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. 2023 May 26;15(11):2934. doi: 10.3390/cancers15112934

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© 2023 by the authors.

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

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The serrated pathways of CRC tumorigenesis. Traditional serrated pathways develop in the distal (left) side of the colorectum and are linked to KRAS mutations. Alternatively, sessile serrated pathways develop in the proximal (right) side of the colorectum and are enriched in the BRAF (V600E) point mutation. From the normal colon tissues, microvesicular hyperplastic polyps (MVHPs) form that are the precursors to sessile serrated adenomas (SSAs). SSAs then develop into CRCs, and display microsatellite instability (MSI) if MLH1 is epigenetically silenced.