Serrated polyps of the gastrointestinal tract- evolving concepts: A review article


Hyperplastic polyps with serrated morphology are known to have increased neoplastic progression. They show characteristic epigenetic alterations too and are difficult to diagnose on endoscopy. Histopathology is necessary for evaluation and confirmation with further molecular studies for management. A brief discussion of serrated polyps with newer concepts based on recent articles is hereby reviewed.



Introduction : India achieved the elimination goal of leprosy, at the national level with prevalence rate of 0.88/10, 000.In coastal districts of Andhra Pradesh the annual new case detection rate is 1.4/10,000. In District leprosy centers of Andhra Pradesh the diagnosis of leprosy is based on the number of patches  and nerve involvement .Bacillary load is not done routinely in all the cases by slit skin smears at the District leprosy centers. Early cases and atypical presentation of Hansen’s disease are likely to be missed at the District leprosy centers.

Aim :
1. To know the distribution of Hansen’ disease in the
three districts of coastal Andhra Pradesh.
2. To assess the
role of histopathology and Fite faraco stain in diagnosing various types of Hansen’ disease in correlation with
clinical features.

Materials and Methods : This is a prospective study for a period of one year from January 2008 to December 2008.The newly registered cases at the District leprosy centers were reviewed. The data was obtained from the records of respective district leprosy centers of the three districts of coastal Andhra Pradesh; Visakhapatnam, Vizianagaram and Srikakulum. Total number of new cases
registered in these three districts was 1050. These cases were analyzed with respect to modalities of diagnostic methods adopted and response to therapy. Out of 1050 new cases registered in 915 cases the diagnosis was made by the District Medical Officer with ease basing on the WHO guidelines using the clinical criteria of number of patches. These 915 cases were administered multidrug
therapy and were followed up at District leprosy center, with good response to therapy. In 135 cases the medical officers at District leprosy centers found it difficult to evaluate and manage the cases, hence the cases were referred to the dermatology department at the Medical College for evaluation and management. At the Medical College out of 135 cases referred from District leprosy center, in 92 cases a definitive diagnosis of leprosy was possible with clinical picture and slit skin smears. In 43 cases the results of slit skin smears did not correlate with clinical findings, hence skin biopsy was done in these forty three cases and sent for histopathological examination to the Department of pathology. The sections were stained with Hematoxylin and Eosin and modified Ziehl Neelsen’s (Fite- faraco) stain.

Results : In these three districts the newly registered cases of leprosy for a period of one year was 1050. Adult to child ratio was 4.4:1 and male to female ratio was1.3:1. In 87.14% of cases the diagnosis of leprosy was possible at the District leprosy centers basing on the WHO classification. In rest of the cases (12.85%), the diagnosis was not possible at District leprosy units and was referred to the tertiary care centre. Out of 135 cases referred from District leprosy units to the dermatology department at the Medical College, in
92 cases diagnosing of leprosy was made based on the clinical features and slit skin smears. Out of these 92 cases, in 37 cases the diagnosis was lepromatous leprosy and in 55 cases the diagnosis was tuberculoid leprosy. In 43 cases definitive diagnosis could not be made out, with the help of slit skin smears and these cases were biopsied and sent for histopathological examination. The overall
clinico histopatholgical correlation was 67.4%. Maximum number of cases showing clinico histopathological correlation were lepromatous leprosy (77.7%) followed by borderline tuberculoid (70.83%) and borderline lepromatous (66.6%). In fourteen cases
(32.5%), clinical diagnosis did not correlate with histopathology and bacillary index. In eight cases with clinical diagnosis of borderline lesions (borderline lepromatous and borderline tubercuolid) and two cases with clinical diagnosis of lepromatous leprosy, turned out
to be indeterminate leprosy on histopathology with bacillary index. One old case of treated Hansen’s disease ten years back, presented with a small nodule on the back with clinical diagnosis of dermatofibroma, histopathology combined with bacillary index showed the features of Histoid Hansen’s. Three cases with clinical diagnosis of leprosy turned out to be chronic dermatitis on histopathology
with negative bacilli.

Conclusion : Diagnosing polar groups of leprosy by clinical criteria at district leprosy center is very high but for accurate subtyping of borderline lesions, detecting early lesions of leprosy, histopathological examination and bacillary index is very essential. Hence in view of the decline in the prevalence of leprosy after multidrug therapy, and the basis of diagnosing leprosy being mainly on clinical  features, all the newly detected cases of leprosy registered at the District leprosy centers should undergo histopathological examination and measure the bacillary index in order to accurately subtype the lesions.