Suggested Treatment :Total colon removalThey decided to remove the colon ! The countless polyps in the colon predispose to the development of colon cancer; if the colon is not removed, the chance of colon cancer is considered to be very significant.
Confirm cuz( it was dx out of KFSH)it was ordered by oncologic to r/o other associated lesions this is bec the criteria of the FAP says that it may have others like desmoids in 10 – 15 percentMap answering a lot of Qs in surgeons head..like is there vessels encasement..if yes they need to close it b4 surgery so no bleeding may occur..also mapping for asociated tumors to know thier site and whether they’re accessible for biopsy and behavior
1. A catheter was advanced into the distal duodenum.
Two overlapping stents were deployed from the proximal jejunum to the distal duodenum. uncovered enteral stentsNotice the suctioning tube last img.. Say: no immediate complications were noted.
They thought it can be due to obstruction by food stuck there or stent migration and usually distally due to peristalsis. Or can be due to proliferation after stent.
Air/cm image: http://www.rushradiology.com/web/Sections/GeneralRadiology/GastrointestinalImaging.aspx endoscopy: wikipedia
Image ref: http://www.aradnj.com/3D-Virtual-Colonoscopy.html and the other one: http://www.sprucestreetinternalmedicine.com/Medical/vColon.html
Imaging of intra- and extraabdominaldesmoid tumors.Casillas J, Sais GJ, Greve JL, Iparraguirre MC, Morillo G.Pubmed articleCurrent trends in the management of extra-abdominal desmoidtumoursPanayiotis J Papagelopoulos1*, Andreas F Mavrogenis1, Evanthia A Mitsiokapa2, KleoTh Papaparaskeva3, Evanthia C Galanis4 and Panayotis N Soucacos1http://www.dtrf.org/dtrf_aboutdesmoids.htm web
Gardner's syndrome Case Study
Gardners SyndromeCase StudyShatha J. Al Mushayt
Patient History Male 32 Y/O UpperGI bleeding Anorexia Outsidepathology report Weight loss
Patient history • Multiple polyps all Suggested over the Treatment: colon (*FAP) Colon Removal Colonoscopy Outside * Familial Adenomatosis Polyposispathology report
About The PathologyOutline: Familial Adenomatosis Polyposis (FAP) Desmoids Gardner’s Syndrome
Familial Adenomatosis Polyposis An inherited condition caused by a mutation in a gene. Characterized by the formation of hundreds to thousands of colon polyps.
Desmoids Tendonlike tumors of the connective tissues Associated with FAP in 5-10 % Benign, rarely metastasize; but can be locally aggressive & invasive to surrounding tissues difficult to be cut out.
Gardners syndrome A subtype of FAP. Characterized by: Multiple colon polyps + tumors outside the colon. The extracolonic tumors may include: • Desmoid tumors • Bone & soft tissue tumors.
Comparative Imaging of FAP Colonoscopy The diagnostic test of choice(quantification & histology). Endoscopic image of sigmoid colon of patient with FAP. Air/contrast Barium Enema Detect larger colonic polyps but can miss smaller ones. Air/contrast barium enema
Comparative Imaging of FAP Virtual colonoscopy (by CT or MRI) Detect >80% of large polyps; Is beginning to be done for screening outside research settings. CT
Desmoids imaging No specific imaging features to distinguish desmoids from other masses. ( Biopsy is always needed). CT & MRI are the most useful modalities for size & extent. US: initially for superficial tumors involving the abdominal wall.
Desmoids imaging CT: variable intensity & margin. If C+ usually enhanced; but may not. MRI: variable signal intensity on T1 & T2. US: variable echogenesity & margin.
Golden Standard modality for this caseCT: for size and extent of desmoids. Confirming FAP. Colonoscopy.
“I’m a great believer in luck, and I find the harder I work the more I have of it”. Thomas Jefferson THANK YOUPresentation is over !