This document discusses benign neoplasms of the colon and rectum. It defines benign neoplasms and provides classifications of polyps, including non-neoplastic polyps like hyperplastic, hamartomatous, and inflammatory polyps. It also discusses neoplastic polyps, specifically adenomas, providing details on different types (tubular, tubulovillous, villous), sizes (early, intermediate, late), and characteristics. The document outlines approaches to diagnosis including examinations, tests, and instruments. It covers treatment methods like polypectomy and complications. It concludes with recommendations for follow up and surveillance of adenomas.
3. DEFINITION
Benign : (L, benignus) : Not malignant; not
recurrent, favorable for recovery
Neoplasm : any new and abnormal growth;
specifically a new growth of tissue in wich the
growth is uncontrolled and progressive
Dorland’s Illustrated Medical Dictionary, 30th Edition,
Philadelphia, Saunders, 2000
6. CLASSIFICATION OF POLYPOID OF COLON
I. Non Neoplastic Polyps
A. Metaplastic or Hyperplastic polyps
B. Hamartomatous polyps
C. Inflamatory polyps
D. Benign lymphoid polyp
II. Neoplastistic polyps
A. Adenoma
Keighley, Williams, Surgery of The anus, rectum and colon, 3rd Ed, 2008
7. A. METAPLASTIC OR HYPERPLASTIC POLYPS
Usually small (2-5 mm)
Plaque-like
Same colour
Aetiology unknown
environmental factor
Asymptomatic
Semipedunculated or
sessile
Management
polypectomy
No follow up ( British Society
For GI , 2002)
Keighley, Williams, Surgery of The anus, rectum and colon, 3rd Ed, 2008
8. B. HAMARTOMATOUS POLYPS
Infant and children < 10
Y
Diameter 1-2 cm
Smooth surface
25 % sessile
90 % within 20 cm anal
verge
rectal bleeding
Prolap polyp
Colonic intussusception
Diarrhoea
Tenesmus
Rectal prolap
B.1. Juvenile Polyps
Simptom :
Keighley, Williams, Surgery of The anus, rectum and colon, 3rd Ed, 2008
9. Polypectomy
Transanal excision
Sigmoidoscopic snare
Others:
Recurrence is uncommon
Only 10-20 % recurrence
Neither a malignant
No routine follow up
(Nugent et.al. 1993)
Management
10. an autosomal dominant
disease caused by
germline mutation of the
serine threonine kinase 11
Not complete penetrasion of
19p13.3 cromosom
Hamartomatous polyps in
the gastrointestinal tract
Mucocutaneous melanin
pigmentation.
B.2. Peutz-Jeghers Syndrome (PJS)
1. Francis M. Giardiello, Jill D. Trimbath. Peutz-Jeghers Syndrome and Management Recommendations. Clinical
Gastroenterology and Hepatology 2006;4:408–415
2. M. Kopacova, I Tachei, S. Rejchrt, J.Bures : PJS: diagnosis and therapeutic approach : Word J Gastroenterol
2009, Nov. 21; 15(43): 5397-5408 avilable in wjg@wjgnet.com
11. RISK OF PJS
increased risk for :
common and unusual types of gastrointestinal tumor (
colon :39 %)
nongastrointestinal tumors (Breast : 54%)
Morbidity and complication
Bleeding and anemia
Invagination.
(Francis M. Giardiello, Jill D. Trimbath. Peutz-Jeghers Syndrome and
Management Recommendations. Clinical Gastroenterology and
Hepatology 2006;4:408–415)
12. Francis M. Giardiello, Jill D. Trimbath. Peutz-Jeghers Syndrome
and Management Recommendations. Clinical Gastroenterology
and Hepatology 2006;4:408–415
18. PA : HAMARTOMAS POLYP
Proliveration smooth muscle
Marcela Kopacova, Ilja Tacheci, Stanislav Rejchrt, Jan Bures. Peutz-
Jeghers
syndrome: Diagnostic and therapeutic approach. World J Gastroenterol
2009
19. INFLAMATORY POLYPS
scattered worm
Or thread-like (Filiform)
Adjacent mucosa and
formation of mucosal tag
of various shapes and
sizes
Superficial ulceration
white slough
Not a malignant
20. BENING LYMPHOID POLYPS
Lymphoid hyperplasia
Most present in 1/3
distal of rectum
Smooth, round,
submucosal lession
Majority are sessile
Usually Single
Keighley, Williams, Surgery of The anus, rectum and colon, 3rd Ed, 2008
21. NEOPLASTIC POLYPS
ADENOMA
Most important polyp
Main precursor colorectal cancer
Catagories on basis of size:
Early (type I) : Small , ≤ 0,5 cm, APC mutation, 10 % LOH on
Cromosome 18q
Intermediate (II) : Medium, 0,6- 1 cm , 50 % K-ras mutation
late(III), Large > 1 cm, 50 % LOH on cromosome 18q
Catagories on basis of shape:
Tubular
Tubulovillous
villous
Keighley, Williams, Surgery of The anus, rectum and colon, 3rd Ed, 2008
22. Pedunculated or
sessile
1 mm until 5 cm
Small smooth
contour
Larger lobular
pattern
Darker than mucosa
Pedicle 1-3 cm
Tubular Adenoma
Keighley, Williams, Surgery of The anus, rectum and colon, 3rd Ed, 2008
23. Usually large and sessile
Shaggy surface
Soft
Edge are ill-define
Flat or protude
Extends carpet like
lession
Often circumferential
Darker than surrounding
mucosa
Villous Adenoma
Keighley, Williams, Surgery of The anus, rectum and colon, 3rd Ed, 2008
24. DIAGNOSIS
Bleeding
Diarrhoea and passage
of mucous
Prolaps
Abdominal colic
Must be done
Soft difficult to
palpate
Velvety
pedunculated
Simptom and Sign Rectal Examination