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PubMed1984

Computed tomographic distinction of submucosal lipoma and adenomatous polyp of the colon.

Described here is a patient with 2 large pedunculated colonic tumors detected by barium enema radiography. By computed tomography (CT) 1 was found to be a submucosal lipoma characterized by oval shape, smooth demarcation, and homogeneous density with a CT number of -68 HU, whereas the other was an adenomatous polyp with slightly fuzzy outline and a much higher CT number. This case indicates that CT can be a definitive diagnostic modality for distinguishing between a colonic lipoma and other solid or cystic tumor of the colon.

Barium Sulfate↗
PubMed2004

A novel endoscopic device for retrieval of polyps resected from the colon and rectum.

BACKGROUND: Retrieval of polyps resected from the colorectum is time consuming, despite the availability of various devices, such as grasping forceps, nets, and suction traps, for this purpose. A novel device for retrieval of polyps was developed and tested. METHODS: Patients with polyp(s) less than or equal to 6 mm in diameter were included in this study. The effectiveness of the device for polyp retrieval was evaluated. OBSERVATIONS: In total, 180 of 184 polyps were retrieved from 100 patients. Four polyp specimens (2.2%) were lost after polypectomy. None of the retrieved specimens were damaged. All retrieved polyps could be assessed histopathologically, and a definitive diagnosis was made. CONCLUSIONS: The newly developed device proved to be reliable when used in clinical practice.

Adult↗
PubMedDate not supplied

[Diagnosis and treatment of juvenile polyp of the colon].

In a five year period 75 colonoscopies were carried out in 66 children with rectal bleeding. Five patients presented with severe anemia. Their age ranged from 2 to 16 years (mean 6.6). Most of the procedures were performed on an outpatient basis (87%) and under oral sedative premedication (78%). At least the splenic flexure was reached in each case. We found 59 polyps in 47 children (71%). All polyps were snared and removed during the same procedure. There were no serious complications. Colonoscopy is a most usefull diagnostic and therapeutic procedure in children with rectal bleeding, where there is a high probability that a juvenile polyp can be found which can be safely treated during the same session.

Adolescent↗
PubMed1988

Cholecystectomy and adenomatous polyps of the colon in women.

The relationship between prior cholecystectomy and colon cancer in women has been a subject of recent research interest. No study has yet reported on cholecystectomy and adenomatous polyps, a precursor lesion for most colon cancers. This pilot case-control study interviewed 245 women who had undergone colonoscopy between 1983 and 1985 at Columbia-Presbyterian Medical Center with a structured telephone-administered questionnaire. Fifty-six were colon cancer cases, 105 were adenomatous polyp (AP) cases, and 84 were controls (without colonic neoplasia). Adjusted for age and educational attainment, the odds ratio for prior cholecystectomy among colon cancer cases compared to controls was 1.79 (95% confidence limits, 0.59 to 5.44) and 2.26 for right-sided colon cancer cases (95% confidence limits, 0.61 to 8.42). Despite a lack of statistical power, these estimates are consistent with earlier reports. The odds ratio for adenomatous polyp cases was 1.02 (95% confidence limits, 0.40 to 2.64), suggesting no association between prior cholecystectomy and adenomatous polyps. These preliminary findings are currently being explored in a large-scale case-control study.

Aged↗
PubMed2002

Immunohistochemical study of myofibroblasts in normal colonic mucosa, hyperplastic polyps, and adenomatous colorectal polyps.

