Serrated polyposis syndrome, also called hyperplastic polyposis, is a condition characterized by numerous neoplastic polyps throughout the colon and rectum. The polyps possess a distinct serrated morphology. The term serrated refers to the ‘saw-tooth’ pattern formed by epithelial cells in the colonic crypts on standard histologic preparations. Historically, serrated lesions have been lumped together under the term ‘hyperplastic polyps’, and were assumed to carry no malignant potential. Over the past decade, however, an increasing body of evidence suggests that serrated lesions exist along a spectrum and represent an alternative molecular pathway to the development of colorectal cancer in contrast to the traditional adenocarcinoma sequence. Although a hallmark genetic signature for serrated polyposis syndrome remains unidentified, this is an area of active investigation.