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PubMed1980

Rectal cancer following colectomy for polyposis.

Reevaluation of 178 patients treated for multiple colonic polyposis by abdominal colectomy and restoration of bowel continuity confirmed that patients with both rectal and colonic polyps are at substantial risk of having rectal cancer develop postoperatively. Rectal cancer has not occurred in any of 35 patients who had no rectal polyps preoperatively. However, 46 (32%) of 143 patients with multiple colorectal polyposis have had cancer develop during a median follow-up of nearly 20 years. Multivariate analysis showed a highly significant association between the number of rectal polyps present preoperatively and decreased survivorship free of rectal cancer (P less than .001), and a strong correlation between the presence of cancer in the resected colon and subsequent development of rectal carcinoma (P less than .01). No correlation could be established between low anastomosis and prevention of rectal carcinoma. The risk of cancer developing in the retained segment of large bowel can be established only by extended postoperative observation.

Actuarial Analysis↗
PubMed1991

Severe colonic dysplasia in a child with familial adenomatous polyposis.

Familial adenomatous polyposis (FAP), is a genetic premalignant condition which, if untreated, will ultimately manifest with the development of colorectal carcinoma. It is a disease of young adulthood. Rectal and colonic polyps are seldom seen before 10 years of age. Screening of clinically asymptomatic relatives thus generally starts during the teenage years. Carcinoma of the colon is exceedingly rare in children with FAP. While all adult patients should be surgically treated before the appearance of any carcinoma, early detection of dysplasia is paramount. The present case history relates to an 8-year-old boy with FAP who was found to have a significant degree of dysplasia in a polyp. This case remains the exception and a uniform approach to the screening and treatment of patients with FAP is still encouraged.

Adenomatous Polyposis Coli↗
PubMed1974

Villous adenoma of the colon and rectum: an ultrastructural study.

The villous component of nine colonic polyps (three pure villous adenoma and six mixed adenomatous and villous adenomas) was studied by light and electron microscopy. Normal colonic mucosa was used for control. The predominant cell was an undifferentiated epithelial cell resembling those of the base of the crypts of normal colonic mucosa. A minority of these cells differentiated toward goblet cells and absorptive cells. Interdigitations of the plasma membrane with enlarged intercellular spaces were frequently observed, possibly related to the loss of water and electrolytes in some of these tumors, suggesting an analogy to renal tubular plasma membrane changes in kalliopenic nephropathy. Numerous membrane-bound, inter and intracellular "inclusion bodies" representing degenerated lymphocytes and epithelial cell organelles were commonly found. Viral inclusions were not detected in this material. The possibility that the inclusion bodies observed in villous adenoma may represent lysosome-modified vesicles, secondary to absorption of protein and surface mucosubstances appears unlikely.

Adenoma↗
PubMed2004

MR-based full-body preventative cardiovascular and tumor imaging: technique and preliminary experience.

Recent improvements in hardware and software, lack of side effects, as well as diagnostic accuracy make magnetic resonance imaging a natural candidate for preventative imaging. Thus, the purpose of the study was to evaluate the feasibility of a comprehensive 60-min MR-based screening examination in healthy volunteers and a limited number of patients with known target disease. In ten healthy volunteers (7 men, 3 women; mean age, 32.4 years) and five patients (4 men, 1 woman; mean age, 56.2 years) with proven target disease we evaluated the performance of a comprehensive MR screening strategy by combining well-established organ-based MR examination components encompassing the brain, the arterial system, the heart, the lungs, and the colon. All ten volunteers and five patients tolerated the comprehensive MR examination well. The mean in-room time was 63 min. In one volunteer, insufficient colonic cleansing on the part of the volunteer diminished the diagnostic reliability of MR colonography. All remaining components of the comprehensive MR examination were considered diagnostic in all volunteers and patients. In the five patients, the examination revealed the known pathologies [aneurysm of the anterior communicating artery ( n=1), renal artery stenosis ( n=1), myocardial infarct ( n=1), and colonic polyp ( n=2)]. The outlined MR screening strategy encompassing the brain, the arterial system, the heart, the lung, and the colon is feasible. Further studies have to show that MR-based screening programs are cost-effective in terms of the life-years saved.

