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PubMed2000

Colon polyps and cancer.

Several important studies on screening for colorectal neoplasia were published in 1998-99, including average-risk as well as high-risk groups, and different strategies such as endoscopy, fecal occult blood tests, and other more specific markers of neoplasia. Some of these studies included the use of interventions other than initial screening and polypectomy; a few dealt with diagnostic methods in symptomatic patients, and the new diagnostic tool of virtual colonoscopy was highlighted by several authors. Endoscopic treatment for large adenomas and early colorectal cancer has become more widespread, but clearly it has limitations. Current discussion of the topic of colorectal polyps and cancer is largely based on the concept of the adenoma-carcinoma sequence, which is thought to be the most probable pathogenesis for colorectal cancer.

Adenomatous Polyps↗
PubMed1977

Nature and significance of colonic polyps.

The concept of inevitable premalignancy in all adenomatous polyps of the colon was challenged as early as 1958, and since that time much debate has centered about the malignant potential of adenomatous polyps of the colon. Current thinking indicates that the majority of colonic polyps fall into one of four categories: hyperplastic, villous adenoma, adenomatous, and villoglandular. Analysis of the present series of 387 colonic polyps removed endoscopically indicates that the villoglandular group has a notable malignant potential, and that the pure adenomatous polyp probably carries a minimal malignant threat. The present series does not challenge the accepted concept that hyperplastic polyps are of no malignant potential, and that villous adenomas are quite frequently malignant at the time of diagnosis.

Colonic Neoplasms↗
PubMed2001

The effect of electrothermal cautery-assisted resection of diminutive colonic polyps on histopathologic diagnosis.

We examined diminutive colonic polyps to identify relationships between thermal electrocoagulation or resection trauma cytologic artifacts, type of thermal electrocoagulation, polyp size, and the interobserver variation among 3 pathologists. The 3 pathologists independently evaluated 119 colonic polyps 5 mm or less in maximum dimension for diagnosis and degree of thermal electrocoagulation or resection trauma cytologic artifacts. The maximum dimension of the polyps and type of thermal electrocoagulation were recorded. The average percentage of polyps in which a definitive diagnosis could not be made because of cytologic artifacts was 16.5% (range, 11.8%-19.3%). Decreasing polyp size was associated linearly with the inability to make a definitive diagnosis owing to cytologic artifacts. Polyps smaller than 2 mm significantly more often could not be definitively diagnosed by at least 1 pathologist owing to cytologic artifacts, including some polyps that were excised without thermal electrocautery. Interobserver variation increased with decreasing polyp dimension. Two millimeters seems to represent a cut point, below which the likelihood that a definitive diagnosis can be made can be increased if thermal electrocoagulation is used. This small size seems to make them especially susceptible to cytologically injurious forces.

Adenoma↗
PubMed2003

Non-association between acrochordons and colonic polyps in a minority population.

PURPOSE: To determine usefulness of skin tags as a predictor of colonic polyps, in patients of a minority population. SETTING: Inner-city community hospital serving predominantly African Americans and Hispanics. METHODS: Evaluation of 480 consecutive patients undergoing colonoscopy. The presence or absence of skin tags was noted, and their correlation with the colonic polyps determined. RESULTS: Colonic polyps were detected in 92 patients (19%). None of these patients had skin tags, whereas skin tags were found in 87 patients (18%), and none of them had colonic polyps. CONCLUSION: The mere presence of acrochordons (skin tags) should not be used as an indication for screening colonoscopy especially in African Americans and Hispanics.

Adult↗
PubMed1995

The prevalence of colonic polyps in acromegaly: a colonoscopic and pathological study in 103 patients.

