Update on Problem Polyps in the Colon

The majority of polyps in the colon are hyperplastic polyps, adenomas, and inflammatory polyps (Table 1). Pathologists usually receive material in the form of biopsies or endoscopic polypectomy specimens. The role of the pathologist is to establish a diagnosis, or at least to be able to put it into one of the general polyp categories, and to determine whether the lesion has been adequately excised. The clinical management often depends on the specifics in the pathology report. It is important to realize that a biopsy of a polypoid lesion is similar to examining the “tip of the iceberg”. Thus, it is important to know the endoscopic appearance of the polyp prior to making any final decision regarding the nature of the lesion. This lecture will not provide a detailed summary of all of the polypoid lesions of the colon, but, instead, will focus on diagnostically difficult and new and controversial areas regarding polyps in the colon. Emphasis will be placed on hyperplastic, serrated and adenomatous polyps, in both the sporadic and IBD setting.