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PubMed1985

The histopathology of bleeding from polyps and carcinomas of the large intestine.

Carcinomas, adenomas and nonneoplastic polyps of the large intestine were examined histopathologically for evidence of recent and old hemorrhage. Three percent of the carcinomas lacked evidence of hemorrhage, as did 7% of the adenomas. Fifty percent of hyperplastic polyps were negative for hemorrhage, but 23% had considerable hemorrhage or hemosiderin. These findings may have a bearing on the results in fecal occult blood testing for the detection of cancer. Carcinomas bleed mainly from erosions on their luminal surface, but adenomas rarely show this feature. Twisting and bending of polyps, leading to fracture of fronds, and vascular obstruction, with passive congestion and stromal hemorrhage, appear to be the main sources of bleeding in polyps. Adenomas on the left side of the large intestine showed greater evidence of bleeding than did lesions on the right, but carcinomas did not show this relationship. Factors correlated with more severe hemorrhage were size, pedunculation, and villous growth of adenomas; for carcinomas, they were size, lack of mucin content, and lower differentiation. The age and sex of the patient and the extent of spread of carcinomas did not correlate with hemorrhage.

Adenoma↗
PubMed1988

Family history of colorectal cancer as a risk factor for benign and malignant tumours of the large bowel. A case-control study.

The relationship between first degree family history of colorectal cancer and the risk of benign or malignant tumours of the large bowel was investigated in a case-control study. Two groups of cases (283 patients with adenomatous polyps and 414 patients with adenocarcinoma of the large bowel) and 2 groups of controls (399 polyp-free subjects and 456 hospitalized patients) were interviewed. Since no difference in the frequency of family history between the 2 control groups was detected, these were lumped together. A 3-fold increase in risk of adenomatous polyps in relatives of patients with colon cancer was observed (OR = 3.18, 95% CI 2.06-4.89). The relative risk of colorectal cancer among relatives of patients with adenocarcinoma was 2.36 (95% CI 1.54-3.60). No significant difference in the frequency of first degree relatives with a history of cancer of the large bowel was detected between patients with colorectal cancer and those with adenomatous polyps. When only history of colorectal cancer among parents was considered, the results closely paralleled those of the previous analysis.

Adenoma↗
PubMed1985

Tissue CEA detection by immunoperoxidase (PAP) test in colorectal polyps: correlations with the degree of dysplasia.

We study the presence of Carcinoembryonic antigen (CEA) on 39 colorectal polyps by the immunoperoxidase technique. The histological examination demonstrated 15 tubular adenomas, one villous adenoma, two tubulo-villous adenomas, six tubular adenomas with slight dysplasia, one tubular adenoma with moderate dysplasia, four tubular adenomas with severe dysplasia, three tubulo-villous adenomas with severe dysplasia, five tubular adenomas with neoplastic degeneration, and two tubulo-villous adenomas with neoplastic degeneration. Twenty-eight of thirty-nine polyps (71.79%) showed a positive staining reaction for CEA. Regarding the intensity of the reaction (classified as absent or negative [-], slightly positive [+], and markedly positive [+ +]), 11/39 polyps presented a negative reaction (28.21%), 19/39 (48.71%) presented a slight reaction, and 10/39 polyps (25.64%) presented a marked reaction. Results demonstrated a higher intensity of the staining reaction in severely dysplastic polyps and in neoplastic degeneration. In conclusion, it is possible that the presence of CEA can be useful to show an initial cellular restlessness of certain polyps.

Adenoma↗
PubMed1991

Benign lymphoid polyposis of the colon. Report of a case in an adult.

A new case of benign lymphoid polyposis of the colon in an adult is presented. Relatively frequent in childhood, this disease remains exceptional in adults. The main concern is differentiation from adenomatous polyposis; the differential diagnosis can be particularly difficult for complex forms of polyposis with coexistent adenomatous and lymphoid polyps. Benign lymphoid polyposis of the colon does not appear to have any propensity for malignant degeneration, and major surgical resection is not indicated.

Colonic Neoplasms↗
PubMed1987

The Melbourne Colorectal Cancer Study. Characterization of patients with a family history of colorectal cancer.

The characteristics of 702 colorectal cancer patients are described in relation to the presence of absence of a family history of colorectal cancer in near relatives. No statistically significant associations were found between those with a family history of colorectal cancer and age at detection, sex, country of birth, religion, number of cancers (single, synchronous, or metachronous), previously removed benign colorectal polyps, and adenomatous polyps found in the resection specimen. The family history rate of colorectal cancer for colon cancer cases was statistically significantly higher than for rectal cancer cases (chi 2(1) = 3.8, P = .05) and there was a gradient of decreasing risk from colon to rectum. The family history rate of colorectal cancer in parents of those who were less than 50 years old was twice that of those 50 or older (P = .07), consistent with the view that earlier age of onset is a characteristic of those with a family history of colorectal cancer. There was a statistically significantly higher family history rate of colorectal cancer in respondents who knew of the disease compared with those who did not (chi 2(1) = 5.5, P less than .05). It is unclear if this effect represents recall bias or self-selection bias. In contrast, the rates for a family history of heart disease and stroke were similar, irrespective of the respondent's knowledge of their colorectal cancer status. Thus in the Melbourne study, the family history rate of colorectal cancer was higher in colon cancer than in rectal cancer, there was a decreasing gradient of risk from colon to rectum, and a tendency for earlier age of onset of colorectal cancer in those with a history of this cancer in a parent.

