Colon Polyps The term polyp of the colon alludes to a bulge into the lumen from the typically level colonic mucosa. Polyps are typically asymptomatic yet may ulcerate and drain, cause tenesmus if in the rectum, and, when substantial, create intestinal hindrance.Slide 2
Colon Polyps Neoplastic (adenomas and carcinomas), Hamartomatous, Non-neoplastic, and Submucosal (neoplastic/non-neoplastic).Slide 3
Non-neoplastic polyps Hyperplastic Mucosal Inflammatory pseudopolyps SubmucosalSlide 4
Normal colonic mucosaSlide 5
Hyperplastic PolypsSlide 6
Normal colonic mucosaSlide 7
Hyperplastic colonic polypSlide 8
Hyperplastic polyps Located in the rectosigmoid < 5 mm in size R arely, if at any point, form into colorectal growthsSlide 9
Risk of proximal neoplasm 21 to 25 % of patients with a distal hyperplastic polyp had a proximal neoplasm (4 to 5 % propelled neoplasm). In the four studies in which a colonoscopy was performed independent of distal discoveries, the relative danger of any proximal neoplasia (progressed or not) was 1.3 (95 percent CI 0.9 to 1.8).Slide 10
Hyperplastic polyposis disorder (HPS) alludes to a condition portrayed by various, substantial as well as proximal hyperplastic polyps and, every so often, littler quantities of serrated adenomas, or blended hyperplastic/adenomatous polyps.Slide 11
WHO criteria for HPS At minimum five hyperplastic polyps proximal to the sigmoid colon, of which two are more prominent than 1 cm in width, or Any number of hyperplastic polyps happening proximal to the sigmoid colon in a person who has a first degree relative with hyperplastic polyposis, or Greater than 30 hyperplastic polyps conveyed all through the colon.Slide 12
Mucosal polyps Mucosal polyps are little (for the most part <5 mm) excrescences of tissue that endoscopically look like the nearby level mucosa and histologically are typical mucosa. They have no clinical centralitySlide 13
Inflammatory pseudo-polyps Inflammatory pseudopolyps are unpredictably formed islands of leftover in place colonic mucosa that are the consequence of the mucosal ulceration and recovery that happens in provocative entrail ailment (IBD). Normally numerous, frequently filiform and scattered all through the colitic district of the colon. They may likewise be more disengaged and semipedunculated in zones of more dynamic late aggravation, and have bodily fluid follower to their apicesSlide 14
Pseudopolyps in IBDSlide 15
Submucosal polyps Lymphoid totals, Lipomas, Leiomyomas, Pneumatosis cystoid intestinalis, Hemangiomas, Fibromas, Carcinoids, Metastatic soresSlide 16
Endoscopic Ultrasound Useful in characterizing the site of root and for biopsy of sub-mucosal injuries if the analysis is in uncertaintySlide 17
Hamartomatous polyps Juvenile polyps Peutz-Jeghers polyps Cronkhite-Canada disorderSlide 18
Juvenile Polyps Juvenile polyps are hamartomatous sores that comprise of a lamina propria and enlarged cystic organs instead of expanded quantities of epithelial cellsSlide 19
Normal mucosaSlide 20
Juvenile colonic polypSlide 21
Familial Juvenile Polyposis FJP is connected with an expanded hazard for the advancement of colorectal growth, and in a few families, gastric malignancy, particularly where there are both upper and lower gastrointestinal polyps.Slide 22
Peutz-Jeghers polyps The Peutz-Jeghers polyp is a hamartomatous sore of glandular epithelium bolstered by smooth muscle cells that is adjoining with the muscularis mucosaSlide 23
Colonic Peutz-Jeghers polypSlide 24
Duodenal Peutz-Jeghers polypSlide 25
Duodenal Peutz-Jeghers polypSlide 26
Peutz-Jeghers polyps Patients with PJS are at expanded danger of both gastrointestinal (gastric, little entrail, colon, pancreas) and nongastrointestinal diseases with a combined malignancy danger of around 50 percent by age 60.Slide 27
Cronkhite-Canada disorder Alopecia, Cutaneous hyperpigmentation, Gastrointestinal polyposis, Onychodystrophy, Diarrhea, Weight misfortune and Abdominal tormentSlide 28
Cronkhite-Canada disorder The polyps are hamartomas Characteristic components incorporate myxoid development of the lamina propria and expanded eosinophils in the polyps. Five-year death rates as high as 55 percent have been accounted for with most passings because of gastrointestinal dying, sepsis, and congestive heart disappointment. Treatment has included nutritious support, corticosteroids, corrosive concealment, and anti-microbialsSlide 29
ADENOMATOUS POLYPS About 66% of every colonic polyp are adenomas. Adenomas are by definition dysplastic and in this manner have threatening potential. Almost all colorectal growths emerge from adenomas, yet just a little minority of adenomas advance to disease (1 in 20 or less).Slide 30
ADENOMATOUS POLYPS The ideal opportunity for advancement of adenomas to malignancy is around seven years. Around 30 to 40 percent of the United States populace beyond 50 one years old at least one adenomas The combined colorectal tumor hazard is around 5 percent.Slide 31