Adult↗
PubMed2003

Cooperative effects of matrix metalloproteinase and cyclooxygenase-2 inhibition on intestinal adenoma reduction.

Matrix metalloproteinases (MMPs) and cyclooxygenase-2 (COX-2) are expressed in both sporadic and familial adenomatous colonic polyps and tumours and have been independently shown to play causal roles in intestinal tumour formation in mouse models of colon cancer. The apparent roles of these enzymes in intestinal tumorigenesis led us to examine, in the Min mouse model of colon cancer, if selective COX-2 and MMP inhibitors provide additive or synergistic therapeutic benefits in intestinal tumour prevention. The broad-spectrum MMP inhibitor (A-177430; MMPI) and the selective COX-2 inhibitor (A-285969; COX-2I) both showed dose-dependent inhibition of the number of adenomas in Min mice. Using suboptimal doses, the MMPI reduced tumour multiplicity by 32%, the COX-2I by 48% and, both agents in combination resulted in a 67% decrease compared to control demonstrating a cooperative effect on intestinal tumorigenesis. Apoptosis, proliferation, and angiogenesis were assayed in tumors from each treatment group. These agents in combination allowed for a lowered dosage to be administered to achieve significant biological effects. Clinically, this could potentially reduce side effects associated with currently used MMP and COX-2 inhibitors. Together, these compounds could represent an easily tolerated chemopreventive approach.

Adenoma↗
PubMed1998

Rectal cancer following colectomy and ileorectal anastomosis for familial adenomatous polyposis.

BACKGROUND: Familial adenomatous polyposis (FAP) has historically been treated by colectomy and ileorectal anastomosis (IRA). Preservation of the rectum allows the subsequent development of cancer in the rectum. The risk of rectal cancer following ileorectal anastomosis in the Australian population has not been published to date. METHODS: An audit of the Familial Adenomatous Polyposis Registry of Western Australia was undertaken to assess patients who had undergone colectomy and ileorectal anastomosis. Fifty-five patients ranging in age from 13 to 65 years were studied. RESULTS: Seven patients (13%) developed cancer of the rectum with a median follow-up of 10 years (range: 1-31 years). Median interval to diagnosis of carcinoma of the rectum following colectomy and IRA was 10 years. All patients who developed cancer in the retained rectum had rectal polyps. Colon cancer was present in the initial colectomy specimen in 13 patients (of these, five patients developed rectal cancer). Flat polyps were noted in five patients. Four patients with flat polyps developed cancer of the rectum. CONCLUSIONS: Total colectomy and IRA should be considered as part 1 of a staged procedure in the patient with FAP. With the exception of the patient with no evidence of rectal polyps, completion proctectomy should be undertaken within 10 years of the initial colectomy.

Adenomatous Polyposis Coli↗
PubMed2001

Perspectives in endoscopic mucosal resection.

The birth of endoscopic mucosal resection probably can be traced back to the early days of colonoscopy and polypectomy. With the advent of colonoscopy, endoscopists began encountering pedunculated and sessile mass lesions arising from the mucosal surface. The concept of snare polypectomy developed quickly, and this technique has become the standard of care in the management of colon polyps. Large sessile lesions, however, remain problematic, especially when they arise from the thin wall of the cecum and ascending colon. Serosal burns and frank perforations represent the most significant complication of this technique.

Digestive System Neoplasms↗
PubMed1986

[Diagnosis of inflammatory and tumorous changes of the large intestine using colonic sonography].

By water instillation into the large intestine, sonographic visualization of the whole length of the colon from the recto-sigmoid to the caecum can be achieved. Detailed evaluation of the lumen, the wall and the surrounding connective tissue may be carried out. Diagnostic sonography of the colon in 41 patients with pathological changes confirmed by colonoscopy showed that colonic polyps and carcinomas can be detected by this method. In Crohn's disease, typical changes can be seen, which allow the degree of inflammatory infiltration to be assessed. Thus, sonography of the colon is a diagnostic procedure which gives discriminating evidence in diseases of the large intestine.

Adult↗
PubMed1982

Adenomatous and carcinomatous changes in hamartomatous polyps of the small intestine (Peutz-Jeghers syndrome): report of a case and review of the literature.