Patients with acromegaly are reported to be at risk of developing adenomatous colonic polyps, which are considered to be preneoplastic lesions. This assumption is, however, usually drawn from results obtained in rather small series of patients or without a control group. We, therefore, undertook a prospective colonoscopic and pathological study comprising 103 acromegalic patients and 138 nonacromegalic control subjects referred for irritable bowel syndrome. The prevalence of adenomatous colonic polyps was significantly increased in acromegalic patients compared to that in control subjects (22.3% vs. 8.0%; P = 0.0024). The significance was similarly present in male acromegalic patients (28.6% vs. 5.5% in male control subjects; P = 0.0026), but was absent in female acromegalic patients. The prevalence of colonic polyps was also significantly increased in the group of acromegalic patients under 55 yr of age (20.0% vs. 3.0% in the control group of the same age; P = 0.0026). Other characteristics of adenomatous colonic polyps in acromegaly were the multiplicity and the presence proximal to the splenic flexure. No difference in the duration of acromegaly was found between patients with or without adenomatous polyps. The prevalence of hyperplastic colonic polyps was also significantly increased to 24.3% in acromegalic patients vs 4.4% in control subjects (P < 0.001). In conclusion, in view of the increased incidence of adenomatous colonic polyps, colonoscopy should be part of the follow-up examination in acromegaly.

Acromegaly↗
PubMed1986

Association between acrochordons and colonic polyps.

Fifty-four male and female patients with suspected colonic disease were examined for the presence of acrochordons prior to colonoscopy. Thirty-five of these patients (65%) had skin tags and twenty-six (48%) were found to have colonic polyps. In this study patients with acrochordons were significantly (p less than 0.005) more likely to have adenomatous polyps; thus, skin tags may be good markers for the presence of polyps in patients with suspected colonic disease. However, any association between colonic polyps and acrochordons in the general population requires further examination.

Adult↗
PubMed2000

A high level of physical fitness during thirties is a negative risk factor for colonic polyps during fifties.

This case-control study examined the relationship between the occurrence of colonic polyps in men in their fifties and the level of their physical fitness while in their thirties. The subjects consisted of 51 male Japan Self-Defense Forces officials in their fifties who had colonic polyps, as diagnosed by colonoscopic examination, and 46 control individuals. As an indicator of physical fitness between 30 and 39, we selected the best time recorded for each individual during that decade of life for the 1,500 meter Physical Fitness Test run. We calculated the odds ratio for polyps according to selected risk factors (including physical fitness), and a logistic regression analysis was used to adjust for possible confounding variables. Odds ratio (95% confidence interval, p value) for colonic polyps with physical fitness in the thirties was 0.36 (0.16-0.82, p < 0.05). With adjustment for the subjects' maximum Body Mass Index in both their thirties and fifties, and serum total cholesterol, the odds ratio was 0.39 (0.15-0.99, p < 0.05). We suggest that the occurrence of colonic polyps in men in their fifties can be reduced by maintaining a high level of physical fitness while in their thirties.

Adult↗
PubMedDate not supplied

Characterization of colonic polyps by two-dimensional gel electrophoresis.

To identify proteins that may specifically characterize colonic polyps we have investigated the abundance of numerous proteins in epithelial cells from 15 normal colon specimens and 13 colonic polyps, using two-dimensional gel analysis to detect possible differences in expression. Silver-stained digitized images of the gels were analyzed with Melanie II 2.1 software. We consistently detected more than 700 protein spots on each gel, and found that the intensity of 59 of them was significantly altered in polyp specimens (Wilcoxon test assuming P< or =0.05). Immunostaining, microsequencing and mass spectrometry (matrix-assisted laser desorption/ionization - time of flight; MALDI-TOF) techniques were used to identify these proteins and selected others that did not show differential regulation. The expression of numatrin (nucleophosphine/B23), hsp 70, and hsp60 was increased in polyps; levels of fatty acid binding protein (L-FABP), 14-3-3 sigma, citokeratin 20, cytochrome c oxidase polypeptide Va, Rho GDP-dissociation inhibitor (Rho GDI), and beta- and gamma-actins were decreased. Although the levels of expression of a given protein often varied among polyp specimens, it generally held true that the direction of variation (up or down) remained constant across the panel. We concluded that proteins showing constant differential regulation across all or most of the polyp specimens represent the most characteristic regulatory pathways in colon polyps, while more sporadic variations reflect characteristics of individual polyps.

Adenomatous Polyps↗
PubMed1990

[Colonoscopy in the diagnosis and follow-up of colonic polyps].

