Neoplastic polyps

Introduction to neoplastic polyps Tumorous Polyp (TumorousPolyp) is a true tumor of the proliferation of large intestinal epithelial cells. The single tumors are collectively called adenomas. According to their histological features and biological behavior, they can be divided into glandular, villous and mixed three types. Multiple cases are common with familial adenoma, others have non-familial adenoma and Gardner's syndrome with extra-digestive tumors, Turcot's syndrome, etc., they have different malignant rates and are considered precancerous. The lesion, therefore the diagnosis of adenoma has important clinical significance. basic knowledge The proportion of illness: 5% (60% of specific cancer population, 5% of the general population) Susceptible people: good for infants and adults over 50 years old Mode of infection: non-infectious Complications: anemia

Tumor polyposis

The tissue of adenomas is not well understood. Initially, Lane showed that the deep crypt cells migrated to the surface, and dysplasia gradually developed. The consistency of these adenoma epithelium and deep ectopic epithelial histochemistry strongly supported adenomas. Originating from the depths of the crypt, another hypothesis of the origin of adenomas is the eosinophilic epithelium described by Urbanskl et al. in 1986. They found that in this lesion, the sag contains goblet cells and is replaced by a layer of eosinophilic cells. Attached, eosinophilic epithelium is often located near the adenoma epithelium, and sees both migration, but other authors have found that the presence of eosinophilic crypts in lesions lacking adenomatous glands, and some authors note To the role of lymphoid follicles in the intestinal mucosa, these follicles are often adjacent to the adenoma epithelium and have been found to be involved in the development of adenomas in humans and experimental animals.

Neoplastic polyp prevention

There is no effective prevention method for this disease. Early detection and early treatment are the key to prevention and treatment.

Neoplastic polyp complications Complications anemia

Some patients may have long-term blood in the stool and cause anemia.

Tumor polyposis symptoms Common symptoms Abdominal discomfort Spotted bleeding Defecation frequency Abnormal hyperplasia Lean stool thinning purulent secretion

Adenoma is a protrusion of the mucosal epithelial tissue of the large intestine to the intestine. The appearance is slightly red. It can be distinguished from the gray-white hyperplastic polyps by the east, but even the experienced endoscopic doctor does not exceed 70%. Adenomas below 0.5 cm or hyperplastic polyps >0.5 cm or more are highly susceptible to misdiagnosis.

Most adenomas are tubular adenomas, and their exact incidence rates vary from one statistical report to another, because some statistics are based on clinical data, and some are based on experience, and are consistent with the patient's age, gender, and whether the diagnostic criteria are uniform. And the naming is uniform, etc., tubular adenomas occur in the rectum, sigmoid colon, more common, accounting for 85%, the size varies from a few millimeters to 10cm, adenomas with a diameter of 1 to 2cm are more common, no The adenomas found in the symptomatic population are often smaller than the clinical patients. The adenomas <5mm in diameter are called microadenomas, mainly tubular adenomas, but moderate or even severe dysplasia can occur, and occasionally invasive carcinomas are found. It is worth paying attention to.

The shape of adenoma is mostly spherical or hemispherical, the surface is smooth, there may be lobes, obvious congestion, redness, some spotted hemorrhage, forming a tabby-like structure. When there is secondary infection, the surface is accompanied by mucus purulent secretion. 5% to 10% of tubular adenomas are adjacent to the mucosa around the pedicle, and even white spots can appear on the opposite side of the adenoma. The white spots are round, about a few millimeters in size, clustered in small pieces, and the nature is not completely clear. Histologically, it is mainly a change in inflammation.

Villus adenomas are rare, and occur in adults over 50 years old. They are more common in the left colon. Among them, the rectum is about 82%, the sigmoid colon is about 13%, and the right colon is rare. Most of them are pedicle and yati. There are only 17% of the pedicles, the shape is irregular, the pedestal is flower-like or cauliflower, the yati is a pompom, the pedicle is similar to a bunch of grapes, the surface is not smooth, there are countless fine villi-like protrusions, often attached There is a large amount of mucus, the texture is brittle, often accompanied by erosive bleeding, generally larger than 2cm in diameter, larger than tubular adenoma, and gradually increased with age.