The authors report the unique case of a patient with the Peutz-Jeghers (P-J) syndrome who had multiple small bowel hamartomatous polyps, some of which also showed adenomatous and carcinomatous changes. Over the course of 30 years, over 100 small bowel and colonic polyps were resected; all histologically demonstrated the typical features seen in hamartomatous polyps. Several jejunoileal polyps excised during the last few months of the patient's life showed not only hamartomatous features but also adenomatous epithelium. As far as the authors can determine, this is the first documented case of adenomatous changes found within a small bowel hamartomatous polyp. In addition, at least one duodenal polyp demonstrated areas of hamartoma, adenoma, and in situ carcinoma. The literature on the occurrence of gastrointestinal adenomas and carcinomas in patients with the P-J syndrome is reviewed, and the relationship of hamartomas, adenomas, and carcinomas of the gastrointestinal tract is discussed.

Adenoma↗
PubMedDate not supplied

Antiproliferative effect of nonsteroidal antiinflammatory drugs against human colon cancer cells.

Several lines of evidence suggest that nonsteroidal antiinflammatory drugs may be effective in preventing colorectal cancer. These include animal experiments, case-control studies, and clinical experience with sulindac in promoting the regression of adenomatous colon polyps in adenomatous polyposis coli. We determined the antiproliferative activity of various nonsteroidal antiinflammatory drugs, including two sulindac derivatives, against human colon cancer cells in vitro. Ht-29, SW480, and DLD-1 cells were continuously incubated with serial drug dilutions for 6 days prior to fixation. Cell number was determined using the sulforhodamine B assay, and drug concentrations which inhibited cell growth by 50% were estimated for each agent by interpolation. All drugs exhibited antiproliferative activity against Ht-29 and DLD-1 cells, and most inhibited SW480 cells. For Ht-29 cells, the 50% inhibitory concentration varied from 55 microM for diclofenac to 2100 microM for 5-aminosalicylic acid, with three drug groups of high, intermediate, and low potency evident. Inhibition of cell growth by sulindac sulfide was reversible following drug removal. Nonsteroidal antiinflammatory drugs exert an antiproliferative effect against human colon cancer cells with a wide range of potencies. A cytostatic response was demonstrated with sulindac sulfide. These data further support the potential role of these agents for chemoprevention of colorectal neoplasia.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1986

Radiologic diagnosis of invasive carcinoma on adenomatous polyps of the colon.

The radiographic appearance at double contrast enema of 33 cases of invasive cancer on adenomatous polyps (AP) of the colon is reviewed. The radiologic diagnosis of malignancy was prospectively made in 54.5% of the cases. In 45.5% of the cases, malignancy was not suspected at the time of examination. The endoscopic appearance of these lesions was identical to that seen on the barium study. There are no radiologic criteria able to entirely rule out the possibility of a carcinomatous transformation of an AP. However, the radiologic features of malignancy (indentation of the intestinal wall and/or irregular outline of the surface of the polyp) have to be considered quite reliable.

Adenocarcinoma↗
PubMed1977

Periampullary malignancy in Gardner's syndrome.

Three cases of familial polyposis coli with associated periampullary malignancies are reported and the literature reviewed, which disclosed 16 additional cases. An additional five unreported cases are known to exist. The authors believe that the development of periampullary malignancy in FPC is a definite extracolonic manifestation of the disease and should be considered a variant of Gardner's syndrome. It is recommended that all FPC patients with colon polyps undergo routine surveillance of the upper gastrointestinal tract and that all duodenal polyps discovered be surgically removed when feasible.

Adolescent↗
PubMed1998

[The yield of endoscopic follow-up after removal of adenomatous polyps from the colon].

OBJECTIVE: To determine the results of follow-up endoscopy after resection of adenomatous polyps from the colon. DESIGN: Retrospective. SETTING: De Heel Hospital, department of Internal Medicine, Zaandam, the Netherlands. PATIENTS AND METHOD: The 124 patients, 66 males and 58 females, with a mean age of 53 years (range: 23-74), in whom a colonpolyp had been removed endoscopically, who had no colonic carcinoma and no positive family history, were registered for follow-up after one year and after 3 or 5 years. In 1997, data were collected on the polyps found and removed at follow-up. RESULTS: At the original coloscopy, 68 patients (55%) had one polyp, 46 (37%) had two to four polyps and 10 (8%) > or = five polyps. The localizations of the polyps were: rectum 17%, sigmoid 66%, descending colon 12%, transverse colon 3%, ascending colon 1% and caecum 1%. Over one-third of the polyps were larger than 1.5 cm. Ninety-eight patients underwent a first follow-up endoscopy after an average of 12 months (range: 0.4-57); one or more polyps were found and removed in 37 of them (38%). At a second follow-up endoscopy after an average of 28 months (range: 5.4-68 months), polyps were again found and removed in 26 of the 57 patients (46%). If two or more polyps had been removed at an earlier coloscopy, the risk of polyps being found again at the next coloscopy was larger (p < 0.001).

