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Relationship of polyps to cancer of the large intestine.

BACKGROUND: Pathologic and epidemiologic evidence indicates that patients with sporadic (nonfamilial) adenomatous polyps of the large intestine are at high risk of developing colorectal cancer. PURPOSE: Our primary goal in this study was to evaluate the colorectal cancer mortality rate among persons who have had a histologically confirmed benign colorectal polyp. METHODS: We used the retrospective follow-up method to evaluate the risk of death from colorectal cancer in 2872 Rhode Island men and women who were 24 through 79 years of age at the time of surgery for benign polyps in the years 1959 through 1975. RESULTS: Among 2872 subjects, the mortality from colorectal cancer, standardized for age, sex, and calendar time, was estimated as 1.74 (95% confidence interval = 1.44-2.09) times the rate in the general population of Rhode Island residents. Colorectal cancer mortality was higher in the first 5 years of follow-up than it was later. There was little relationship between the numbers of polyps and colorectal cancer mortality, and there was only a modest association between the size of polyps and mortality. Colorectal cancer mortality was more than twice as high in subjects whose polyps were proximal to the sigmoid compared with those with sigmoid or rectal polyps. The observed elevation of risk of colorectal cancer was almost entirely confined to subjects who had an adenomatous polyp. The risk increased strongly with the percentage of villous features in the polyp and was about twice as high in subjects with villous adenoma than in those with other adenomatous polyps. CONCLUSIONS: Our results support the suspected relationship between colorectal polyps and cancer incidence and extend the association to colorectal cancer mortality.

Adult↗

[Endoscopic treatment of polyps of the large intestine: authors' experience with 250 cases of polypectomy].

The Authors report their experience of endoscopic polipectomy. This technique represents a gold standard treatment for polyps of the colon-rectum because it is safe and effective, being correlated with low-risk of complications as perforation and hemorrhage. Hospitality stay was only 24-48 hours. The polyps were histologically examined and grade of dysplasia was determined. The patients underwent surgical resection of the colon when an invasive carcinoma was found.

Adult↗

Primary intestinal cryptococcosis mimicking adenomatous polyp in an HIV-negative patient.

Primary cryptococcal infection is thought to arise in the lungs, whereas secondary lesions may be found anywhere in the body. Because intestinal involvement is rare, especially in nonimmunocompromised patients, little is known about this localization. Nevertheless, the intestinal tract has long been suggested a possible portal of entry of Cryptococcus neoformans, although the hypothesis has never been sufficiently documented. We report an isolated cryptococcosis of the sigmoid colon mimicking an adenomatous polyp. The lesion has an endoscopic interest, being the first of its kind reported in the literature, and a more important pathogenic interest, as it highlights a further pathway of cryptococcal infection, one of major importance in immunocompromised patients.

Adenomatous Polyps↗

DNA flow cytometry of large-bowel biopsies showing that adenoma tissue predicts the ultimate nature of the lesions.

Ploidy of neoplastic large-bowel cells in lesions from which biopsies showed only adenoma tissue by histopathologic examination was investigated retrospectively by DNA flow cytometry. Biopsy and resected-specimen blocks gave interpretable ploidy profiles from 83 lesions. The expectation that adenomas will show diploidy in biopsies and that adenocarcinomas will show aneuploidy in biopsies was fulfilled in 80% of the lesions. In addition, four lesions with diploid biopsies were polyps with minimal invasion. Thus, diploidy would have correctly predicted that local resection was adequate treatment for 62 lesions and conversely that cancer resection was the appropriate treatment for 8 lesions, for an overall predictive success rate of 87%. In conjunction with endoscopic, radiologic and other data, DNA flow cytometry of biopsies from apparently benign large-bowel lesions could become a useful addition to therapeutic decision-making.

Adenocarcinoma↗

Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome is inherited as an autosomal dominant trait with variable incomplete penetrance. Patients with Peutz-Jeghers syndrome characteristically have hamartomatous polyps throughout their entire gastrointestinal tract, particularly in the small bowel, and mucocutaneous hyperpigmentation involving the lips, oral cavity, and skin. Although the intestinal hamartomatous polyps have a lower incidence of malignant change in the gastrointestinal tract than do adenomatous polyps, recent information suggests that the overall neoplastic transformation from Peutz-Jeghers syndrome is not a rare event.

Adenomatous Polyps↗

[Diffuse stomach cancer in the minor form of familial adenomatosis coli. Correlation or coincidence?].

We report about a 66-year-old female patient with Gardner syndrome, a special form of familial adenomatosis coli, and a stomach carcinoma occurring at the same time. Recently, there have been more reports about duodenal carcinomas and stomach polyps in intestinal adenomatosis due to an improvement in diagnostic methods. The concomitant occurrence of a stomach carcinoma is, however, a very rare finding. So far, altogether 10 case histories have been published world-wide. The case presented here and a review of the literature again lend current interest to the hypothesis formulated by Amman in 1976 according to which the occurrence of a stomach carcinoma in connection with a Gardner syndrome/familial adenomatosis coli, particular in the minor form of this entity (recessive hereditary course, less than 100 polyps in the intestines, occurrence of polyps in old age) must be regarded as an additional characteristic of this disease. On the basis of this hypothesis, all adenomatosis patients should undergo gastroscopy.

Aged↗

Bannayan-Riley-Ruvalcaba syndrome: spectrum of intestinal pathology including juvenile polyps.

Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a disorder that includes juvenile polyposis as part of its pathologic spectrum, and it recently has been shown to share phenotypic and genotypic features with Cowden's disease. In existing literature, descriptions of intestinal pathology in patients with BRRS are relatively sparse and occasionally erroneous. We describe the intestinal pathology in multiple specimens from three children with BRRS. Examination of gastrointestinal biopsies from these children revealed predominantly colonic and rectal polyps with the histology of juvenile polyps. Additionally, two cases with clusters of ectopic ganglion cells within the lamina propria, one in a colonic polyp and one in a duodenal biopsy, and an atypical polyp were observed. Bannayan-Riley-Ruvalcaba syndrome should be included in the list of differential diagnostic considerations when a child or young adult presents with a juvenile polyp, particularly if unusual histologic features such as atypical polyps or ectopic ganglion cells are encountered.

Adenomatous Polyposis Coli↗

Adrenal adenomas and adrenal carcinomas in association with hereditary adenomatosis of the colon and rectum.

Hereditary adenomatosis of the colon and rectum (HACR) is associated with a wide variety of extracolonic manifestations. Two cases of neoplasia involving the adrenal gland are reported, one adenoma and one carcinoma. The literature relating these lesions to HACR and other syndromes of malignant and nonmalignant growth disturbance is reviewed. The increasing list of the extracolonic manifestations associated with HACR emphasizes the generalized nature of the growth disorder of this disease. An increased awareness of these lesions is important, as many patients with HACR now live longer by avoiding death from colorectal carcinomas due to the increasing usage of prophylactic colectomy.

Adenoma↗