Out of 5000 patients examined endoscopically colon polyps were detected in 64%. The polyps were characterized by: higher incidence in 70-79-year-olds, high percentage of tubular adenomas (79%), large sizes of polyps with complex structure and their prevalence in the left colon, signs of malignancy in 0.64% of the removed polyps. The chance to develop cancer from tubular adenoma was 0.28%, tubular-villous, 1.4%, villous 3%. Recurrent polyps following polypectomy arose in 65% of cases. Tumor relapses emerging mainly within the first postoperative year occurred in 14% of cases. In 4 patients with cancer its onset was registered at the site of the removed large adenomas of complex histological structure. Colonoscopy proved an adequate method of diagnosis and follow-up of colon polyps. Endoscopic polypectomy can be considered as a measure to prevent colon cancer.

Aged↗
PubMed1982

Tissue bile acids in patients with colon cancer and colonic polyps.

The purpose of this study was to determine whether in man unusual types of concentrations or bile acids were present in colonic polyps, colon carcinomas, or the adjacent, apparently normal tissue. Methods for the determination of soluble and tissue-bound bile acids were validated. Of 14 polyps analyzed, eight contained detectable levels of bile acid, predominantly chenodeoxycholic acid; no lithocholic acid was observed in either the tissue-bound or soluble bile acid fractions. Bile acids were found in four of nine samples of colon carcinoma; in one tumor, tissue-bound lithocholic acid was present. Bile acids were similarly found in seven of 10 samples of normal bowel taken adjacent to the carcinoma. In the soluble bile acid fraction, cholic acid was more abundant than chenodeoxycholic acid. There was no correlation between tissue histology and bile acid composition or concentration. Under the conditions used, this study did not disclose a relationship between tissue bile acids and colorectal histology.

Adenocarcinoma↗
PubMed1998

Long pedunculated colonic polyp composed of mucosa and submucosa: proposal of a new entity, colonic muco-submucosal elongated polyp.

We encountered 15 patients with colonic polyps showing histologic features that did not belong to any of the known categories. All polyps were elongated and drumstick-shaped, with lengths of 12 to 160 (mean, 29 mm) mm. Histologically, the polyps were covered with normal mucosa and consisted of edematous, loose, fibrous, connective tissues and dense, fibrous submucosal layers, often showing dilation of blood vessels and lymphatics. Although the mechanism of generation of such polyps remains unknown, their elongation may be caused by intestinal motion. Because this kind of polyp has not been described previously outside Japan, we here introduce a new type of polyp, which we have proposed calling the colonic muco-submucosal elongated polyp.

Adult↗
PubMed1975

Epithelial blood group antigens in colon polyps. I. Morphologic distribution and relationship to differentiation.

The distribution patterns of epithelial blood group AB antigens (BG) in colon polyps of varying degrees of differentiation were studied by the mixed cell agglutination reaction. BG appeared in colon polyps if a certain degree of dedifferentiation was present. Two different distribution patterns were recognized: 1) association of BG with the secretory part of goblet cells with slight-to-moderate atypia and 2) association of BG with the whole cells in cases of pronounced dedifferentiation and loss of secretory activity. The second type resembled the distribution pattern of BG found previously in colon carcinomas. With respect to BG, the mucosa of colon polyps behaved similarly to embryonal colon mucosa. The detection of BG represents a useful method to assess objectively the degree of dedifferentiation in most colon polyps.

ABO Blood-Group System↗
PubMed2004

High prevalence of hyperplastic colonic polyps in acromegalic subjects.

We evaluated the prevalence and features of colonic polyps in a population of acromegalic subjects, compared to a control group of patients with irritable bowel syndrome (IBS). Colonic polyps were found in 30 acromegalic subjects (40%) and in 10 controls (13%) (P < 0.0001). Among the acromegalic patients, polyps were of the hyperplastic type in 27 subjects (90%) and adenomatous in 3 (10%). In the control group, polyps were hyperplastic in nine subjects (90%) and adenomatous in one (10%). We also observed a significant association (P < 0.0001) between the presence of hyperplastic polyps and the older age in both the acromegalic and the control groups. There were no differences between the two groups regarding sex, site, size, or macroscopic and histological types of polyps. Acromegalic patients have a higher prevalence of colonic hyperplastic polyps than IBS subjects, while the prevalence of adenomatous polyps is similar in the two groups.

