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PubMedDate not supplied

Histopathologic and flow cytometric analysis of colorectal polyps resected at endoscopy.

Forty-seven colorectal polyps of various histologic types were studied using retrospective flow cytometric (FCM) DNA analysis to determine the prevalence of aneuploid cell populations and whether they were associated with any particular histologic features. Overall, 6 of 47 polyps (12.8%) contained DNA aneuploid cells, comprising 4 adenomatous polyps, 1 of 12 with mild atypia (8.3%), 2 of 19 with moderate atypia (10.5%) and 1 of 4 with severe atypia (25.0%), and 2 of 4 polyps (50.0%) with histologic features of carcinoma in situ (CIS). The incidence of DNA aneuploid cells in CIS was significantly higher than that of all adenomatous polyps (p = 0.043). All of the 8 hyperplastic polyps were diploid. The detection of aneuploidy as a marker of increased risk for malignant transformation was possible even in colorectal adenomas measuring < or = 10 mm. These results show that retrospective FCM analysis can detect DNA aneuploidy in adenomatous polyps and that DNA aneuploidy may occur before histologic evidence of invasive carcinoma.

Adenoma↗
PubMed2006

Occult colorectal polyps on CT colonography: implications for surveillance.

OBJECTIVE: Our purpose was to determine the prevalence of polyps that are invisible on CT colonography (CTC) in a population previously screened for colorectal neoplasms. Differences in the prevalence of occult polyps in various populations might help explain the discordant reported sensitivities for polyp detection in published reports of CTC. SUBJECTS AND METHODS: Seventy-five consecutive patients who had been previously screened for polyps underwent same-day colonoscopy and CTC. Many of the patients had personal histories of previous polypectomies and were undergoing surveillance colonoscopy. The scans were interpreted prospectively by an experienced radiologist. Polyps missed prospectively on CTC were analyzed retrospectively by three experienced radiologists and categorized as perception errors (visible in retrospect), technical errors (e.g., obscured by feces or fluid), or occult (invisible). RESULTS: Thirty polyps 5 mm or larger were found at colonoscopy, 18 of which were missed prospectively on CTC. Of the 18 missed polyps, 12 could not be identified in retrospect, even though they were located in clean, dry, well-distended colonic segments. These were classified as occult. Ten of the 12 occult polyps showed flat morphology on review of colonoscopy video recordings. Of the remaining six missed polyps, two were classified as perception errors, two as technical errors, and two as a combination of technical and perception error. CONCLUSION: In this population, colonographically occult polyps were common and accounted for more detection failures than perception errors and technical errors combined. The high prevalence of occult polyps may be explained by the fact that previous screening may have led to removal of easy-to-see polyps, creating a study population with a higher percentage of hard-to-see polyps.

Aged↗
PubMed1986

Epidemiology of polyps in the rectum and colon. Recovery and evaluation of unresected polyps 2 years after detection.

In an endoscopic population screening study for colorectal polyps among 200 men and 200 women, 50-59 years of age, 215 polyps less than 5 mm in diameter were left in situ for the present 2-year follow-up examination. The attendance rate was 102 of 106 (96%) for polyp patients and 77 of 90 (86%) in the control group. Of 194 polyps, 143 (74%) in the 102 polyp-bearing individuals were recovered for histological evaluation and 57 polyps were registered as new. Ninety-nine (50%) of the polyps were hyperplastic, 45 (23%) were adenomas, and 45 (23%) were mucosal tags. Both growth and regression of polyps were registered. Regression was commoner in the distal part of the rectum than in the proximal part or distal sigmoid colon. Growth was similar for recovered adenomas and hyperplastic polyps, whereas mucosal tags more often showed diminution in size. No polyp had reached a size of more than 5 mm in 2 years, and no case of severe dysplasia or carcinoma was registered. The estimated total polyp mass more than doubled both for adenomas and hyperplastic polyps. It is concluded that the time interval between initial examination with removal of polyps 5 mm or larger in diameter and the first follow-up examination may safely be set at 2 years.

Colonic Polyps↗
PubMed1987

Relationship between tobacco smoking and colorectal polyps.

A prospective endoscopic screening examination of a randomized population sample of 200 men and 200 women, aged 50-59 years, enabled the differentiation between individuals with and without polyps in the rectum and sigmoid colon. Both number of years of smoking and percentage years of life with smoking were associated with the presence of adenomas and hyperplastic polyps, both for men and women. No relationship was found between these factors or the daily number of cigarettes and the degree of dysplasia or the size or multiplicity of polyps. Two years' follow-up examination showed a tendency to fewer new polyps among male ex-smokers compared with smokers; however, the difference was not quite significant. No significant difference was found when comparing smokers with never smokers. In the relatively smaller groups of women no significant difference with regard to number of polyps was found among smokers, ex-smokers, and never smokers. The results provide evidence for an association between smoking and colorectal neoplasia and may suggest an initiating effect of smoking on carcinogenesis in the colon and rectum.

Adenoma↗
PubMed1988

Colonoscopy in the diagnosis and management of colorectal neoplasia in a DGH.

