Colorectal Polyps

0
1249
      • Colorectal Polyps
        • Morphology
          • Broadly divided into sessile (flat) and pedunculated (on a stalk).
        • Histologic types
          • Inflammatory (pseudopolyp): (MCQ)
            • Seen in UC
          • Lymphoid:
            • Mucosal bumps containing intramucosal lymphoid tissue;
            • no malignant potential (MCQ)
          • Hyperplastic:
            • Overgrowth of normal tissue
            • no malignant potential(MCQ)
          • Adenomatous:
            • Premalignant
            • classified (in order of increasing malignant potential) as
              • tubular (75%),(MCQ)
              • tubulovillous (15%)
              • villous (10%)
          • Hamartomatous:
            • Normal tissue arranged in abnormal configuration
            • juvenile polyps, Peutz–Jeghers polyps(MCQ)
        • Signs and symptoms
          • Asymptomatic (most common) (MCQ)
          • Melena
          • Hematochezia
          • Mucus
          • Change in bowel habits
        • Diagnosis
          • Flexible endoscopy (sigmoidoscopy or colonoscopy)
        • Treatment
          • Attempt colonoscopic resection if: (MCQ)
            • Pedunculated, well or moderately well differentiated
            • no venous or lymphatic invasion
            • invades only into stalk
            • margins negative.
        • Otherwise, a segmental colon resection is indicated. (MCQ)
        • Malignant potential of a polyp is determined by: size, histologic type, and epithelial dysplasia.
          • SIZE and RISK of CA (MCQ)
          • < 1 cm -1–3%
          • 1–2 cm – 10%
          • >2 cm -40%
        • HISTOLOGY and RISK of CA(MCQ)
          • Tubular -5%
          • Tubulovillous -20%
          • Villous -40%
        • ATYPIA and RISK of CA(MCQ)
          • Mild -5%
          • Moderate -20%
          • Severe -35%
      • Polyposis syndromes of the bowel.
        • Familial polyposis coli (FAP)
          • Autosomal dominant (MCQ)
          • Polyps develop between the second and fourth decades
          • colon cancer inevitable without prophylactic colectomy
          • Caused by abnormal gene on chromosome 5(MCQ)
          • Indication for operation:Polyps
          • Operations
            • Proctocolectomy with Brooke’s ileostomy
            • Proctocolectomy with continent ileostomy
            • Colectomy with ileorectal anastomosis
            • Proctocolectomy with ileal pouch—anal anastomosis
        • Gardner’s syndrome
          • Autosomal dominant (MCQ)
          • Innumerable polyps with associated osteomas, epidermal cysts, and fibromatosis(MCQ)
          • colon cancer inevitable without surgery
        • Turcot’s syndrome
          • Autosomal recessive(MCQ)
          • Multiple adenomatous colonic polyps with CNS tumors (especially gliomas) (MCQ)
        • Cronkite–Canada syndrome
          • GI polyposis with alopecia, nail dystrophy, and hyperpigmentation(MCQ)
          • minimal malignant potential(MCQ)
        • Peutz–Jeghers syndrome
          • Autosomal dominant(MCQ)
          • Hamartomatous polyps of the entire GI tract
          • melanotic pigmentation of face, lips, oral mucosa, and palms(MCQ)
          • increased risk for cancer of the pancreas, breast, lung, ovary, and uterus(MCQ)
        • Hereditary nonpolyposis colon cancer syndrome (HNPCC or Lynch syndrome)
          • Autosomal dominant(MCQ)
          • Lynch syndrome I: (MCQ)
            • Patients without multiple polyps who develop predominantly right-sided colon cancer
          • Lynch syndrome II: (MCQ)
            • Same as Lynch I but additional risk for extracolonic adenocarcinomas of the uterus, ovary, cervix, and breast


What is a Colon Polyp
Colon polyp is an extermely common condition found during colonoscopy. It can eventually grow to become colon cancer. One or more polyp is found in up to 50% of individuals over the age of 60. With adoptation of screening colonoscopy in the general population, many individuals are found to have colon polyp.. The common symptoms, etiologies and type of colonic polyps as well as screening guideline are presented with footages taken from the Los Angeles Endoscopy Center.
Colorectal cancer and polyps
The pathology of colorectal polyps and cancer including risk factors, gross and microscopic appearances
Endoscopy Polypectomy of Polyp of Descending Colon
TYPES OF COLON POLYPS

The most common types of polyps are hyperplastic and adenomatous polyps. Other types of polyps can also be found in the colon, although these are far less common and are not discussed here.

Polypectomy of a Rectal Polyp
Colorectal polyps are classified histologically as neoplastic
or nonneoplastic.

What Are Colon Polyps?
A colon polyp is a bump on the internal lining of the bowel caused by genetic changes in the cells lining the colon. Two types of polyps can become cancerous
Polypectomy of Colon Sigmoid Polyp
Polypectomy of Colon Sigmoid Polyp
Colorectal polyps are classified histologically as neoplastic
or nonneoplastic.
Colonoscopy Video Tour: Removal of a Colon Polyp (Polypectomy)
ACG Trustee Mark B. Pochapin, MD, FACG, Director, Division of Gastroenterology New York University Langone Medical Center
(former Director of The Jay Monahan Center for Gastrointestinal Health), narrates a tour of a patient’s colon during a colonoscopy where he discovers a pre-cancerous polyp and removes the polyp (polypectomy).
Three Colon Pre-Cancerous Polyps Removed.mov
This is a colonoscopy video performed by Dr. Joseph Galati, with the removal of three colon polyps in the sigmoid colon. This is interesting in that three nearly identical polyps are found in the same proximity of the colon, all of which were pre-cancerous. By removing the polyps, the risk of cancer is reduced dramatically.
Endoscopic Removal of Large and Difficult Colon Polyps
Abstract: Videos are presented showing the technique of endoscopic mucosal resection (EMR) of large and difficult polyps carried out by the authors at their center, which is also a referral center for EMR of large and flat polyps, difficult polyps, and partially removed polyps. Most of the procedures are done in an outpatient setting under monitored sedation.