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PubMed1994

A small pedunculated adenomatous polyp of the colon found to contain the focus of invasive carcinoma extending to the serosa: report of a case.

A small pedunculated polyp was detected among other polyps in the transverse colon of a 64-year-old man, the resected specimen of which showed an adenomatous polyp 1 cm in diameter, containing the foci of adenocarcinoma invading the submucosa, muscularis, and serosa. This case report stresses the importance of performing careful pathologic examination of resected specimens obtained from endoscopic polypectomy, even for small pedunculated colon polyps.

Adenocarcinoma↗

PubMed1999

Frequency of advanced neoplasia in the proximal colon without an index polyp in the rectosigmoid.

PURPOSE: Screening endoscopy has the potential to reduce colorectal cancer mortality. However, the efficacy of screening flexible sigmoidoscopy compared with colonoscopy strongly depends on the frequency of advanced proximal neoplasms without an index polyp in the rectosigmoid. We have therefore determined this frequency in our endoscopy population. METHODS: Endoscopic and histologic data were analyzed from all patients on whom integral colonoscopy was performed between 1980 and 1995. Advanced neoplasia was defined as cancer or adenomas >10 mm in diameter, adenomas with a villous component, or severe dysplasia. Patients with polyposis syndrome or inflammatory bowel disease were excluded. RESULTS: Colonoscopy was performed on 11,760 patients. 2,272 (19.3 percent) had at least one colorectal neoplasm, of which 39 percent had the neoplasm above the rectosigmoid. Twenty-two percent of all patients with neoplasia had no index polyp in the rectosigmoid and 16 percent of these had no index polyp, but at least one advanced proximal neoplasm. CONCLUSIONS: Although 39 percent of patients had neoplasms above the rectosigmoid, only 16 percent had an advanced proximal neoplasm without an index polyp in the rectosigmoid. This gives a figure on which to base the evaluation of screening sigmoidoscopy programs against those of screening colonoscopy.

Adenoma, Villous↗

PubMed1994

Double-contrast barium enema study with computed radiography: assessment in detection of colorectal polyps.

Feasibility and diagnostic performance of digital radiography in gastrointestinal imaging have not been fully investigated. We performed double-contrast barium enema study with computed radiography (CR-DCBE) on a routine basis, and the efficacy of this system for detection of colorectal polyps was investigated. The files of 76 patients, who had undergone both CR-DCBE and colonoscopy, were reviewed by two observers who were blinded to the colonoscopic findings. The radiation dose of CR-DCBE was reduced to 50% of conventional film-screen system. By using colonoscopic findings as a reference, the sensitivity and positive predictive value for colorectal polyps were 66% to 71% and 32% to 41%, respectively. There was no significant interobserver difference. The use of postprocessing with gray-scale reversal and edge enhancement did not significantly improve the results. The sensitivity for polyps smaller than 1 cm was comparable with published data of conventional film-screen systems. Our preliminary results show that CR-DCBE has an acceptable sensitivity for detection of colorectal polyps. It is suggested that the use of CR is a promising approach to digital gastrointestinal radiography.

Adult↗

PubMed2004

Local excision of rectal polyp: indications and techniques.

The local excision of a rectal polyp is often wrongly considered to be a minor surgical procedure. In reality, the malignant potential of adenomas and the not-infrequent presence of cancer in larger polyps, require, for their removal, an oncologically correct operation with strict indication and accurate execution. Despite an increasing inclination to extend the indications of endoscopic polypectomies to polyps of larger size and villous configuration, the local surgical approach remains the preferred treatment in most cases. Here the indications and the results of different surgical techniques proposed for the local excision of a rectal polyp are reported. Among these procedures, transanal endoscopic microsurgery is gaining a primary role in many circumstances.

Adenoma, Villous↗

PubMedDate not supplied

Follow-up of hot biopsy forceps treatment of diminutive colonic polyps.