Prevalence of adenomatous colonic polyps increments with ageSlide 32
Synchronous injury An adenoma that is analyzed in the meantime as a list colorectal neoplasm is known as a synchronous sore . Thirty to 50 percent of colons with one adenoma will contain no less than one different synchronous adenoma.Slide 33
Metachronous sore One that is analyzed no less than six months after the fact is considered metachronous injurySlide 34
Pathologic grouping The histologic components and size of colonic adenomas are the real determinants of their dangerous potential. The glandular design of adenomas is portrayed as tubular, villous, or a blend of the two.Slide 35
Tubular adenomas Tubular adenomas represent more than 80 percent of colonic adenomas. They are portrayed by a system of expanding adenomatous epithelium. To be delegated tubular, the adenoma ought to have a tubular segment of no less than 75 percentSlide 36
Colonic adenomaSlide 37
Colonic adenoma with pseudoinvasionSlide 38
Villous adenomas Villous adenomas represent 5 to 15 percent of adenomas. They are described by organs that are long and expand straight down from the surface to the focal point of the polyp. To be named villous, the adenoma ought to have a villous segment of no less than 75 percent.Slide 39
Vilous adenomaSlide 40
Colonic adenoma with dangerous changeSlide 41
Tubulovillous adenomas Tubulovillous adenomas represent 5 to 15 percent of adenomas. Have 26 to 75 percent villous segment.Slide 42
Polyp base Sessile - base is connected to the colon divider, Pedunculated if a mucosal stalk is intervened between the polyp and the divider. Adenomas are most generally found inside raised injuries, up to 27 to 36 percent are level (having a stature short of what one-a large portion of the distance across of the injury) and up to 1 percent are discouragedSlide 43
Dysplasia All adenomas are dysplastic. Another framework that perceives two evaluations of dysplasia - HIGH and LOW . Additionally, the more established terms "carcinoma in situ" or "intramucosal adenocarcinoma" ought to both be depicted as high-review dysplasiaSlide 44
Invasive danger Invasive threat is characterized by a break of the muscularis mucosa by neoplastic cells. Since there are no lymphatic vessels in the lamina propria, they are not connected with metastasis, and can be overseen along customary rules in adenoma take afterSlide 45
Clinical presentation and characteristic history of Adenomas are for the most part asymptomatic and are frequently identified by colon disease screening tests. Little adenomas don\'t regularly drain Adenomas are found in 17 to 43 percent of patients with a positive FOBT however they are likewise identified in 32 to 41 percent of asymptomatic men with a negative FOBT . Propelled adenomas will probably drain and cause a positive fecal mysterious blood test.Slide 46
Risk variables for central disease inside an individual adenoma Villous histology, Increasing polyp estimate, High-review dysplasiaSlide 47
Polyp measure & propelled highlights The extent of adenomas indicating progressed histologic components (high-review dysplasia or >25 percent villous histology) increments from 1 % in little adenomas (<5 mm) to 7 to 12 % for medium-sized adenomas (5 to 10 mm) 20 % for huge adenomas (>1 cm)Slide 48
Age & propelled highlights Older age is additionally connected with high-review dysplasia inside an adenoma, autonomous of size and histologySlide 49
Advanced pathologic hazard elements Adenomatous polyps >1 cm in breadth Adenomatous polyps with high-review dysplasia Adenomatous polyps with >25 percent villous histology Adenomatous polyps with obtrusive malignancySlide 50
Detection and colonoscopic evacuation of polyps Colonoscopy is viewed as the ideal examination for the location of adenomatous polyps, especially in perspective of the capacity to give helpful polypectomy in conjunction with findingSlide 51
Detection and colonoscopic expulsion of polyps The colonoscopic miss rate dictated by two same day endoscopic examinations in 183 patients was 27 percent for adenomas <5 mm, 13 percent for those 6 to 9 mm, and 6 percent for adenomas >1 cmSlide 52
Prevention Guidelines proposed by American College of Gastroenterology (ACG): An eating routine that is low in fat and high in natural products, vegetables, and fiber. There might be points of interest with cruciferous vegetables and natural types of grain fiber. Support of typical body weight through consistent practice and caloric confinement. Evasion of smoking and inordinate liquor utilize, particularly lager. Dietary supplementation with 3 g of Calcium Carbonate.Slide 53
Surveillance Patients with little rectal hyperplastic polyps s
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