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Benign Neoplasm of Colon and Rectum
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.
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Benign Neoplasm of Colon and Rectum
- 1. BENIGN NEOPLASM OFCOLON AND RECTUM Abdul Mughni Digestive Surgery Dept , Medical Faculty of Diponegoro Univ. – Kariadi Hospital
- 2. OBJECTIVE Definition ICD9 / 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
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- 6. CLASSIFICATION OF POLYPOIDOF 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 ORHYPERPLASTIC 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 Transanalexcision Sigmoidoscopic snare Others: Recurrence is uncommon Only 10-20 % recurrence Neither a malignant No routine follow up (Nugent et.al. 1993) Management
- 10. an autosomaldominant 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
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- 14. COLONOSCOPY Caecum Ileum terminalKolon Transversum Desenden Sigmoid Rectum
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- 16. THERAPY : SNAREPOLYPECTOMY FOR POLYPS WITH Ø>1CM
- 18. PA : HAMARTOMASPOLYP 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 scatteredworm 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 largeand 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 Diarrhoeaand passage of mucous Prolaps Abdominal colic Must be done Soft difficult to palpate Velvety pedunculated Simptom and Sign Rectal Examination
- 25. Anemia Mucousdiarrhoea 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 PeranalExcision of Pedunculated Polyp Polypectomy Trough Rigid Sigmoidoscope
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- 28. Tran Anal Incision TrananalEndoscopic 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 ANDSURVEILANCE OF ADENOMA
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