Sessile serrated adenoma

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Author: Mikael Häggström [note 1]


Microscopic examination

The characteristics of sessile serrated adenoma are:[1]

  • Sawtooth serrations of the epithelium
  • Abundant mucin, similar to hyperplastic polyps
  • Basal crypt dilation, with mucous retention, and lateral spread of the crypt bases, commonly described as boot shaped or anchor shaped crypts.


On low magnification, a sessile serrated adenoma may be flat (left) or protuberant (right):[2]

Variations on higher magnification:

Microscopic report

A brief report is sufficient:

Cecum polyp, polypectomy:
Sessile serrated adenoma.

Differential diagnoses

Regarding location, the diagnosis of a sessile serrated adenoma is supported by a location within the proximal colon (cecum, ascending, and transverse colon), while hyperplastic polyps are most common in the sigmoid colon and rectum. However, both may occur throughout the colon.[4][5]


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

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  1. Enoch Kuo, M.D., Raul S. Gonzalez, M.D.. Colon - Polyps - Sessile serrated adenoma. PathologyOutlines. Topic Completed: 1 January 2018. Minor changes: 1 October 2020
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Liu, Cheng; Walker, Neal I; Leggett, Barbara A; Whitehall, Vicki LJ; Bettington, Mark L; Rosty, Christophe (2017). "Sessile serrated adenomas with dysplasia: morphological patterns and correlations with MLH1 immunohistochemistry ". Modern Pathology 30 (12): 1728–1738. doi:10.1038/modpathol.2017.92. ISSN 0893-3952. 
    - "This work is licensed under a Creative Commons Attribution 4.0 International License."
  3. Torlakovic, Emina Emilia; Gomez, Jose D.; Driman, David K.; Parfitt, Jeremy R.; Wang, Chang; Benerjee, Tama; Snover, Dale C. (2008). "Sessile Serrated Adenoma (SSA) vs. Traditional Serrated Adenoma (TSA) ". The American Journal of Surgical Pathology 32 (1): 21–29. doi:10.1097/PAS.0b013e318157f002. ISSN 0147-5185. 
  4. Author: Adrian C. Bateman, M.B.B.S., M.D.. Colon - Polyps - Hyperplastic polyp. Pathology Outlines. Minor changes: 23 September 2021
  5. David Driman, MBChB FRCPC. Sessile serrated adenoma of the colon. MyPathologyReport. Updated July 23, 2021

Image sources