Although the hot biopsy technique is widely used to treat diminutive colon polyps, there is concern over its efficacy and safety. Our study involved 39 patients undergoing routine colonoscopy in whom 62 diminutive polyps were found in the rectosigmoid. These lesions were treated with hot biopsy forceps in the standard manner. Flexible sigmoidoscopy was repeated 1 and 2 weeks later with the original treatment sites being identified. Eleven of the 62 sites (17%) revealed persistent viable polyp remnants, indicating incomplete treatment. In terms of safety, there were no clinical complications in this small study and most post-biopsy ulcers were healed by 2 weeks. This study shows that the hot biopsy technique may be unreliable in eradicating diminutive colon polyps.

Biopsy↗

PubMed1984

Colorectal polyps in Cowden's disease (multiple hamartoma syndrome).

Colorectal polyps are described in five patients with Cowden's disease. A brother-sister kindred and two unrelated patients had multiple colonic polyps 0.1-0.4 cm in diameter. Microscopical examination of seven polyps removed from these four patients showed distinctive lesions which were probably hamartomatous, and characterized by disorganization and proliferation of the muscularis mucosae with minimally abnormal overlying mucosa. The fifth patient had a solitary 2-cm epitheloid leiomyoma resected from the rectum. Review of all cases of Cowden's disease in the English literature suggests that gastrointestinal polyposis may be a frequent finding if it is specifically searched for. It does not appear that the previously reported association of Cowden's disease with gastrointestinal cancer is valid. The discovery of multiple colonic polyps 0.1-0.4 cm is diameter with a rectosigmoid distribution and a hamartomatous microscopical appearance is characteristic of Cowden's disease. Cowden's disease should be included in the differential diagnosis of gastrointestinal polyposis states.

Adult↗

PubMed1985

Prevalence of colorectal polyps among Michigan pattern and model makers.

A group of 902 pattern and model makers were screened for colorectal cancer and polyps using a 60-cm flexible sigmoidoscope. Three recent mortality studies have found a significant excess of colorectal malignant neoplasms in this occupational group. Four adenocarcinomas, two carcinoids, and two cancers in situ were found. In addition, 150 (17%) of the individuals were found to have polyps. Among white males 40 to 70 years of age, the prevalence rate was found to be 23%. The prevalence of colorectal polyps among the pattern and model makers was compared with that of four previously studied asymptomatic populations who were also examined using a 60-cm flexible sigmoidoscope. Polyp rates were found to be significantly greater among pattern and model makers than among three of the four comparison populations. The odds ratios between these three populations and the study population ranged from 1.9 to 2.7 and closely approximate the ratios found in previous studies evaluating colon cancer in this occupational group.

Adenocarcinoma↗

PubMed1996

Histologic classification of endoscopically removed flat colorectal polyps: a multicentric study.

A total of 594 flat colorectal polyps, removed at endoscopy, were histologically classified into non-neoplastic (n = 49) and neoplastic (n = 545) polyps. Non-neoplastic polyps were subdivided into metaplastic (n = 45) and hyperplastic (n = 4), whereas neoplastic polyps were subdivided into adenomas (n = 481), intramucosal carcinomas (n = 28) and invasive adenocarcinomas (n = 36). Several adenoma phenotypes were discerned: tubular (n = 375), serrated (n = 59), villous (n = 39), mixed (n = 7) and fenestrated (n = 1). Intramucosal carcinomas were subdivided into tubular (n = 26) and serrated (n = 2), and invasive adenocarcinomas into tubular (n = 32), serrated (n = 3) and fenestrated (n = 1). The microscopic characteristics of each histologic phenotype described in this communication are defined and illustrated.

Adenoma↗

PubMed2006

Determinants of compliance with colonoscopy in patients with adenomatous colon polyps in a veteran population.

