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PubMed2006

Sessile serrated adenomas of the large bowel. Clinicopathologic and immunohistochemical study including comparison with common hyperplastic polyps and adenomas.

Sessile serrated adenoma (SSA) is a newly characterized type of the large bowel adenoma. It arises in hyperplastic polyp (HP) and represents a precursor lesion of colorectal carcinoma with microsatellite instability. SSAs differ from common HPs by abnormal proliferation of the crypt epithelium and by nuclear atypia. We examined 15 SSAs from 15 patients. The age range was 25-80 years (average 60 years). Six patients were females and 9 were males. For comparison, we examined 10 conventional tubular adenomas and 10 common HPs with vesicular cells. The sites of SSAs were as follows: 8 in rectum, 4 in rectosigmoid colon, 1 in transverse colon, 1 next to mucinous carcinoma of ascending colon, 1 in anastomosis after resection of the transverse colon adenocarcinoma. The diameter of the lesions ranged from 5 to 12 mm. Histologically, SSAs showed asymmetrical proliferation of the epithelium, irregular shape of the crypts with their branching and some crypt dilatations especially in the basal parts of the crypts. Cellular atypia (dysplasia) was usually low. In 5 cases the nuclei were focally stratified and localized in the lower part of the cells. High-grade dysplasia was found only in SSA adjacent to mucinous adenocarcinoma. Immunohistochemically, SSAs showed secretion of gastrointestinal mucin expressing MUC2 and MUC5A. Both MUC2 and MUC5A were also positive in mucinous carcinoma. In previous studies these expressions were considered specific for serrated type of carcinogenesis. However, our study found positivity of MUC2 and MUC5A also in conventional adenomas. Expression of p53 in SSAs was minimal. SSAs have malignant potential comparable with conventional adenomas and for this reason they must be distinguished from HPs.

Adenoma↗
PubMed1988

A randomized trial of vitamins C and E in the prevention of recurrence of colorectal polyps.

Because supplements of vitamins C and E had been associated with reduction of fecal mutagen levels, a double-blind randomized trial was designed to examine the effects of these vitamins on the rate of recurrence of colorectal polyps, presumed precursors for colorectal cancer. Two hundred patients believed to be free of polyps after removal of at least one colorectal polyp were randomized to receive a supplement of 400 mg each of ascorbic acid and alpha-tocopherol, or a placebo. Fifteen patients had to be excluded because a review of pathology indicated that their polyps were not adenomatous. A second colonoscopic examination was planned after 2 yr of supplementation. One hundred thirty-seven people (75% of eligible subjects) completed the study; polyps were observed in the second colonoscopy in 41.4% of 70 subjects on vitamin supplements and in 50.7% of 67 subjects on placebos. After adjustment for differences between groups in demographic and dietary factors before study entry, the relative risk of polyp occurrence was 0.86, with 95% confidence limits from 0.51 to 1.45, in an analysis of 129 subjects with complete information on demographic and dietary factors who had completed the trial. Of the 48 patients who had not completed the study, 7 had died, 33 had not returned to their physician for an examination, and 8 had had a follow-up colonoscopy or sigmoidoscopy. Inclusion of the three polyps found in these eight examinations led to an estimate of relative risk of 0.86 (95% confidence limits, 0.51 to 1.43). The findings of this investigation suggest that any reduction in the rate of polyp recurrence associated with vitamin supplementation is small, and a larger study would be required to ensure that an effect of this size was not a chance finding.

Ascorbic Acid↗
PubMed1987

[Acromegaly and colorectal proliferations].

Hypersomatotropism causes not only the typical acromegalic symptoms but also very often a splanchnomegaly with participation of the enteron. We performed a colonoscopy in 16 patients with a persistent active acromegaly in spite of full used therapy possibilities. Only in four cases (25%) we could find a polyp. They were distributed on the colon transversum (one), descendens (one) and sigmoideum (two). Three of them (histology: tubular adenoma) had a diameter of less than 5 mm. Only one adenoma had an extent of 3.5 x 3 x 2.5 cm (histology: tubular-villous adenoma). Not any polyp showed signs of malignity. There existed no relations between the coloscopic findings, the degree of activity and the duration of illness. Localisation, histology, frequency and age distribution of the found out polyps of our patients were in the range of real frequency of the occurrence of colorectalic neoplasms. We conclude: Acromegaly is correlated not more than accidentally with colorectalic neoplasms (benign, malignant). Therefore preventive medical examinations of acromegalic patients are not rich in meaning.

Acromegaly↗
PubMed1987

[Hyperplastic colorectal polyp: histological, histochemical and immunohistochemical study of 43 cases].

Forty-three solitary hyperplastic polyps removed from the colon or the rectum (HPC) were examined under light microscopy. A histochemical and immunohistochemical study was undertaken in order to evaluate semiquantitatively the nature and the distribution of epithelial mucins and the secretion of carcinoembryonic antigen (CEA). Ten HPC had a peculiar morphologic pattern (four with regenerative dysplasia and six with adenomatous foci). CEA secretion was always increased (37 per cent of cases) or highly increased (63 per cent of cases) with respect to the normal colonic mucosa. The nature and distribution of the secreted acid mucins were modified: sulfomucin was equal (25 per cent of cases) or higher (75 per cent of cases) than that in normal rectal or sigmoid colonic mucosae; sialomucin was strongly decreased in 91 per cent of cases. Some of these functional changes (CEA) are also observed in neoplastic lesions. These findings are not in accord with the hypothesis that hyperplastic polyp is a simple hyperplasia of the mucosal epithelium and suggest a disorder in cellular differentiation, particularly for the larger polyps.

