Miller GC, Liu C, Bettington ML, et al. - Researchers performed a retrospective study to evaluate 52 traditional serrated adenoma (TSA)-like lesions arising in 30 inflammatory bowel disease (IBD) individuals and diagnosed in colectomy or endoscopic specimens. With a median size of 15 mm, the 27 colectomy lesions presented predominantly as ill-defined areas with granular appearance, located throughout the large bowel and correlated with synchronous advanced colorectal lesions in 58%. Low-grade serrated dysplasia, high-grade serrated dysplasia, TSA-type cytology were present in 56%, 37% and 7%, respectively. They distinguished increased Ki67 immunostaining and abnormal p53 expression in 96% and 48%, respectively; 74% had a KRAS mutation, and 4% a BRAF mutation. They noted that endoscopically resectable TSA-like lesions were all discrete polypoid lesions, smaller in size (median 9 mm), predominantly in the distal large bowel, with an adjacent precursor polyp in 24%, and correlated with synchronous and metachronous advanced colorectal lesions in 6%. TSA-type cytology, p53 overexpression, KRAS mutation, BRAF mutation were present in 92%, 4%, 41% and 32%, respectively. They diagnosed CRC or high-grade adenomatous IBD-associated dysplasia in 4 individuals on follow-up. They found that none of the individuals with lesions showing TSA-type cytology only established an advanced lesion. The outcomes demonstrated that some TSA-like lesions, essentially from colectomy, may represent a form of IBD-associated dysplasia correlated with an elevated risk of advanced neoplasia.