AIM: To determine factors affecting compliance of a follow-up colonoscopy in patients with previously diagnosed adenomatous colon polyps. METHODS: A retrospective review was performed on patients with adenomatous polyps excised between January and December 1998. Twenty-nine clinical factors were assessed in patients grouped into whether they were compliant (n = 81) or noncompliant (n = 38) with follow-up colonoscopy. Significant variables by univariate analysis were included in multivariate regression. RESULTS: One hundred and nineteen patients with adenomatous colon polyps were identified. Of 119 patients, 114 had a documented recommendation for follow-up of 5 years or less, with 69% having been compliant. In a univariate analysis, greater number of polyps (P = 0.04), NSAID use (P = 0.02), statin use (P = 0.005), first-degree relatives with colon cancer (P = 0.05) and compliance with out-patient clinic follow-up (P < 0.001) were significantly associated with patient compliance. Multivariate analysis revealed statin use (P = 0.05), first-degree relatives with colon cancer (P = 0.06) and compliance with out-patient clinic follow-up (P < 0.001) were independent predictors of compliance. CONCLUSIONS: History of statin use and family history of colon cancer are good predictors of compliance. The strongest predictor can be anticipated with compliance assessed with encounters for other visits. Strong efforts should be directed at improving patient education about colon cancer by the physician and facilitating patient compliance.

Adenomatous Polyps↗

PubMed1998

Adenosarcoma of the uterine cervix presenting as a cervical polyp.

A case of adenosarcoma arising from the uterine cervix of a 55-year-old female who complained of vaginal discharge is reported. A polyp, 6 x 2 x 1.5 cm in size, identified in the cervical canal was clinically diagnosed as benign cervical polyp and resected. Histologically, the polyp was composed of benign epithelial components and sarcomatous stroma wherein periglandular hypercellularity and some mitoses including atypical ones were noted. Immunohistochemically, stromal cells were positive for muscle-type actins, desmin and estrogen receptor. Adenosarcoma is a rare, biphasic tumor of the uterus and usually presents as a polypoid mass in the endometrial cavity. When they arise from the cervix, adenosarcomas may be confused with benign cervical polyps clinically and pathologically. As the former often recurs, microscopic differentiation is crucial for further treatment.

Actins↗

PubMed1987

Colorectal polyps: an important cause of rectal bleeding.

Seventy one children with rectal bleeding were examined by total fibreoptic colonoscopy. Large bowel polyps were found in 45; 27 (60%) had solitary rectal polyps. Altogether, 83% of resected polyps were juvenile. No complication of colonoscopic polypectomy occurred. New polyps reoccurred in four (9%) treated children.

Adolescent↗

PubMed1983

Upper gastrointestinal tract polyps in familial adenomatosis coli.

Upper gastrointestinal tract polyps were sought prospectively using endoscopy and biopsy in 34 patients with familial adenomatosis coli belonging to 18 unrelated families. Gastric and/or duodenal polyps, usually small and multiple, occurred in 28 patients (82%). Histologically verified extracolonic adenomas were present in 19 patients (56%). Gastric adenomas, all in the antrum, and duodenal adenomas occurred in four (12%) and 16 (48%) patients, respectively. In one patient, a duodenal adenocarcinoma and a bile duct adenoma were also found, and one patient had an adenocarcinoma of the bile ducts. Multiple non-neoplastic polyps were found in 19 patients (56%), most often in the stomach and also in the duodenum in 12 patients; they co-existed often with adenomas. In addition, there were nine patients with ileal polyps, most of them showing lymphoid hyperplasia but also one with adenomas. It is suggested that familial adenomatosis affects the whole gastrointestinal tract, not only the colon and rectum as believed earlier. Although upper gastrointestinal tract adenomas are not as consistent and multiple as those in the colon, and probably do not require prophylactic surgery, regular lifelong endoscopic follow up is warranted because of obviously increased cancer risk.

Adolescent↗

PubMed1989

Histopathological assessment of bleeding from polyps of the colon and rectum.

One hundred and twenty seven colorectal polyps were examined to assess histopathological evidence of recent and old haemorrhage to test the usefulness of faecal occult blood tests in detecting colorectal neoplasia, in particular premalignant adenomas. Evidence of haemorrhage was consistently found in adenomas but was rare in non-neoplastic polyps. Haemorrhage within adenomas was predominantly stromal and associated with dilated, congested vessels. Factors associated with more severe haemorrhage were size, pedunculation, and villous growth; the degree of epithelial dysplasia and the age and sex of the patient were not associated factors. Proximal polyps showed more old haemorrhage than rectal polyps, but there was no such difference for recent haemorrhage.

Aged↗

PubMed1979

Gastric polyps in familial polyposis coli.