Age Factors↗
PubMed1986

Clinical features in familial polyposis coli. Results of the Danish Polyposis Register.

Three hundred nineteen affected members of 94 Danish families with familial polyposis coli had been registered in the Danish Polyposis Register by the end of 1982. Of the 247 histologically verified cases, 168 were propositi and 79 were call-up patients. The frequency of colorectal cancer at the time of diagnosis of polyposis was 69 percent in propositi vs. 3 percent in call-up patients. The cumulative survival rate after ten years was 97 percent in call-up patients, as compared to 42 percent in propositi. The prognosis of polyposis patients has improved significantly since the establishment of the Danish Polyposis Register in 1971.

Adolescent↗
PubMed1987

The role of preoperative colonoscopy in colorectal cancer.

Routine preoperative colonoscopy has been recommended for those patients with the diagnosis of colorectal cancer to identify synchronous polyps and/or cancers which might otherwise be undetected on barium enema or at the time of operation. It has been suggested that this approach may alter surgical therapy or follow-up. The charts of 98 patients who underwent preoperative colonoscopy solely for the purpose of detecting additional polyps or cancers prior to open surgical resection for colorectal cancer were retrospectively reviewed. All patients had biopsy or barium-enema evidence of colorectal cancer. Patients with familial polyposis or chronic ulcerative colitis were excluded. Synchronous cancers were detected in 7.1 percent of patients, and synchronous neoplastic polyps in 29 percent. Forty-three percent of synchronous cancers and 73 percent of synchronous neoplastic polyps would not have been included in the standard surgical resection for the index cancer if the additional information provided by colonoscopy had not been available. Surgical treatment and/or follow-up were altered in 33 percent of patients as a consequence of the colonoscopic evaluation. Colonoscopy prior to surgery for colorectal carcinoma is highly desirable and may potentially improve long-term survival.

Adult↗
PubMed2005

Histologic risk factors and clinical outcome in colorectal malignant polyp: a pooled-data analysis.

PURPOSE: The malignant polyp carries a significant risk of lymphohematic metastasis and mortality. Clinical usefulness of histologic risk factors is still controversial. The study was designed to compute the association between the main histologic risk factors and the occurrence of unfavorable outcomes in patients with malignant polyps. METHODS: A MEDLINE search regarding malignant polyps was performed. Three histologic risk factors (positive resection margin, poor differentiation of carcinoma, vascular invasion) and five (residual disease, recurrent disease, lymph node metastasis, hematogenous metastasis, mortality) unfavorable clinical outcomes were evaluated. Further analysis was performed by subgrouping polyps in high-risk and low-risk groups. RESULTS: Thirty-one studies enrolling 1,900 patients with malignant polyp were selected. Positivity of resection margin was significantly predictive of the presence of residual disease (odds ratio, 22; P < 0.0001), poorly differentiated carcinoma was associated with an increased mortality (odds ratio, 9.2; P < 0.05), and vascular invasion with a higher lymph node metastasis risk (odds ratio, 7; P < 0.05). Patients with high-risk polyps showed a significantly worse outcome than those with low-risk, especially for mortality (odds ratio, 11; P < 0.05). Surgical-related death was as low as 0.8 percent. CONCLUSIONS: All three histologic risk factors are significantly associated with the clinical outcome. Classification in low-risk and high-risk patients may be regarded as a meaningful staging procedure.

Carcinoma↗
PubMed1985

Hereditary nonpolyposis colorectal cancer (Lynch syndromes I and II): a common genotype linked to oncogenes?

We hypothesize that: hereditary nonpolyposis colorectal cancer (HNPCC) accounts for a significant proportion of the colon cancer burden; the premalignant colonic mucosa in HNPCC patients may be comparable in many respects to the premalignant polyps in its hereditary multiple adenomatous polyposis counterpart; and finally, study of HNPCC colonic mucosa may harbor important clues for elucidation of the multistep process of carcinogenesis, including relationships between activated oncogenes, genetics, and environmental perturbations.

Adenoma↗
PubMed2002

Synchronous proximal polyps and cancer in patients with polyps detected at sigmoidoscopy: results of a single, rural-based sigmoidoscopy clinic.

The prevalence of polyps and cancer in the proximal colon among patients who have polyps detected on sigmoidoscopy was determined in a large rural referral hospital in north central Pennsylvania. Eleven thousand one hundred sixty patients underwent sigmoidoscopy between 1991 and 1997. Polyps were detected in 709 patients. Five hundred twenty-three patients who had a polyp at sigmoidoscopy and full colonoscopy completed within one year were included in this study. 120 patients (23%) had a proximal polyp detected at colonoscopy. The prevalence of proximal polyps and histologically advanced polyps was related to the size, number, and histology of the distal index polyp found at sigmoidoscopy. However, the absolute difference in prevalence of proximal polyps stratified by dings at sigmoidoscopy was small. A total of 5 adenocarcinomas were detected in the proximal colon. All proximal cancers detected at colonoscopy occurred in patients with a distal polyp less than 10 mm. Our data emphasize the importance of colonoscopy in all patients with a polyp detected at sigmoidoscopy independent of its size and histology.

