Colorectal Adenocarcinoma with an Alternative Serrated Pathway

Makoto Eizuka, Keisuke Kawasaki, Yosuke Toya, Risaburo Akasaka, Koki Otsuka, Akira Sasaki, Takayuki Matsumoto, Tamotsu Sugai

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


In a 64-year-old woman, we identified a flat, elevated lesion that was located at the caecum and was composed of 3 different areas (areas A, B, and C). We diagnosed it as "carcinoma with sessile serrated adenoma/polyp (SSA/P)" histologically. Although area A was diagnosed as classical SSA/P, area B was regarded as a high-grade SSA/P. In contrast, area C showed a differentiated-type adenocarcinoma that invaded the submucosa. The patient had a recurrence of cancer 1.5 years after endoscopic resection. Overexpression of TP53 was detected in area C. Although BRAF mutation was detected in all areas, CpG island methylator phenotype-high cancer was found only in area C. The genomic phenotype of the cancerous tissue was classified as microsatellite stable (MLH1 gene not methylated). In the present case, we showed that a lesion with genetic alterations based on the histological sequence SSA/P → high-grade SSA/P → cancer in SSA/P and an alternative serrated pathway may exhibit aggressive behavior.

Original languageEnglish
Pages (from-to)116-124
Number of pages9
JournalCase Reports in Gastroenterology
Issue number1
Publication statusPublished - 13-04-2018
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Gastroenterology


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