Patients presenting to a district general hospital (DGH) with colorectal neoplasms have been studied before and after the introduction of a colonoscopy service, in order to investigate the diagnostic, therapeutic and economic benefits of performing colonoscopy in preference to sigmoidoscopy and double contrast barium enema (DCBE). Colonoscopy led to a 3-fold increase in the incidence of colonic polyps, and 22% of all adenomas showed worrying features. Severe dysplasia and malignancy was seen most frequently in large adenomas (greater than 2 cm), and in those with a villous component. Laparotomy was avoided in 31 patients with proximal polyps, giving colonoscopy an added therapeutic and economic advantage over sigmoidoscopy and DCBE. Colonoscopy was used less frequently to detect colonic carcinomas, as over half of these were rectal, or presented as emergencies. These findings confirm the value of performing colonoscopy in patients who present with colorectal symptoms.

Adenoma↗
PubMed1983

[Adenomatous lesions of the papilla in familial adenomatous rectocolic polyposis. Value of duodenoscopy].

When compared to the general population, individuals with Gardner's syndrome may have a 100- to 200-fold increased risk of developing periampullary carcinoma. This prospective work was undertaken in order to study the endoscopic aspects and to perform biopsies of the papilla in 9 patients (7 males, 2 females, aged 18-65 years) with familial polyposis coli or Gardner syndrome. In 4 cases the papilla was endoscopically grossly polypoid and biopsies showed adenomatous lesions. In 5 cases, the papilla appeared endoscopically normal; in 2 cases, the papilla appeared endoscopically normal; in 2 of these cases biopsies showed adenomatous proliferation; in the 3 other cases, the biopsies were normal. In 5 cases, there were adenomatous duodenal lesions outside the papilla. These results suggest that: a) adenomatous lesions of the papilla are frequent in familial polyposis coli and Gardner's syndrome; b) the endoscopic gross aspect of the papilla may be normal even when there are adenomatous lesions; c) adenomatous lesions of the papilla may be associated or not with adenomatous lesions of the 2nd duodenum; d) as the natural history of these lesions is not known and because of the risk of cancer of Vater's ampulla, it seems reasonable to perform routine duodenoscopies with biopsies in order to ensure early diagnosis of cancer.

Adenoma↗
PubMed2000

Predictive value of histology at the invasive margin in the prognosis of early invasive colorectal carcinoma.

To accurately select patients with malignant colorectal polyps who are at high risk of adverse outcome, we examined the predictive value of clinicopathological factors, with special attention paid to the histology at the invasive margin. We examined 75 submucosal carcinomas from 75 patients, initially resected by polypectomy, including endoscopic, trans-anal, trans-sacral, and trans-sphincteric local excision. The associations between clinicopathological features such as sex and age; tumor size, location, shape, depth of submucosal invasion, vascular invasion, histology at the central part, and histology at the invasive margin; and the presence or absence of a residual adenomatous component and adverse outcome were examined by univariate and multivariate logistic regression analyses. Lymph node metastases were found in 2 patients, local recurrence in 4, and distant metastases in 2. Univariate logistic regression analysis showed that unfavorable histology at the invasive margin was significantly associated with lymph node metastasis or local recurrence (P = 0.0373), whereas the association of lymphatic invasion and vascular (lymphatic or venous) invasion with lymph node metastasis or local recurrence had marginal significance (P = 0.0785; P = 0.0990). Multivariate logistic regression analysis, with unfavorable histology at the invasive margin and lymphatic invasion as independent variables, showed that unfavorable histology alone had significance (P = 0.0373) in predicting adverse outcome. Widely accepted criteria such as massive submucosal invasion, positive vascular invasion, and poorly differentiated histology, were less useful in predicting adverse outcome. These results suggest that unfavorable histology at the invasive margin is a useful risk factor for predicting lymph node metastasis or local recurrence in patients with malignant colorectal polyps.

Adult↗
PubMed1983

Jejunal carcinoma in a child.

A case of Peutz-Jeghers Syndrome in an 8-yr-old girl with an adenocarcinoma arising in the duodenum and jejunum is herein reported with a 9-yr follow-up. This carcinoma fulfills histologic criteria for malignancy in the Peutz-Jeghers Syndrome. We suggest that this represents a documented case of malignancy arising in a Peutz-Jeghers polyp.

Adenocarcinoma↗
PubMed2002

Surgical management of malignant colorectal polyps.

The anatomic landmarks of the depth of invasion for pedunculated lesions (Haggitt level) and the Sm system for the sessile lesions give excellent objective information in the management of malignant colorectal polyps. Malignant polyps with low risk of lymph node metastasis include pedunculated lesions with invasion into Haggitt levels 1, 2, and 3. Level 4 pedunculated lesions and sessile lesions in which the invasion is into Sm1 or Sm2 level also have low risk if there are no adverse factors. These lesions can be treated by a complete local excision. Lesions that have high risk of lymph node metastasis are those with invasion into the lower third of the submucosa (Sm3), lesions that contain lymphovascular invasion, and lesions sited in the lower third of the rectum. These lesions require an oncologic colorectal resection. For lesions in the distal third of the rectum, a per anal full-thickness excision followed by an adjuvant chemoradiation may be an alternative. The box below summarizes malignant colorectal polyps requiring oncologic bowel resections:

Adenoma↗
PubMed1981

[Juvenile polyp in the small bowel (author's transl)].

A single case of a solitary juvenile polyp of the small bowel is presented in a 10 month old infant which produced a jejuno-jejunal intussusception. A review of the literature failed to show a similar case. The pathology of the polyp is discussed.

Humans↗