Acromegaly↗
PubMed1975

Pedunculated malignant colonic polyps with superficial invasion of the stalks.

Malignant colonic polyps on substantial stalks were seen in 3 patients. In each case the base of the pedicle was free of tumor. The author suggests that these were initially benign adenomatous polyps but subsequently became malignant. These findings suggest that initially benign colonic polyps can become malignant over a period of time and that the presence of a substantial stalk may not always be pathognomonic of benignity.

Adenocarcinoma↗
PubMed2005

Colon polyp retrieval after cold snaring.

BACKGROUND: The removal of small colon polyps by cold snare transection without electrocautery effectively eliminates polyps, and anecdotal reports indicate a low risk of bleeding and perforation. Concerns about using cold snaring have centered on the risk of immediate bleeding and the difficulty in retrieving the polyp. The objective was to determine the retrieval rates of polyps after cold snaring after two different methods of resection and retrieval. METHODS: Consecutive polyps were identified by a single colonoscopist who chose the technique of polypectomy (hot snare, cold snare, or cold forceps). If cold snaring was chosen, an independent observer assigned the polyp to method A (cold resection of polyp without tenting and then suction of the transected polyp into a trap) or method B (ensnare the polyp, pull it into the colonoscope channel, and then transect it while suctioning). The size and the approximate location of all polyps were recorded and all collected specimens were sent separately for histologic examination. Results Of 519 consecutively encountered polyps, 400 were removed by cold snare: 197 were assigned to method A and 203 to method B. The mean size of polyps that were cold snared was 3.5 mm. The mean time to remove and to retrieve polyps with method A was 14.5 seconds (n = 58) and with method B was 18.1 seconds (n = 60) ( p = 0.03). There were no complications from cold snaring. The rate of successful retrieval with method A was 100% (197 of 197 polyps) and with method B was 98% (199 of 203 polyps) ( p = 0.04). CONCLUSIONS: Cold snare removal of colon polyps is associated with a high polyp retrieval rate. Each of two methods of polyp retrieval was effective. Snare transection without tenting of the polyp, followed by suctioning of the specimen off the polyp site, was more efficient, though the difference in efficiency was minimal. Difficulty or failure to retrieve polyps should not be a concern with regard to cold snare polypectomy.

Cold Temperature↗
PubMed1982

Colonic polyps in patients with acromegaly.

Seventeen patients with acromegaly were prospectively studied with barium enemas and colonoscopy to investigate the possibility that acromegaly is associated with an increased frequency of colonic polyps and colon cancer. Polyps were identified in nine patients and were removed and examined in eight. In five patients the polyps were adenomatous, and in four of the five there were multiple polyps. The presence of polyps closely correlated with the presence of skin tags (p = 0.041) and also with the age of the patient (p less than 0.01). No new cases of colonic cancer were discovered; however, reviewing the records of 44 patients with acromegaly, four cases were previously diagnosed with colon carcinoma. This study identifies a unique group of patients that are at risk for the development of colonic polyps and perhaps colon cancer.

Acromegaly↗
PubMed1991

Tobacco smoking as a risk factor for colon polyps.

BACKGROUND: Data from a cancer screening project among pattern makers were used to evaluate the association between tobacco smoking and prevalence of colon polyps. METHODS: From 1981-1983, 549 White men were examined by flexible sigmoidoscopy and completed self-administered questionnaires including smoking histories. RESULTS: One or more colon polyps were detected in 76 men. Standardized prevalence rates (SPR) for polyps increased by smoking category (never smoked = 0.094; ex-smokers = 0.118, current smokers = 0.214) and by cigarettes per day, years of smoking, and pack-years among both current and ex-smokers. Both adenomatous and hyperplastic polyps showed an association with smoking while other types of polyps and polyps with unspecified histology did not. The risk associated with smoking was greater for polyps greater than one centimeter in diameter. An interaction with occupational exposures was suggested by a greater increase in the SPR for polyps among current smokers employed as pattern makers for more than 10 years than among current smokers similarly employed for 10 years or less. CONCLUSIONS: Since at least some colon polyps are considered precursor lesions to colon cancer, one of the most common cancers in the United States, this report suggests that the possible link between colon polyps and smoking deserves further evaluation.

Adult↗