CONTEXT: Myofibroblasts are distinct cells with characteristics of both smooth muscle cells and fibroblasts. Through their ability to secrete cytokines, chemokines, prostaglandins, growth factors, and matrix components, they are thought to play critical roles in inflammation, growth, repair, and neoplasia. OBJECTIVE: The goal of this study was to identify the distinct cell populations of the lamina propria of normal colon and colorectal polyps. DESIGN: We studied the expression of alpha-smooth muscle actin (alphaSMA), smooth muscle myosin (SMM), desmin, vimentin, and c-kit by intestinal mesenchymal (stromal) cells in the normal colonic mucosa (n = 5), as well as in hyperplastic polyps (n = 5), sporadic colorectal adenomas (n = 47), and adenomas from patients with familial polyposis (n = 36). RESULTS: In the normal colonic mucosa, the pericryptal stromal cells were alphaSMA+, SMM+, desmin-, and vimentin+, defining them as myofibroblasts. In contrast, cells of the muscularis mucosae were alphaSMA+, SMM+, desmin+, and vimentin-, defining them as smooth muscle cells. alpha-Smooth muscle actin also highlighted direct connections between the muscularis mucosae and the pericryptal myofibroblasts, and vimentin immunostaining showed a network of connections between the alphaSMA+ pericryptal myofibroblasts and the alphaSMA- fibroblasts in the interstitium. In all hyperplastic polyps and adenomatous polyps, the interstitial stromal cells (fibroblasts) now also express alphaSMA and form a syncytium of alphaSMA+ networklike connections throughout the lamina propria. Stromal cells of sporadic adenomas demonstrated the same immunohistochemical staining characteristics displayed by adenomas from patients with familial polyposis and by hyperplastic polyps. Conclusions.-These findings indicate that in normal colon, alphaSMA- fibroblasts are the predominant cell type in the lamina propria. However, the pericryptal (subepithelial) stromal cells are a distinct cell type (alphaSMA+ myofibroblast) that is immunophenotypically different from muscularis mucosae smooth muscle cells and are connected to the interstitial, nonpericryptal fibroblasts with which they exist as a network throughout the lamina propria of the normal colon. Furthermore, in both hyperplastic and neoplastic polyps, there are changes in nonpericryptal fibroblasts from vimentin+, alphaSMA-, and SMM- to vimentin+, alphaSMA+, and SMM+; thus, the interstitial fibroblasts are replaced by myofibroblasts. The factors that cause these changes and the origin of the myofibroblasts need to be determined to clarify the biology of colorectal tumorigenesis.

Adenoma↗
PubMed2006

Hamartomatous polyps of the colon: ganglioneuromatous, stromal, and lipomatous.

Intestinal ganglioneuromas comprise benign, hamartomatous polyps characterized by an overgrowth of nerve ganglion cells, nerve fibers, and supporting cells in the gastrointestinal tract. This polyposis has been divided into 3 subgroups, each with a different degree of ganglioneuroma formation: polypoid ganglioneuroma, ganglioneuromatous polyposis, and diffuse ganglioneuromatosis. The ganglioneuromatous polyposis subgroup is not known to coexist with systemic disorders that often have an associated intestinal polyposis, such as multiple endocrine neoplasia type IIb, neurofibromatosis type I, and Cowden syndrome. We report a case of ganglioneuromatous polyposis plus cutaneous lipomatosis in a 41-year-old man with no established systemic disease. However, he possessed unique anatomic findings in addition to his ganglioneuromatosis, suggesting that the ganglioneuromatosis-lipomatosis in our patient may represent an unrecognized syndrome. This case report and brief review of the literature provide an overview of intestinal ganglioneuromatosis in relation to the hereditary polyposis syndromes and describe the individual ganglioneuromatosis subgroups.

Adult↗
PubMed1982

Juvenile polyps of the colon and rectum.

Two hundred and fifty-eight patients with juvenile polyps were reviewed. Ten patients less than 20 years of age were found to have adenomas. The points to be presented can, therefore, be emphasized. Juvenile polyps are a distinct pathologic entity and can occur at any age and in either sex. Adenomas do exist in pediatric patients. We should not assume that every polyp in patients less than 20 years of age is automatically a juvenile polyp and, therefore, benign. Barium enema is recommended for any child or adolescent in whom one or more polyps are found. In multiple polyposis, the finding that one polyp is of the juvenile type does not necessarily rule out the presence of adenoma. Any patient with a solitary adenoma who has multiple polyps, whether adenoma or juvenile polyps, should be observed at appropriate intervals by sigmoidoscopic, roentgenographic and, possibly, colonoscopic examination. Finally, we hope that this study will inspire others to investigate further this interesting pathologic condition.