Mixed adenoma, just a histological term, most of which grows in tubular adenomas, glandular epithelial cells appear villous, and form a mixed type, so similar to tubular adenomas, with pedicle, more than seen, visible The surface is not smooth, there may be deep cracks, lobulated, with many villous processes.

Because there is no characteristic change in the general morphology of adenomas, there is still some error in endoscopic diagnosis and adenoma typing. Thompason et al. stain endoscopically removed polyps with 1% trypan blue, which can be accurately combined with dissecting microscopy. Describe the general morphological features of adenomas. They found that the lobular structures of tubular adenomas and villous adenomas are significantly different. The degree of atypical hyperplasia and invasive carcinoma can be predicted based on the degree of heterogeneity of the mucosal surface sulcus and the condition of fissures or ulcers. presence.

The main symptoms of familial multiple adenoma are blood and mucus in the stool, increased stools, loose stools, and various degrees of abdominal discomfort and systemic symptoms such as weight loss and anemia. Cancers often have intestinal obstruction and are asymptomatic. The prominent feature of familial adenoma is the multiple adenoma of the large intestine. The number is more than 100. The Bussoy statistics range from 104 to 5,000, with an average of about 1000. The adenoma is distributed in the left colon, especially the sigmoid colon. The most rectum, Yamada according to the degree of density of adenoma distribution, the adenoma disease is divided into dense and non-closed type, the former refers to a dense growth of adenoma, almost normal mucosa, the latter refers to the normal mucosa between the adenoma In general, more than 1000 adenomas are mostly dense, and less than 1000 are non-dense. Under X-ray, there is a nearly uniform circular filling defect in the whole large intestine, diameter 0.3-0.5. Cm, the contour is smooth, in the dense part of the polyp, the double contrast of the gas sputum is very similar to the corn-like arrangement, but the traditional tincture enema is easy to be submerged by the expectorant and missed diagnosis.

Tumor polyp examination

1.X-ray barium enema

Although colorectal polyps can be sensitively detected through the filling defect of tinctures, the lesions are often not correctly classified and characterized. Endoscopy can not only observe the microscopic lesions of the large intestine mucosa under direct vision, but also through tissue biopsy and cytology brush examination. Determining the nature of the lesion is therefore the most important means of detecting and confirming large intestine polyps.

2. Endoscopy

The polyps found must be biopsied to understand the nature, type and presence of polyps of the polyps. Small or pedicled polyps can be removed by biopsy forceps or snares, large or broad-based polyps. It is often only possible to take a biopsy.

3. Biopsy

Because the amount of villus and the degree of dysplasia in different parts of the same adenoma are often different, the lesions taken at the biopsy can not fully represent the whole picture. There is no cancer in the biopsy. It is not certain that the adenoma has no cancer at all, so the adenoma The degree of atypical hyperplasia and non-cancerous changes often require the removal of the entire tumor. After careful biopsy, it is certain that the pathological results of biopsy can be used for reference, but it is not the final conclusion. The results of this preoperative biopsy and postoperative biopsy Pathological diagnosis is quite common in villous adenomas. For example, in the Tuyloy collection, 1140 cases of villous adenomas were reported. Preoperative biopsy was benign, and postoperative confirmation of canceration was 23%-80. %, clinicians must understand this limitation in the diagnosis of adenoma biopsy.

Diagnosis and diagnosis of neoplastic polyps

diagnosis

According to the medical history, clinical manifestations and laboratory data is not difficult to make a diagnosis.

Differential diagnosis

Mainly differentiated from non-neoplastic polyps of the large intestine, tissue biopsy can be identified.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.