The histological heterogeneity of sessile serrated adenomas with dysplasia had been illustrated in earlier studies.24, 25, 26, 27 Our major group of dysplasia not otherwise specified exhibits a broad spectrum of architectural changes, including crowding, hyperserration and cribriform growth, while cytological changes include mucin-depleted, foveolar and hypermucinous forms. This evidence concerns the gene MUC5AC and adenoma.