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Rational management of malignant colon polyps based on long-term follow-up.

We reviewed the long-term results of management of 38 patients with carcinoma in colorectal polyps. Of these, 16 patients demonstrated malignant invasion of the lamina propria but not the muscularis mucosa (group I), and 22 patients showed malignant invasion of the muscularis mucosa (group II). Primary therapy for group I patients consisted of polypectomy in 12, local excision in one, and colonic resection in three. One patient had a subsequent abdominal-perineal resection and was found to have no residual disease and no lymph node involvement. Follow-up of the group I patients showed that 11 were alive and well (mean 5.8 years) and five died of unrelated causes (mean 5.2 years). Of group II patients, 12 underwent polypectomy, six local excision, and four colectomy. Of these 22 patients, 11 underwent further operation, including nine major bowel resections and two local re-excisions. None of these 11 patients had either residual tumor or lymph node metastases. One patient died of complications after abdominal-perineal resection. Follow-up showed that 18/22 group II patients were alive and well 5 to 15 years later (mean 7.5 years); four died of unrelated causes (mean 3.2 years). We then reviewed another group of 220 patients who had undergone resection for invasive colon cancer to relate the presence or absence of lymph node metastases to the depth of malignant invasion in the bowel wall. We found that 44% of this entire group had lymph node involvement. Of 36 patients with tumor confined to the bowel wall, nodal metastases occurred in only 22%. Of eight patients with malignancy superficial to the muscularis propria, only one had nodal involvement. We conclude that colon cancer tends to progress in an orderly fashion and the risk of nodal metastases increases with the depth of invasion. Carcinoma in a polyp represents a very early stage of colon cancer. We therefore recommend polypectomy as primary treatment for pedunculated polyps containing carcinoma either superficial to or invading muscularis mucosa. If histologic review demonstrates incomplete excision, lymphatic invasion, or poor differentiation, patients with lesions invading the muscularis mucosa should undergo formal colonic resection.

Adenocarcinoma↗

Colonic polyps and adenocarcinoma complicating ureterosigmoidostomy: report of a case.

A case of bilateral juvenile polyps and unilateral adenocarcinoma at the ureterocolic junctions occurring 40 years after ureterosigmoidostomy for exstrophy of the bladder is reported. Although adenocarcinoma of colon at the anastomotic site represents an uncommon late complication of ureterosigmoidostomy, patients undergoing this form of urinary diversion have a risk of developing colonic carcinoma that is 100 to 550 times greater than the normal population. Moreover this complication is being reported with increasing frequency in the literature. Different pathogenetic factors may play a role in carcinogenesis, but none has been satisfactorily proven. We suggest the possibility that polyps developing at the site of a ureterocolic junction may represent precancerous lesions.

Adenocarcinoma↗

An evaluation of left sided colonic polyps as a marker for right sided cancers.

The detection of a left-sided polyp on flexible sigmoidoscopy has been suggested as providing a heralding sign for right-sided tumours. We assessed our own experience with right-sided colonic cancers with reference to detection modality, surgical intervention and their association with left-sided polyps. We performed a retrospective review of a prospectively collected colorectal cancer database, with endoscopic and radiological records. Patients were subcategorised on the basis of the presence or absence of left-side polyps. Ninety-one consecutive patients who underwent curative surgery for right-sided colonic cancers were studied. Endoscopy was used to detect right-sided carcinomas in 10 (83%) of the 12 cases with synchronous left-sided polyps and radiological imaging utilised in 2 cases. In patients without evidence of left sided disease endoscopy was used in 40 (51%) of the 79 patients. In our experience most right sided cancers do not have a synchronous polyp evident on the left side 79 (87%).

Adult↗

Detection and characterization of sucrase-isomaltase in adult human colon and in colonic polyps.

A panel of monoclonal antibodies specific for sucrase-isomaltase, but differing in their ability to stain the proliferative crypt cells in human jejunum, was used to investigate expression of this enzyme in adult human colon and colonic tumors. Immunofluorescence staining on cryostat sections demonstrated the presence of sucrase-isomaltase in the apical region of normal colonic crypt cells but not on surface epithelium. Colonic sucrase-isomaltase was purified by immunoprecipitation with selected monoclonal antibodies and identified predominantly as high-mannose and complex glycosylated single-chain precursors endowed with relatively low levels of enzyme activities. Most polyps examined (10/16) were also found to express significant amounts of sucrase-isomaltase. In contrast, only 3 of 45 adenocarcinomas were positive by immunofluorescence staining; no correlation was found between enzyme expression and tumor classification either by "Dukes" stage or degree of histological differentiation. These results demonstrate that colonic crypt cells and some benign tumor cells synthesize and express at their cell surface a form of sucrase-isomaltase immunologically distinct from that present in the brush borders of small intestinal villose cells.

Adenocarcinoma↗

Immunohistochemical Cal9-9 in primary colonic polyps and polyps synchronous with colorectal cancer.

A prospective study was undertaken to examine the immunohistochemical expression of tumor antigen Cal9-9 in 56 colorectal cancers and 95 colonic adenomas, divided into 65 primary polyps and 30 polyps synchronous with colorectal cancer. Seventy five per cent of tumours were positive for Cal9-9. Antigen was expressed more frequently in advanced Duke's C and D and poorly differentiated colorectal cancer. Overall 51% of adenomas were positive for Cal9-9. Antigen expression correlated significantly with increasing size (p less than 0.001), synchronicity with colorectal cancer (p less than 0.001), severe dysplasia (p less than 0.001) and villous typing (p less than 0.003). Discriminate analysis using the first three variables correctly classified 79% of positive and 89% of negative Cal9-9 results. The similar frequency of antigen expression seen in colorectal cancers and their synchronous adenoma suggests a field change in the tumour bearing colon. Adenomas positive for Cal9-9 may have a greater malignant potential for carcinomatous change.

Adenoma↗