Jihan Fathallah, MD1, Mohammed Al-Jumayli, MD2, Donya R. Jahandar, BA3, Reza Hejazi, MD1, Chase Young, MS4
1Kansas City University of Medicine and Biosciences, Kansas City, KS; 2Kansas City University of Medicine and Biosciences, Kansas CIty, KS; 3University of Kansas Medical Center, Kansas City, MO; 4University of Missouri, Kansas City, MO
Introduction: Sessile serrated adenomas (SSAs) are precursors for 20% of microsatellite unstable colon cancers with the CpG island methylator phenotype. They are the result of a BRAF mutation and promoter hypermethylation of tumor suppressor genes or mismatch repair genes. Eighty percent of SSA harbor BRAF V600E mutation with some having KRAS mutation. BRAF V600E mutation can lead to different kinds of malignancies. Therefore, we conducted a retrospective study to assess the association between SSAs and extra-colonic malignancies.
Methods: We performed a retrospective study of patients diagnosed with SSA on colonoscopies done in Kansas University Medical Center from 2016 to 2018. The diagnosis of SSA was confirmed by histologic exam interpreted by pathologists. The group of SSA patients was compared to patients diagnosed with non-SSA polyp (control group).The electronic records were reviewed for data extraction regarding demographics and extracolonic malignancies.
Results: 400 patients were diagnosed with SSA from 2016 to 2018 compared to 372 patients with tubular/villous adenomas. The majority of patients in SSA and non-SSA groups were Caucasians (92% and 84.5% respectively). Mean age in group of SSA was higher than control group (age 65±11 vs 55age±10). Underlying morbidity i.e. obese/overweight (43.75% vs 24.5%), and HTN (51.25% vs 21%) were more common in SSA group. The two groups demographics are shown in table1. 60% of patients with SSA, including 6.25% of patients with skin cancer and 5.5% of those with breast cancer, had family history of cancer in first degree relative. Only 2.75% of patients with SSA had history of different organ transplant. Thirteen extra-colonic malignancies were identified (Table2). Patients with SSA had significantly higher rates of skin cancers including, non melanoma skin cancer (12%) and breast cancer (8.25%) compared to non-SSA patients (6.2%, and 3%, p-values < 0.05 respectively).
Discussion: To our knowledge this is the largest study of the association between SSA and extra-colonic malignancies.We found a significant association between breast and skin cancer with SSA. This could be potentially explained by presence of BRAF V600E mutation in SSA which is a precursor for different types of tumors especially melanomas. We suggest prospective studies are needed to determine whether patients with SSA should have more expanded and different cancer screening tests. Until then we emphasize the importance of skin exams and screening mammograms for patients with SSA.
Citation: Jihan Fathallah, MD; Mohammed Al-Jumayli, MD; Donya R. Jahandar, BA; Reza Hejazi, MD; Chase Young, MS. P0105 - ASSOCIATION BETWEEN SESSILE SERRATED ADENOMA AND EXTRA-COLONIC MALIGNANCIES. Program No. P0105. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.