Adenocarcinoma↗
PubMed1986

Elevated production of growth factor by human premalignant colon adenomas and a derived epithelial cell line.

Growth factor activity which stimulates anchorage-independent growth (AIG) in a rat fibroblast line, was detected in human premalignant adenoma tissue from familial polyposis coli colectomy specimens and in serum-free culture supernatant from an adenoma cell line PC/AA. The activity extracted from adenoma tissue was compared quantitatively in the AIG bioassay with extracts of normal mucosa from split thickness colorectal tissue. Adenoma tissue yielded three times the amount of acid-extractable protein g-1 wet wt and adenoma extracts consistently had significantly greater specific activity over a wide protein concentration range. Activity extracted from adenoma tissue and from the derived cell line PC/AA were compared qualitatively after fractionation by gel filtration. Both extracts showed almost identical profiles of biological activity after assay of individual fractions for AIG stimulation, suggesting that the factor(s) originates from the epithelial component of the adenoma tissue since PC/AA is a pure epithelial cell line. Activity eluted as two major peaks with apparent mol. wts of 9 kd and 20-25 kd (relative to standards) in both cases. This report demonstrates for the first time that elevated production of a growth factor may be an early change in the evolution of human colorectal cancer from small, premalignant adenomas.

Adenoma↗
PubMed1997

Small colorectal serrated adenomas: endoscopic findings.

BACKGROUND AND STUDY AIMS: Serrated adenomas are a distinct form of colorectal neoplasia. Several reports have indicated that serrated adenomas may give rise to invasive adenocarcinoma. The present study describes the endoscopic findings in 54 colorectal serrated adenomas detected in 35 patients. PATIENTS AND METHODS: Thirty-five of 1225 patients (2.9%) who underwent colonoscopy during 1993 in the gastrointestinal endoscopy section at Karolinska Hospital (22 men, 13 women; mean age 68 years, range 49-84 years) were found to have a total of 182 polyps, including 118 adenomas and 64 hyperplastic polyps at histopathology. Fifty-four of the 118 adenomas (46%) were of the serrated type. In two of the 35 patients, two large exophytic colorectal adenocarcinomas were also present. RESULTS: Twenty-nine of the serrated adenomas (53.5%) were flat, 23 were sessile (42.5%), and two were pedunculated (4%). The mean sizes of the flat and sessile lesions were 3.5 mm (range 2-10 mm) and 5.9 mm (range 2-20 mm), respectively. The endoscopic appearance of serrated adenomas of 5 mm or less (n = 39, 72%) was similar to that of hyperplastic polyps. Forty-two (78%) of the lesions were located in the sigmoid and rectum. Fifty-one lesions showed low-grade dysplasia (including one with microinvasive carcinoma), and the remaining three had high-grade dysplasia. CONCLUSIONS: The study suggests that small polyps with a hyperplastic appearance should not be regarded as innocuous, since they may represent serrated adenomas carrying a malignant potential.

Adenoma↗
PubMed1987

Practical aspects of endoscopic management of malignant polyps.

World experience now overwhelmingly supports the policy of conservative management by endoscopic snare polypectomy of "focal" cancer in polyps (malignancy in adenomas and polypoid carcinomas), providing that the polyp is pedunculated and that endoscopic and histological criteria are favorable. Invasion to within 2-3 mm of the snare-resection line is acceptable, providing that the advancing tumour margin is well-circumscribed. Unfavourable characteristics include poorly differential tumour, involvement of stalk vessels, and sessile configuration. This management policy applied to 90 patients between 1971 and 1981 resulted in successful 5-year follow-up of the 74 patients treated by polypectomy alone. Among the 16 patients managed surgically, no local lymph nodes were involved in any case, although 4 patients were found to have residual local tumour at the polypectomy site.

Biopsy↗
PubMed1988

[Are filiform fibromas of the skin a marker for colonic neoplasia?].

750 consecutive out-patients undergoing diagnosis for possible disease of the colon but no history of colon neoplasia were examined for skin tags (achrocordons). They were found in 257 patients, in 30 as multiple (greater than five) lesions. Benign adenoma of the colon was found with similar frequency in patients with (27.6%) and without (22.1%) tags. However, colon carcinoma was twice as frequent in patients with skin tags (8.2%) than controls (4.1%). Patients with multiple tags had an even higher risk of colon carcinoma (odds ratio 7.8; 95% confidence limits 2.2-24.4; P less than 0.01) and a slightly increased risk of benign colon adenoma (odds ratio 2.4; 95% confidence limits 0.9-6.0; P less than 0.05). Whether this association is important in the diagnosis of colon tumours should be tested further by investigating healthy subjects with skin tags.

Aged↗