This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB. This is a 72-year-old woman who was referred for resection of a large lesion in her transverse colon, and we always in these patients go to the secum because there's a substantial prevalence of synchronous disease, and you're seeing as we come back from the secum a number of lesions, and so you're going to be asked what the overall diagnosis is in this patient. And this patient actually had lesions of similar appearance extending back through the transverse colon and a variety of lesions that were located in the rectosigmoid colon also. And you have to look carefully at these lesions, and the question is going to be what is the diagnosis in this patient who presents with multiple lesions in the colorectum. Let's look at the lesions in this case. That's a 15 millimeter adenoma. The rest of the lesions that we're gonna see are primarily SSLs, although they're dysplastic in several cases. That's a small dysplastic area in a setting of a broad SSL. That's another one to the left. Here's a small tubular adenoma. And then here coming up is another SSL with cytological dysplasia. Off to the left, the dysplastic part. Extending to the right, you can see the serrated lesion. In a moment, we'll see another SSL over a centimeter in size without dysplasia. This is one of the few patients that I've seen with serrated polyposis syndrome who has multiple dysplastic lesions in the colon. And this meets the type one criteria almost based on what we've seen already. Five lesions proximal to the rectum, all at least five millimeters, two at least 10 millimeters. There's another SSL. But the key here is to recognize the serrated components, to recognize that this is serrated polyposis syndrome. So here's about a 13 millimeter SSL without cytological dysplasia. We've seen three others over a centimeter in size in this movie just so far in the ascending colon. The lesion the patient was referred for was also a very large SSL. So the patient meets the criteria for type one serrated polyposis syndrome. Again, at least five lesions proximal to the rectum, all five millimeters or larger, two that are 10 millimeters or larger. And they actually met the criteria for type two, which is at least 20 serrated class lesions, either SSLs or hyperplastic lesions scattered throughout the colon. The key to recognizing that these are serrated lesions is to look carefully, to recognize that the part that looks like a small adenoma, the dysplastic portion nice to within the yellow line is only part of the lesion. It actually extends out to the right, the more subtle serrated looking type one in the nice classification portion within the white line. This is an SSL with cytological dysplasia. It counts toward the diagnosis of SPS. This is another lesion that was seen in the quiz portion in the proximal ascending colon. And there is a little nodule that looks like an adenoma, it's dysplastic here encased with the yellow line, but it lies within a very broad SSL marked by the white line another large SSL with cytological dysplasia.

surgery

lesion

colon

adenomas

serrated lesions