HISTOPATHOLOGY AND MANAGEMENT OF COLORECTAL POLYPS
Main Article Content
Abstract
Background: Colorectal polyps are common lesions with diverse biological behavior, ranging from benign to premalignant and malignant forms. Accurate histopathological evaluation is essential for risk stratification and determining appropriate treatment strategies. Objectives: This review aims to summarize the key histopathological characteristics of different types of colorectal polyps and to systematize corresponding management and surveillance strategies. Materials and methods: Relevant literature was retrieved from major medical databases, including the 2022 International Agency for Research on Cancer (IARC) classification, recent clinical studies, and review articles published up to 2025 focusing on polyp classification and management. Results: Colorectal polyps are broadly categorized into benign, premalignant (including tubular, villous, serrated adenomas, and hereditary polyposis syndromes), and malignant lesions. Current treatment trends emphasize personalized endoscopic resection techniques such as cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD). Surveillance intervals are recommended based on risk factors including polyp size ≥10 mm, number ≥3, and the presence of high-grade dysplasia. Conclusion: A comprehensive understanding of the histopathological features of colorectal polyps is essential for assessing malignant potential and guiding appropriate treatment and long-term surveillance strategies.
Keywords
colorectal polyp, histopathology, adenoma, management
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
References
2. Science Photo Library. Hyperplastic polyp in the colon, colonoscopy image. 2025. https://www.sciencephoto.com/media/1019457/view/hyperplastic-polyp-in-the-coloncolonoscopy-image
3. International Agency for Research on Cancer (IARC). Tumours of the colon and rectum. 2022. https://tumourclassification.iarc.who.int/chapters/31
4. Gupta S., Lieberman D., Anderson J.C., Burke C.A., Dominitz J.A., Kaltenbach T., et al. Recommendations for follow-up after colonoscopy and polypectomy: A consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc. 2020. 91(3), 463485, https://doi.org/10.1016/j.gie.2020.01.014
5. Yamada A., Saito Y., Takamaru H., Makazu M., Yokota T., Otake Y., et al. The impact of polyp size on the risk of high-grade dysplasia and cancer in colorectal adenomas: a retrospective study. Gastrointest Endosc. 2020. 91(2), 370-378, https://doi.org/10.1016/j.gie.2019.09.025
6. Taghiakbari M., Abdollahi M., Tavakkoli H., Javanmard B., Amini M., Jafarzadeh A., et al. Correlation of colorectal polyp size and histopathology: A 5-year cross-sectional study. Ann Med Surg (Lond). 2021. 66, 102402, https://doi.org/10.1016/j.amsu.2021.102402
7. Kim J.H., Byun J., Lee M.Y., Park C.H., Park J.C., Shin S.K., et al. Risk of advanced neoplasia in patients with sessile serrated adenoma/polyps according to polyp size. Endosc Int Open. 2021. 9(4), 528-535, https://doi.org/10.1055/a-1343-0610
8. Yamada A., Sakamoto T., Sekiguchi M., Nakajima T., Matsuda T., Saito Y. Prevalence and clinicopathologic characteristics of traditional serrated adenoma in a large colorectal polyp cohort. Endoscopy. 2021. 53(10), 950-957, https://doi.org/10.1055/a-1320-6074
9. Khan M., Lopez K., Shroff A., Sattar A., Goldberg J., Ladabaum U., et al. Outcomes of adenomas in patients with familial adenomatous polyposis after polypectomy. Clin Gastroenterol Hepatol. 2021. 19(4), 833-840, https://doi.org/10.1016/j.cgh.2020.04.073
10. Van Hattem W.A., Brosens L.A., de Leng W.W.J., van Eeden S., Fockens P., Dekker E. Highgrade dysplasia and cancer risk in juvenile polyposis syndrome: Implications for surveillance. Clin Gastroenterol Hepatol. 2020. 18(1), 180-187, https://doi.org/10.1016/j.cgh.2019.05.040
11. Lodder P., van Leerdam M.E., Wagner A., Kuipers E.J., Steyerberg E.W. Surveillance and cancer risk in Peutz-Jeghers syndrome: A systematic review and meta-analysis. Gut. 2020. 69(5), 1076-1083, https://doi.org/10.1136/gutjnl-2019-318349.
12. Tan M.H., Mester J.L., Ngeow J., Rybicki L.A., Orloff M.S., Eng C. Lifetime cancer risks in individuals with germline PTEN mutations. J Med Genet. 2020. 57(12), 762-770, https://doi.org/10.1136/jmedgenet-2020-107135.
13. Dunn A.L.J., Gonzalez R.S. Tubular adenoma. 2025. https://www.pathologyoutlines.com/topic/colontumortubularadenoma.html.
14. Martinez Ciarpaglini C. Tubulovillous / villous adenoma. 2025. https://www.pathologyoutlines.com/topic/colontumortvadenoma.html.
15. Ramnani D. Neoplastic polyps in large bowel. 2025. https://www.webpathology.com/images/gastrointestinal/large-bowel/neoplastic-polyps/42589
16. Kuo E., Gonzalez R.S. Sessile serrated adenoma. 2025. https://www.pathologyoutlines.com/topic/colontumorsessileserrated.html.
17. Kamal M., Hassell L.A. Juvenile (retention) polyp. 2025. https://www.pathologyoutlines.com/topic/colontumorjuvenilepolyp.html.
18. Feely M., Gonzalez R.S. Peutz-Jeghers syndrome. 2025. https://www.pathologyoutlines.com/topic/colontumorPeutz.html
19. Petrolla A., Gonzalez R.S. Cowden syndrome. 2025. https://www.pathologyoutlines.com/topic/colontumorcowden.html.
20. Kondo H., Ogawa S., Ohki T., Hoshino H., Hasegawa Y., Sato K., et al. Pedunculated early colorectal cancer with nodal metastasis: A case report. World J Surg Oncol. 2021. 19, 269, https://doi.org/10.1186/s12957-021-02394-1.
21. Dornblaser D., Young S., Shaukat A. Colon polyps: Updates in classification and management. Curr Opin Gastroenterol. 2024. 40(1), 14-20, https://doi.org/10.1097/MOG.0000000000000988
22. Watanabe T., Muro K., Ajioka Y., Hashiguchi Y., Ito Y., Saito Y., et al. JSCCR guidelines 2022 for the treatment of colorectal cancer. Int J Clin Oncol. 2022. 27(4), 457-479, https://doi.org/10.1007/s10147-022-02121-1.
23. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Colorectal Cancer Screening. 2024. https://www.nccn.org.