Familial polyposis coli has been considered a disease in which polyps are confined to the colon and rectum. The authors recently saw 3 cases in which either adenomatous or hyperplastic polyps were also present in the stomach and duodenum. The polyps were detected only by endoscopy or air-contrast radiographic examination. These cases and other recent studies indicate that gastric and duodenal polyps are more common in familial polyposis coli than previously recognized and should be considered an integral part of the syndrome.

Adolescent↗

PubMed2005

Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept.

Serrated polyps of the large intestine, including traditional hyperplastic polyps, traditional serrated adenomas, and more recently described sessile serrated adenomas, have gained increased recognition in recent years because of growing evidence that one of these lesions, the sessile serrated adenoma, might be the precursor lesion for some cases of microsatellite unstable colorectal carcinoma. Nevertheless, there has been some reluctance to embrace the concept of sessile serrated adenoma, and numerous diagnostic challenges exist. This article, which grew out of the Roger C. Haggitt Gastrointestinal Pathology Society Forum presented in Vancouver, Canada, March 6, 2004 as part of the annual meeting of the United States-Canadian Academy of Pathology, reviews the morphologic and molecular evidence for the concept of various polyps in the general category of serrated polyps of the large intestine, in particular the lesion known as the sessile serrated adenoma, and provides a conceptual framework for diagnosis of these lesions.

Adenocarcinoma↗

PubMedDate not supplied

Nasal polyps and their relation to polyps/hypertrophic polypoid mucosa in the paranasal sinuses: a macro-, endo-, and microscopic study of autopsy materials.

The present study comprised macro- and endoscopic screening of the nasosinusal complex in 56 autopsies, 24 with nasal polyps and 32 without. Seven had nasal polyposis (bilaterally more than two). Hypertrophic polypoid mucosa in the paranasal sinuses was not found in the cases with nasal polyposis and in only 2 (4%) of the total number (24) of cases with polyps. Microscopic examination of nine small polyps, the mucosa from which they originated, and control specimens showed accumulation of eosinophils in the mucosa from which the polyps originated, indicating localized inflammation.

Cadaver↗

PubMed1999

Gastric and duodenal polyps in Smad4 (Dpc4) knockout mice.

The SMAD4 (DPC4) gene was initially isolated as a candidate tumor suppressor from the convergent site of homozygous deletions on 18q in a panel of pancreatic carcinoma cell lines. It encodes a common cytoplasmic signaling molecule shared by the transforming growth factor-beta, activin, and bone morphogenic pathways. We recently inactivated its mouse homologue Smad4 and demonstrated its role in the malignant progression of benign adenomas to invasive adenocarcinomas by analyzing mice with Apc and Smad4 compound mutations. Although simple Smad4 homozygotes were embryonically lethal, the heterozygotes were fertile and appeared normal up to the age of 1 year. Upon further investigation, however, they have developed inflammatory polyps in the glandular stomach and duodenum. By PCR genotyping and immunohistochemical staining, the wild-type Smad4 allele has been lost in the polyp epithelial cells, ie., loss of heterozygosity. On the other hand, we have not found any mutations in such genes as K-Ras, H-Ras, N-Ras, p53, or PTEN. Histologically, the polyps are similar to human juvenile polyps showing moderate stromal cell proliferation and infiltrations by eosinophils and plasma cells. In addition, foci of adenocarcinoma with signet ring cells are also found. These results are consistent with a recent report that germ-line SMAD4 mutations are found in a subset of familial juvenile polyposis.

Animals↗

PubMed1963

[Glandular polyps of the stomach].

Gastric polyps, either solitary or multiple, have been studied in 14 cases. Three of these lesions were benign, two gave evidence of some cellular atypism, six were carcinomas in situ and three were invasive carcinomas. All but one of the transformed polyps were over 1.5 cm. in diameter. The lesions were associated with other primary carcinomas in two patients, and one patient had benign polyposis and pernicious anemia. If only the glandular polyps are included in the material, it is the authors' impression that gastric polyps are of interest and importance as precancerous lesions and should be dealt with as such.

Adenomatous Polyps↗