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.

1. BENIGN NEOPLASM OF COLON
AND RECTUM
Abdul Mughni
Digestive Surgery Dept ,
Medical Faculty of Diponegoro Univ. –
Kariadi Hospital

2. OBJECTIVE
 Definition
 ICD 9 / ICD 10
 Classification
 Diagnosis
 Treatment
 Follow Up and Surveillance

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

4. ICD 9/ICD 10

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

13. MANAGEMENT :
1. GASTROSCOPY

14. COLONOSCOPY
Caecum Ileum terminal Kolon Transversum
Desenden Sigmoid Rectum

15. MULTIPLE PEDUNCULATED POLYPS

16. THERAPY : SNARE POLYPECTOMY FOR
POLYPS WITH Ø>1CM

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

25.  Anemia
 Mucous diarrhoea 
Fluid and electrolid
depletion Syndrome
 Hypokalaemia
 Hyponatraemia
 Acidosis
 Ureaemia
 Rigid Sigmodoscopy
 Flexible sigmoidoscopy
 Colonoscopy
 Chromoscopic
colonoscopy
 Double contras barium
enema
Laboratorium Finding Instrument

26. TREATMENT : POLYPECTOMY
Peranal Excision of
Pedunculated Polyp
Polypectomy Trough Rigid
Sigmoidoscope

27. Colonoscopic Polypectomy

28. Tran Anal Incision
Trananal Endoscopic
Microsurgery (TEM)

29. COMPLICATION OF POLYPECTOMY
 Hemorrage
 Minor : 53%
 Major : 1-2 %
 Perforation : 1-3 %
 Gas Explotion
 After prepared using mannitol
 Polypectomy Syndrome
 Abdominal pain
 Distension
 Brief period fever
 Mortality 0,05%

30. FOLLOW UP AND SURVEILANCE OF ADENOMA

32. TERIMAKASIH
Semoga Bermanfaat