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A sessile serrated lesion (SSL) is a premalignant flat (or sessile) lesion of the colon, predominantly seen in the cecum and ascending colon. SSLs are thought to lead to colorectal cancer through the (alternate) serrated pathway. [1] [2] This differs from most colorectal cancer, which arises from mutations starting with inactivation of the APC ...
Sessile serrated polyps, as seen during endoscopy or colonoscopy, are flat (rather than raised) and are easily overlooked. Serrated lesions range in size from small (<5 mm) to large, and often have a "mucous cap" overlying the polyp. Serrated lesions are frequently located on the folds of the colon (haustral folds). [citation needed]
Micrograph of a sessile serrated adenoma. H&E stain. Sessile serrated adenomas are characterized by (1) basal dilation of the crypts, (2) basal crypt serration, (3) crypts that run horizontal to the basement membrane (horizontal crypts), and (4) crypt branching. The most common of these features is basal dilation of the crypts.
Polyps are either pedunculated (attached to the intestinal wall by a stalk) or sessile (grow directly from the wall). [5] [6]: 1342 In addition to the gross appearance categorization, they are further divided by their histologic appearance as tubular adenoma which are tubular glands, villous adenoma which are long finger like projections on the surface, and tubulovillous adenoma which has ...
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Sessile Serrated Adenoma, Transverse Colon, 0.4 cm. Pathological and histological images courtesy of Ed Uthman at flickr. Date: 16 June 2009, 11:12: Source: Sessile Serrated Adenoma, Transverse Colon, 0.4 cm. Uploaded by CFCF; Author: Ed Uthman from Houston, TX, USA
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Sessile polyps have a shorter pathway for migration of invasive cells from the tumor into submucosal and more distant structures, and they are also more difficult to remove and ascertain. Sessile polyps larger than 2 cm usually contain villous features, have a higher malignant potential, and tend to recur following colonoscopic polypectomy. [18]