[Hyperplastic polyp-like change at the diagnosis of inflammatory bowel disease]

In inflammatory bowel disease (IBD), serrated lesions are of particular importance. The diagnosis of hyperplastic polyp-like change is used for IBD-associated lesions with morphology identical to hyperplastic polyps and with a clearly polypoid lesion on endoscopic examination. Hyperplastic polyp-like change is often detected in association with synchronous or metachronous neoplasia, and may also harbor p53, KRAS and BRAF mutations. We present the case of a 20-year-old female patient who was previously diagnosed and treated for acute abdominal catastrophe and abdominal abscesses. The current colonoscopic examination reflected inflammation of the caecum and the ascending colon, with a 6 mm polypoid lesion in the caecum, from which a specimen was taken. Histopathological examination showed right colon predominant ulcerative colitis with hyperplastic polyp-like change. IBDs significantly increase the risk of colorectal carcinoma by 1.5–2, with colitis-associated dysplasia being the main risk factor. The current professional guidelines recommend surveillance colonoscopy for ≥8 years of disease and for extensive IBD involving ≥1/3 of the colon. In any case, hyperplastic polyp-like change should be distinguished from serrated epithelial change and sessile serrated lesion. The potentially worse prognosis underlying these entities highlights the importance of complete resection and close follow-up in this patient group. Orv Hetil. 2025; 166(31): 1230–1233.