Adenomatous Polyposis Coli↗
PubMed2004

Cronkhite-Canada syndrome containing colon cancer and serrated adenoma lesions.

We describe a case of Cronkhite-Canada syndrome associated with sigmoid colon cancer, and provide a literature review. A 77-year-old man was diagnosed with sigmoid colon cancer after presenting with hypoproteinemia, nail atrophy, loss of scalp hair, hyperpigmentation, and gastrointestinal polyposis. The findings were consistent with Cronkhite-Canada syndrome. The colon polyps were histologically serrated adenomas, whose crypts showed a saw-toothed growth pattern with dysplasia, or tubular adenoma. Cronkhite-Canada syndrome associated with colon cancer has been reported in 31 cases. The availability of histologic material permitted reexamination of 25 of these cases. Serrated adenoma of the polypoid lesions was retrospectively found in 10 (40%) of the 25 cases. By comparison, the incidence of serrated adenomas has been estimated to occur in about 1% of all general polyps. Taken together, it is suggested that Cronkhite-Canada syndrome associated with colorectal cancer frequently has polyps containing serrated adenoma lesions. In the case described here, microsatellite instability and overexpression of the p53 protein were found in the cancer lesion and serrated adenoma lesions, and none of the lesions showed a loss of heterozygosity of various genes or K-RAS mutations. Thus, genetic alterations between the serrated adenoma and the colorectal cancer was correlated in this case. These findings suggested the possibility of a serrated adenoma-carcinoma sequence in this case of Cronkhite-Canada syndrome.

Adenoma↗
PubMed1983

Prevalence of Entamoeba histolytica in patients with schistosomal colonic polyposis.

Two hundred and fifty-seven Egyptian patients were classified into three groups: patients with schistosomal colonic polyposis, those with simple schistosomiasis without polyposis, and a non-schistosomal group. A diagnosis of schistosomiasis was made by clinical history and examination plus three fresh stool examinations or a rectal biopsy. The presence of schistosomal colonic polyps was established by sigmoidoscopy and biopsy of polyps. Stool examinations were made on all individuals, using the merthiolate-iodine-formaldehyde technique to detect Entamoeba histolytica. We found the prevalence of amebiasis in the group with schistosomal colonic polyposis (37%) to be significantly higher than that in the non-schistosomal group (11%) and in the schistosomal group without polyposis (15%). The difference in prevalence of amebiasis between the simple schistosomal and non-schistosomal groups was not significant.

Adolescent↗
PubMed1991

Sulindac inhibits the rate of growth and appearance of colon tumors in the rat.

Sulindac (cis-5-fluoro-2-methyl-1-[p-(methylsulfinyl) benzylidene] indene-3-acetic acid), an inhibitor of prostaglandin synthesis, has been reported to cause regression of colon polyps in patients with familial polyposis coli and Gardner's syndrome. We examined the effect of sulindac on the growth of primary colon carcinomas in rats. Colon tumors were induced in 18 rats by repeated subcutaneous administration of dimethylhydrazine. The site and diameter of each tumor were measured via laparotomy and colonoscopy. Rats were randomized to receive either sulindac (10 mg/kg) twice daily or vehicle (0.5% methylcellulose). After 4 weeks of treatment, the site and size of tumors in the colon were again recorded. In eight rats receiving sulindac, no new tumors were identified, while in 10 control rats, 13 additional tumors were found after treatment. There was a significantly greater increase in size of the tumors in the control group (56.4 mm for 26 tumors) compared with the rats receiving sulindac (9.3 mm for 14 tumors). We report that sulindac inhibits the rate of development and the rate of growth of colon tumors in the rat.

Adenocarcinoma↗