Adenoma↗
PubMed1988

[Potentialities of an x-ray method of determining malignant changes in polyps of the large intestine].

The study was concerned with evaluation of the clinical and roentgenologic data on 57 cases of malignant polyps of the colon. Malignant polyps reaching 10 mm in length were found. Malignancies were identified using endoscopy and biopsy in 58.6% and X-ray examination--45.8%. Among the most effective methods of X-ray examination of the large bowel for cancer should be: high-voltage roentgenography employing incomplete barium enema, primary double contrast examination, direct blow-up and parietography. X-ray signs of malignant transformation of polyps are: persistent retention of barium, wavy and indistinct contours, irregular pattern, rapid growth of neoplasm, retraction of tumor base and disparity between polyp size and its pedicle length.

Colonic Polyps↗
PubMed1975

Invasive and metastasizing carcinoma in a small adenomatous polyp of the colon: report of a case with demonstration of a tumor associated antigen.

An unusual case of metastasis to two lymph nodes from an adenocarcinoma arising in an adenomatous polyp of the sigmoid colon is presented. Invasion of the stalk could not be detected, but penetration of the muscularis mucosae was observed. Immunoperoxidase staining was used to detect an antigen in the invasive and metastatic components of the tumor that reacted with an antiserum to a tumor associated antigen. A focus of intraepithelial carcinoma was also detected by this method. The relevance of these findings to the adenoma-carcinoma sequence is discussed.

Adenocarcinoma↗
PubMed2006

Risk assessment for delayed hemorrhagic complication of colonic polypectomy: polyp-related factors and patient-related factors.

BACKGROUND: Hemorrhage is among the most serious complications of colorectal polypectomy and may occur after a longer postprocedure interval. OBJECTIVE: We aimed to elucidate the risk factors for delayed postpolypectomy hemorrhage, including both polyp characteristics and the general condition of the patients. DESIGN: Retrospective cohort study. PATIENTS: A total of 6617 cases of colorectal polypectomy was performed in 3138 consecutive patients in Japan. MAIN OUTCOME MEASUREMENTS: The risk factors for delayed postpolypectomy hemorrhage were assessed among polyp characteristics (form, size, histologic features) and the method of resection by unconditional logistic regression. Patient conditions (smoking, alcohol, hypertension, diabetes mellitus, hyperlipidemia) were compared between case-control pairs matched on polyp-related characteristics by conditional logistic regression. RESULTS: Hemorrhage occurred in 38 lesions (0.57%) of 37 patients (1.2%): 22 required endoscopic hemostasis and 1 required blood transfusion. Although polyp size was associated with the occurrence of delayed hemorrhage (10.0 +/- 6.9 mm in hemorrhage cases vs 5.6 +/- 3.8 mm in others, P < .0001), other polyp-related factors were not significant. Hypertension was a complication in 25 of 37 (68%) cases and in 21 of 74 (28%) matched controls, showing an adjusted odds ratio of 5.6 (95% CI 1.8-17.2, P = .001). Other patient characteristics were not significant. The interval between polypectomy and hemorrhage was significantly longer in patients with hypertension (median 6 days, range 2-14 days) than in those without hypertension (2.5 days, 1-9 days; P = .019). LIMITATIONS: This study does not provide information regarding prevention of hemorrhage. CONCLUSIONS: Hypertension is a significant risk factor for delayed colorectal postpolypectomy hemorrhage. The interval between polypectomy and hemorrhage can be as long as 14 days in the presence of hypertension.

Aged↗
PubMed2000

Mucin core protein expression in colorectal cancers with high levels of microsatellite instability indicates a novel pathway of morphogenesis.

