Background/Aims: Many studies have suggested that hyperplastic polyps (HPs) are associated with adenomas and even malignancy. We investigated whether or not HPs are associated with the presence of synchronous advanced colorectal neoplasms as a function of their size and location. Methods: A total of 2,482 asymptomatic patients who underwent screening colonoscopies were classified into the following two groups: cases with advanced neoplasms and controls without advanced neoplasms. The proximal colon was defined as all segments proximal to the splenic flexure. We defined diminutive HPs as <6 mm in diameter and non-diminutive HPs as ≧6 mm in diameter. Results: The median age of the patients was 51 years. 76.8% (n = 1,909) of the patients were males. 82 patients (3.3%) had at least one advanced neoplasm. Based on multivariate analysis, the independent risk factors for advanced neoplasms were old age (OR = 2.81), male gender (OR = 2.92), non-advanced adenomas (OR = 3.57), and non-diminutive HPs (OR = 4.75, p = 0.000). Having at least one non-diminutive HP in either the proximal or distal colon was associated with an increased risk of advanced neoplasm, with no statistically significant difference (proximal vs. distal colon, OR = 5.95 vs. 5.36). Conclusions: These results suggest that non-diminutive HPs are important markers of advanced colorectal neoplasms regardless of location.

1.
Tonooka T, Sano Y, Fujii T, et al: Adenocarcinoma in solitary large hyperplastic polyp diagnosed by magnifying colonoscope: report of a case. Dis Colon Rectum 2002;45:1407–1411.
[PubMed]
2.
Goldstein NS, Bhanot P, Odish E, et al: Hyperplastic-like colon polyps that preceded microsatellite-unstable adenocarcinomas. Am J Clin Pathol 2003;119:778–796.
[PubMed]
3.
O’Brien MJ, O’Keane JC, Zauber A, et al: Precursors of colorectal carcinoma. Biopsy and biologic markers. Cancer 1992;70:1317–1327.
[PubMed]
4.
Ansher AF, Lewis JH, Fleischer DE, et al: Hyperplastic colonic polyps as a marker for adenomatous colonic polyps. Am J Gastroenterol 1989;84:113–117.
[PubMed]
5.
Martinez ME, McPherson RS, Levin B, et al: A case-control study of dietary intake and other lifestyle risk factors for hyperplastic polyps. Gastroenterology 1997;113:423–429.
[PubMed]
6.
Jen J, Powell SM, Papadopoulos N, et al: Molecular determinants of dysplasia in colorectal lesions. Cancer Res 1994;54:5523–5526.
[PubMed]
7.
Otori K, Oda Y, Sugiyama K, et al: High frequency of K-ras mutations in human colorectal hyperplastic polyps. Gut 1997;40:660–663.
[PubMed]
8.
Sciallero S, Costantini M, Bertinelli E, et al: Distal hyperplastic polyps do not predict proximal adenomas: results from a multicentric study of colorectal adenomas. Gastrointest Endosc 1997;46:124–130.
[PubMed]
9.
Imperiale TF, Wagner DR, Lin CY, et al: Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 2000;343:169–174.
[PubMed]
10.
Dave S, Hui S, Kroenke K, et al: Is the distal hyperplastic polyp a marker for proximal neoplasia? J Gen Intern Med 2003;18:128–137.
[PubMed]
11.
Lieberman DA, Weiss DG, Bond JH, et al: Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med 2000;343:162–168.
[PubMed]
12.
Imperiale TF, Wagner DR, Lin CY, et al: Using risk for advanced proximal colonic neoplasia to tailor endoscopic screening for colorectal cancer. Ann Intern Med 2003;139:959–965.
[PubMed]
13.
Lin OS, Schembre DB, McCormick SE, et al: Risk of proximal colorectal neoplasia among asymptomatic patients with distal hyperplastic polyps. Am J Med 2005;118:1113–1119.
[PubMed]
14.
Baker K, Zhang Y, Jin C, et al: Proximal versus distal hyperplastic polyps of the colorectum: different lesions or a biological spectrum? J Clin Pathol 2004;57:1089–1093.
[PubMed]
15.
Winawer SJ, Zauber AG, Fletcher RH, et al: Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology 2006;130:1872–1885.
[PubMed]
16.
Yano T, Sano Y, Iwasaki J, et al: Distribution and prevalence of colorectal hyperplastic polyps using magnifying pan-mucosal chromoendoscopy and its relationship with synchronous colorectal cancer: prospective study. J Gastroenterol Hepatol 2005;20:1572–1577.
[PubMed]
17.
Laiyemo AO, Murphy G, Sansbury LB, et al: Hyperplastic polyps and the risk of adenoma recurrence in the polyp prevention trial. Clin Gastroenterol Hepatol 2009;7:192–197.
[PubMed]
18.
Jass JR: Hyperplastic polyps and colorectal cancer: is there a link? Clin Gastroenterol Hepatol 2004;2:1–8.
[PubMed]
19.
Jass JR, Young PJ, Robinson EM: Predictors of presence, multiplicity, size and dysplasia of colorectal adenomas. A necropsy study in New Zealand. Gut 1992;33:1508–1514.
[PubMed]
20.
Grady WM, Carethers JM: Genomic and epigenetic instability in colorectal cancer pathogenesis. Gastroenterology 2008;135:1079–1099.
[PubMed]
21.
Jass JR, Young J, Leggett BA: Hyperplastic polyps and DNA microsatellite-unstable cancers of the colorectum. Histopathology 2000;37:295–301.
[PubMed]
22.
Jass JR, Iino H, Ruszkiewicz A, et al: Neoplastic progression occurs through mutator pathways in hyperplastic polyposis of the colorectum. Gut 2000;47:43–49.
[PubMed]
23.
Chan TL, Zhao W, Leung SY, et al: BRAF and KRAS mutations in colorectal hyperplastic polyps and serrated adenomas. Cancer Res 2003;63:4878–4881.
[PubMed]
24.
Jass JR, Baker K, Zlobec I, et al: Advanced colorectal polyps with the molecular and morphological features of serrated polyps and adenomas: concept of a ‘fusion’ pathway to colorectal cancer. Histopathology 2006;49:121–131.
[PubMed]
25.
Croizet O, Moreau J, Arany Y, et al: Follow-up of patients with hyperplastic polyps of the large bowel. Gastrointest Endosc 1997;46:119–123.
[PubMed]
26.
Chung SJ, Kim YS, Yang SY, et al: Prevalence and risk of colorectal adenoma in asymptomatic Koreans aged 40–49 years undergoing screening colonoscopy. J Gastroenterol Hepatol 2010;25:519–525.
[PubMed]
27.
Choe JW, Chang HS, Yang SK, et al: Screening colonoscopy in asymptomatic average-risk Koreans: analysis in relation to age and sex. J Gastroenterol Hepatol 2007;22:1003–1008.
[PubMed]
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