Adult↗
PubMed1987

[An awareness campaign on the diagnosis and prevention of colon and rectal cancer. Planning and evaluation of its results].

Colorectal cancer is very frequent in Argentina. It is the third most frequent cancer, after skin and breast tumor in the city of Rosario. Our population usually ignores the symptoms of colonic cancer and early diagnosis are infrequent. The Societies of Gastroenterology, Oncology and Colonoproctology organizes a public awareness campaign during july, august and september 1985 in Rosario and its surrounding (population 1,300,000) by means of newspaper, radio and specially by television, describing the symptoms were present, as well as insisting of the possibility of prevention by endoscopy diagnosis and removal of polyps. Literature and pamphlets were distributed, and information letters were send to all the physicians in Rosario. An International update meeting on colon and rectal took place. The results of this campaign were evaluated through the Tumor Registry of Rosario. Since september 1984 still february 1986, the monthly incidence of polyps and cancer of the colon and rectum was recorded. The monthly average incidence of polyps was 18.9. Previous to the campaign, the monthly average of diagnosed polyps was 17.5; during the campaign, 27.5; and after it, 13.8. The monthly average of colorectal cancer was 39, before the campaign, 41; during the campaign, 49, and 26 afterwards. These results were statistically studies by the parametric test of Mann and Whitney. During the campaign a significant (p = 0.05) increase of diagnosed polyps and cancers, was found. Our conclusion is that the awareness was successful, but we think that it is necessary to insist with periodic and longer campaigns.

Argentina↗
PubMed1986

[Morphological and cytophotometric characteristics of polyps of the colon and rectum].

Material from 60 patients with colon and rectum polyps as well as "normal" mucous membrane (44 patients) taken at some distance from polyps are studied. DNA content was measured by a flow cytometry method (ICP-II) in parallel to morphological (cytological and histological) examination of biopsies. Analysis of material was performed by groups depending on the epithelial dysplasia degree in the adenomas. Diploid cells dominated in the adenomas. Significant increase of cells in S- and (G2 + M)-phases of cell cycles is noted in the adenomas with a severe epithelial dysplasia as compared to the adenomas with a mild or moderate dysplasia. Aneuploid cells are detected in 5 adenomas, 4 of them morphologically were those with a severe dysplasia including 2 cases in which it was difficult to differentiate between a severe dysplasia and carcinoma although the signs of invasion were absent.

Colonic Polyps↗
PubMedDate not supplied

[Endoscopic excision of malignant colorectal polyps. Study of a series of 82 cases].

The management of malignant colonic polyps removed by endoscopic polypectomy is a controversial subject. We reported a series of 81 patients with 82 malignant polyps removed by endoscopic polypectomy between 1977 and 1984. 15 polyps contained carcinoma in situ and were treated by endoscopic polypectomy alone. 36 polyps contained superficial cancer; 35 were treated by EP alone; 1 was treated by endoscopic polypectomy and colectomy. 26 polyps contained invasive carcinoma and 2 were classified as polypoid adenocarcinomas. 19 had clear resection margins at polypectomy and seven had involved resection margins: 17 were treated by endoscopic polypectomy alone, 9 were treated by endoscopic polypectomy and colectomy. The patients were followed with colonoscopy. Follow-up has been 6 to 74 months (mean 32 months). The patients whose polyps were treated by endoscopic polypectomy alone, had had no evidence of recurrent tumor at the polypectomy site. Of the 12 patients undergoing colectomy, 4 had residual tumor at the polypectomy site. No patients had involved lymph nodes. There was no evidence of recurrence in any of these cases. Polyps containing contained carcinoma in situ and superficial cancer, polyps containing invasive carcinoma and clear resection margins can be treated with endoscopic polypectomy alone. Polyps with invasive carcinoma and involved resection margins should undergo segmental colonic resection. This approach must be weighed against the age of the patient, the medical status and the morbidity and mortality of the surgical procedure.

Adult↗
PubMedDate not supplied

[Complex recto-colic adenomatous and hamartomatous polyposis with hyperplastic gastric polyps in a 13-year-old girl].

We report the case of a 13-year-old girl who presented mixed polyposis coli and gastric polyps. The rectal and colonic polyps were of the adenomatous and hamartomatous type (i. e. juvenile and Peutz-Jeghers polyps) without any intermediate features; in the stomach, the polyps were of the hyperplastic type. Microadenomas of the appendix and lymphoid hyperplasia of the ileum were also found. The karyotype was normal and the HLA group was A2 B12. No family history of polyps was discovered. To our knowledge no such case (complex polyposis) has been previously described. The present findings suggest that the usual pathological classification of polyposis may be arbitrary and that various pathological types may represent different aspects of the same spectrum of disease. Absence of "intermediate" polyps rule out the hypothesis of the sequence "hyperplastic polyp-juvenile polyp-adenoma".

Adolescent↗