Patients with these lesions may thus need an even more aggressive endoscopic surveillance (49,50). Figure 11 Low power (A. original magnification ×40) and high power (B. original magnification ×200) views of sessile serrated polyp. Note the presence of basal

serration Traditional serrated adenoma (TSA) is a unique and uncommon type of true adenoma that exhibits low grade nuclear dysplasia similar to that seen for conventional adenoma, and also shows a serrated architecture similar to that seen for HP and SSA/P. Prominent cytoplasmic eosinophilia and a villous growth pattern are characteristic (Figure Inhibitors,research,lifescience,medical 12). Figure 12 An example of traditional serrated adenoma Inhibitors,research,lifescience,medical (original magnification ×400). Note the presence of luminal serration,

low grade cytologic dysplasia and cytologic eosinophilia Dysplasia in inflammatory bowel disease Inflammatory bowel disease (IBD) is a well-known risk factor for the development of dysplasia and carcinoma. Dysplastic lesions in the setting of IBD can be flat (endoscopically invisible) Inhibitors,research,lifescience,medical or raised (51,52), which are both graded as indefinite for dysplasia, low grade dysplasia or high grade dysplasia. Raised lesions are commonly termed dysplasia-associated lesions or masses (DALMs) and can be difficult or impossible to distinguish from sporadic adenomas. However, several studies have shown that adenoma-like lesions in IBD patients, regardless of whether it represents an IBD-associated DALM lesion or a sporadic adenoma, can be adequately managed by polypectomy and continued endoscopic surveillance if there is no

coexisting flat dysplasia (53-55). Given Inhibitors,research,lifescience,medical the treatment implications, it is recommended that the diagnosis of dysplasia in the setting of IBD be confirmed by an experienced pathologist (56). The diagnosis of indefinite for dysplasia should not become a waste basket, and should Inhibitors,research,lifescience,medical be reserved for cases showing worrisome cytologic and architectural changes but also showing surface maturation or abundant inflammation. The diagnosis is also appropriate if the mucosal surface cannot be evaluated due to tangential sectioning very of the tissue, the presence of marked cautery effect, or the presence of other processing artifacts. Lynch syndrome Lynch syndrome is the most common inherited colorectal cancer syndrome (57). It is characterized by increased lifetime cancer risks primarily in the gastrointestinal and gynecologic tracts, with colorectal and endometrial carcinomas being most common. The cumulative lifetime risk for colorectal cancer is estimated to be 66% for men and 43% for women (58). Patients with Lynch syndrome tend to check details develop mucinous, poorly differentiated, undifferentiated, or medullary carcinomas in the right colon at a relatively young age. Tumor-infiltrating lymphocytes and Crohn-like peritumoral lymphoid reaction may be prominent.