Particular mucinous phenotypes have been associated with serrated epithelial polyps of the colon. These polyps also show a high frequency of DNA instability. The aim of this study was to examine the expression of mucins in colorectal cancers that arise through the suppressor and mutator pathways. The immunohistochemical distribution of the human apomucins MUC1, MUC2, MUC4, and MUC5AC was determined in 93 sporadic colorectal cancers classified previously (J. R. Jass et al., J. Clin. Pathol., 52: 455-460, 1999) according to levels of DNA microsatellite instability (MSI) as 22 MSI-high (MSI-H), 24 MSI-low (MSI-L), and 47 MS stable (MSS). MUC2 expression was observed in 19 (86%) MSI-H, 10 (42%) MSI-L, and 15 (32%) MSS cancers (P = 0.0001); and MUC5AC expression was observed in 17 (77%) MSI-H, 8 (33%) MSI-L, and 13 (28%) MSS cancers (P = 0.0003). There was no association between MUC1 or MUC4 expression and MSI status. The mucinous phenotype described in serrated polyps (MUC2+/MUC5AC+) was seen in 15 (68%) of 22 MSI-H and only 10 (14%) of 71 MSI-L/MSS cancers (P < 0.0001). Increased expression of the secretory mucins MUC2 and MUC5AC was observed in sporadic MSI-H cancers. Identical mucin changes and DNA MSI occurred in serrated polyps of the colorectum, which suggests that these lesions may represent precursors of MSI-H cancers.

Adult↗
PubMedDate not supplied

Quantitation of colonic injury from argon laser, neodymium: YAG laser and monopolar electrocautery applied to flat mucosa and small sessile polyps of the canine colon.

This study determined the optimum laser energy for ablation of colonic mucosal lesions and small sessile polyps in the canine colon. Neodymium (Nd):YAG laser, argon laser, and monopolar electrocautery were applied to exposed canine colonic mucosa for various application times at various power settings. At the minimum energy level necessary to ablate mucosa, the Nd:YAG laser caused greater muscularis injury than the argon laser and monopolar electrocautery. At higher energy levels, monopolar electrocautery and Nd:YAG laser caused greater muscularis injury than argon laser. Small surgically created polyps in the canine colon were ablated endoscopically with the three energy sources. Single-session complete polyp ablation occurred most frequently with Nd:YAG laser and least frequently with argon laser. The depth of tissue injury beneath polyp ablation sites was least with argon laser and greatest with Nd:YAG laser. This study suggests that the argon laser is safer than the Nd:YAG laser or monopolar electrocautery for coagulation of flat colonic mucosal lesions. Although the argon laser is safer for the coagulation of small sessile colonic polyps, it may be less effective than monopolar electrocautery or the Nd:YAG laser for the single-session fulguration of polyps greater than 5 mm in diameter.

Animals↗
PubMed1990

Genetic analysis of an inherited predisposition to colon cancer in a family with a variable number of adenomatous polyps.

We studied a large kindred with a history of colorectal cancer of early onset. Proctosigmoidoscopic examination of 51 family members identified only 2 with familial polyposis coli, which strongly predisposes those who have it to colorectal cancer and which is defined as the presence of more than 100 polyps in the colon. However, eight family members had 2 to 40 colonic polyps. We suspected that in this family, colorectal cancer was the result of a mutation in the gene on chromosome 5 that is responsible for familial polyposis coli. To test our hypothesis, we obtained genotypic information on 81 family members with respect to seven polymorphic DNA markers previously shown to be linked to the locus for familial polyposis coli. Multilocus analysis of the data demonstrated genetic linkage (lod score, 5.58) between these markers and the locus responsible for the defined syndrome of colonic polyps or colorectal cancer in this kindred. These findings constitute evidence that the genetic defect in this family is a mutation in the gene that causes familial polyposis coli. We conclude that mutations at the genetic locus for familial polyposis coli may be the cause of other, more subtle syndromes involving an inherited susceptibility to colonic adenomatous polyps and colorectal cancer.

Adenomatous Polyposis Coli↗