic polyp Perineurial-like stromal proliferation Prolapse Sessile serrated polyp

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Published on: April 18, 2025

Area of Science:

Gastroenterology
Pathology
Colorectal Cancer Prevention

Background:

Stromal changes in rectal polyps, including prolapse and perineurial-like proliferation, can lead to misdiagnosis of sessile serrated polyps (SSPs).
Accurate differentiation between SSPs and hyperplastic polyps (HPs) is crucial for appropriate patient management and cancer surveillance.

Purpose of the Study:

To evaluate the diagnostic utility of stromal changes and basal crypt distortion in classifying serrated polyps.
To determine interobserver agreement among pathologists in identifying these features.

Main Methods:

Retrospective review of 74 serrated polyps with stromal changes by three gastrointestinal pathologists.
Assessment of stromal changes (prolapse, perineurial-like), basal crypt distortion, and final polyp classification (HP vs. SSP).
Correlation of findings with clinicopathologic features and interobserver agreement calculation.

Main Results:

A consensus diagnosis was reached for 67.6% of polyps (39 HP, 11 SSP).
Interobserver agreement for stromal changes and basal crypt distortion was moderate (kappa = 0.49).
Prolapse changes were associated with HP diagnosis (93.3%), while basal crypt distortion supported SSP diagnosis (50%).

Conclusions:

Serrated polyps with stromal changes present diagnostic challenges but can be classified with reasonable accuracy.
Prolapse changes favor HP, and basal crypt distortion favors SSP, aiding in differentiating these lesions.
Unclassified polyps may represent a heterogeneous group requiring further investigation.