A 62-year-old man undergoes screening colonoscopy. Three polyps are identified: a 2 cm sessile serrated polyp in the cecum, a 6 mm tubular adenoma in the transverse colon, and a 1 cm hyperplastic polyp in the sigmoid. Which polyp carries the highest risk of progression to colorectal cancer?

• A Tubular adenoma (transverse colon)
• B Sessile serrated polyp (cecum) ✓
• C Hyperplastic polyp (sigmoid)
• D Inflammatory polyp (if present)

Explanation

Sessile serrated polyps (SSPs) greater than 1 cm in the proximal colon have a significant malignant potential via the serrated neoplasia pathway, involving BRAF mutation and CpG island methylation. Tubular adenomas have lower risk, and hyperplastic polyps are generally benign unless part of serrated polyposis syndrome.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.