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Lymphomatous polyposis. A neoplasm of either follicular mantle or germinal center cell origin.

Lymphomatous polyposis (LP) is generally thought to be an expression of non-Hodgkin's lymphoma (NHL) of follicular mantle cell (MC) origin. We report nine patients with LP from more than 3,500 cases of NHL studied by the Nebraska Lymphoma Study Group. Our patients differed from those reported previously in that LP represented a follicular center cell (FCC) NHL in two of the nine cases, with the remainder consisting of MC NHL. Three patients developed LP during a relapse of previously diagnosed and treated extraintestinal MC NHL (parotid gland, tonsil, and inguinal lymph node, respectively), whereas the other six patients presented with primary LP. In seven of the nine LP cases, a large mass predominated among a myriad of small polyps. The FCC cases were confined to the small intestine, whereas the MC cases were either pan-intestinal or colonic on their localization. Two MC cases studied by Southern blotting exhibited rearrangement of the bcl-1 locus. Bcl-2 rearrangement was not detected in any of the nine cases when studied by either a polymerase chain reaction-based assay (seven cases) or by Southern blotting (two cases). To date, four patients (three MC, one FCC) have experienced recurrent NHL in gastrointestinal sites. With follow-up ranging from 13 to 147 months, the entire group had a median survival of 41 months (primary MC LP:13, 13, 41, and 77 months; primary FCC LP:45 and 147 months; secondary MC LP:17, 41 and 76 months), and only one patient has died. We conclude that LP is a rare manifestation of NHL of either follicular MC or germinal center cell origin.

Adult↗

Colonic metaplasia of ileostomies. Biological significance for ulcerative colitis patients following total colectomy.

Two patients who had undergone proctocolectomy for ulcerative colitis developed lesions in their ileal stoma that appeared to be inflammatory polyps morphologically similar to those encountered in the large intestine of ulcerative colitis patients. One of these patients eventually developed mucinous adenocarcinoma in the ileal stoma. The ileal mucosa adjacent to the neoplasm had morphologic features of large-bowel mucosa and was richly populated by sulfomucin-containing goblet cells, which are characteristic of large-bowel mucosa. Sulfomucin-containing goblet cells were also found in the inflammatory lesions biopsied from the ileal stomas of both patients, as well as from the adenocarcinoma found in one patient. These findings support the hypothesis that colonic metaplasia can occur in ileal stomas of ulcerative colitis patients. Furthermore, the metaplastic colonic tissue is the site of origin of lesions typically found in ulcerative colitis. Colonic metaplasia occurring in ileal stoma should be recognized by pathologists as a clinical entity. When colonic metaplasia is identified in the ileal stoma of an ulcerative colitis patient, biopsy surveillance of stomal mucosa is recommended.

Adenocarcinoma↗

Adenomas, metaplastic polyps and other lesions of the large bowel: an autopsy survey.

Out of 1,014 large intestines examined, adenomatous polyps were encountered in 170 (16.8%) and metaplastic polyps in 67 (6.6%). Both types of polyps were more prevalent among the Chinese than the Malays and Indians. The prevalence rates corresponded to the relative risks for large bowel cancer for the respective ethnic groups. This suggests that causative factors such as dietary influence which are common to adenomatous polyps and cancer of the large bowel are operating at different levels among the different ethnic groups in Singapore. There are however, several factors between adenomatous polyp and colorectal cancer which are not congruent suggesting that the relationship between these two lesions though close is not a simple or direct one. On the other hand, the present study has shown several similarities between the epidemiological characteristics of metaplastic polyps and cancer of the large bowel. It is speculated that the causative factor(s) for metaplastic polyps may occur in association with carcinogen of the large bowel, but has an independent action. Consequently, while the metaplastic polyp may not itself be regarded as a premalignant lesion, the possibility that it may be a marker for increased risk for colon cancer is not excluded. Ulcerative colitis is rare in Singapore, and is not considered an important lesion in the pathogenesis of large bowel cancer in this country.

Adenoma↗

Polyps and polypoid lesions of the jejunum and ileum. Clinical aspects.

Polyps and polypoid lesion of the small intestine present a major challenge to the surgeon. In contrast to similar lesions in the large intestine, small bowel polyps present late in their course and are difficult to diagnose. Small bowel tumors produce vague symptoms and screening tests are poor. Most of these polyps are found at autopsy or during exploration for another cause. In this article, the authors outline the problem as well as discuss the diagnosis and treatment options.

Adenomatous Polyposis Coli↗

Polyp guideline.

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Colorectal Neoplasms↗

Multiple lymphomatous polyposis.

Multiple lymphomatous polyposis (MLP) is a distinctive and particularly rare clinical type of malignant gastrointestinal lymphoma, which is classified as B-cell centrocytic non-Hodgkin's lymphoma. this rare entity has been recently reclassified as mantle cell lymphoma. We herein report three additional cases of MLP involving various segments of the gastrointestinal tract. MLP has an aggressive biologic behavior and a relatively poor prognosis and must be treated accordingly as a high-grade lymphoma with systemic chemotherapy.

Aged↗

Colorectal adenomatous polyps and carcinoma in Ashkenazi and non-Ashkenazi Jews in Israel.

In Israel, the incidence of colorectal cancer among European-American-born Jews is approximately 2.5 times that of African-Asian-born Jews. To determine the risk of all colorectal tumors for the two ethnic groups, 335 patients with colorectal adenomatous polyps and 295 with colorectal cancer, diagnosed between 1980-1984 at the Sheba Medical Center, were compared to the 35,094 persons attending the outpatient clinics at the same hospital, during September and October 1984. Ashkenazi patients (European-American-born) had a 2.5-fold risk (95% confidence interval 1.9-3.3) of colorectal polyps compared to non-Ashkenazi patients (African-Asian-born). The risk was similar for males (odds ratios [OR] = 2.3) and females (OR = 2.8). Ashkenazis also had a significantly enhanced risk of carcinoma: OR = 3.1; 95% confidence interval 2.2-4.3. The risk ratio was slightly higher for males (OR = 3.5) than females (OR = 2.7). Age-specific analyses demonstrated an elevated risk of both malignant and benign neoplasms among Ashkenazi patients at all ages at diagnosis. Among the polyp patients, the highest risk ratio was for patients between 30 and 49 years old, while among the cancer patients the risk was highest in the group of 60-69-year-olds. The distribution by size of polyps, number of polyps, as well as polyp subsite, was similar for Ashkenazi and non-Ashkenazi patients; however non-Ashkenazis tended to have slightly more right-sided colon cancer.

Adult↗