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Difference between revisions of "Gastrointestinal tract polyps"
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Gastrointestinal tract polyps (view source)
Revision as of 20:19, 6 April 2012
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===Submucosal invasion=== | ===Submucosal invasion=== | ||
*This may be difficult to assess histomorphologically. | *This may be difficult to assess histomorphologically. | ||
===Adenomatous vs. hyperplastic=== | ===Adenomatous vs. hyperplastic=== | ||
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*They are all considered pre-malignant, i.e. if you leave 'em in place they often develop into cancer. | *They are all considered pre-malignant, i.e. if you leave 'em in place they often develop into cancer. | ||
*If multiple... think about [[familial adenomatous polyposis]] (FAP), attenuated FAP, [[MUTYH polyposis syndrome]], [[serrated polyposis syndrome]]. | *If multiple... think about [[familial adenomatous polyposis]] (FAP), attenuated FAP, [[MUTYH polyposis syndrome]], [[serrated polyposis syndrome]]. | ||
===Management of (adenomatous colonic) polyps=== | |||
Follow-up interval for polyps (colonoscopy interval):<ref name=pmid17167138>{{cite journal |author=Levine JS, Ahnen DJ |title=Clinical practice. Adenomatous polyps of the colon |journal=N. Engl. J. Med. |volume=355 |issue=24 |pages=2551–7 |year=2006 |month=December |pmid=17167138 |doi=10.1056/NEJMcp063038 |url=http://content.nejm.org/cgi/reprint/355/24/2551.pdf}}</ref> | |||
*Normal follow-up (includes presence of ''hyperplastic polyps''): ~10 years. | |||
*1-2 low risk (adenomatous) polyps: 5-10 years. | |||
*3-10 low risk polyps ''or'' a high risk polyp: 3 years. | |||
*>10 low risk polyps: <3 years. | |||
*Inadequately removed polyps: <6 months. | |||
Classified as ''high risk'' (any of the following):<ref name=pmid17167138/> | |||
*Tubulovillous. | |||
*Villous. | |||
*High grade dysplasia. | |||
*Size >= 1 cm. | |||
Mnemonic: ''GAS'' = grade (high), architecture (tubulovillous, villous), size (>1 cm). | |||
==Pseudoinvasion in colorectal adenomatous polyps== | ==Pseudoinvasion in colorectal adenomatous polyps== | ||
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*'''H'''emosiderin. | *'''H'''emosiderin. | ||
== | ==High risk features in (colorectal) adenomatous polyps with carcinoma== | ||
Predictors of poor outcome with early submucosal invasion:<ref name=pmid15300569>{{Cite journal | last1 = Ueno | first1 = H. | last2 = Mochizuki | first2 = H. | last3 = Hashiguchi | first3 = Y. | last4 = Shimazaki | first4 = H. | last5 = Aida | first5 = S. | last6 = Hase | first6 = K. | last7 = Matsukuma | first7 = S. | last8 = Kanai | first8 = T. | last9 = Kurihara | first9 = H. | title = Risk factors for an adverse outcome in early invasive colorectal carcinoma. | journal = Gastroenterology | volume = 127 | issue = 2 | pages = 385-94 | month = Aug | year = 2004 | doi = | PMID = 15300569 }}</ref> | |||
#High tumour grade. | |||
*1- | #[[Lymphovascular invasion]]. | ||
* | #High-grade tumour budding. | ||
*> | #*Tumour bud = 1-4 cell(s); "high-grade budding" is >=10 tumour buds in a field of 0.385 mm<sup>2</sup>.<ref name=pmid11952856>{{Cite journal | last1 = Ueno | first1 = H. | last2 = Murphy | first2 = J. | last3 = Jass | first3 = JR. | last4 = Mochizuki | first4 = H. | last5 = Talbot | first5 = IC. | title = Tumour 'budding' as an index to estimate the potential of aggressiveness in rectal cancer. | journal = Histopathology | volume = 40 | issue = 2 | pages = 127-32 | month = Feb | year = 2002 | doi = | PMID = 11952856 }}</ref> | ||
* | #**If the microscope has a 22 mm eye piece and... | ||
#***A 20x objective, the field is approximately 0.950 mm<sup>2</sup> -- to match the area/bud -- it would be 24.68 buds/0.950 mm<sup>2</sup>. | |||
#***A 40x objective, the field is approximately 0.238 mm<sup>2</sup> -- to match the area/bud -- it would be 6.17 buds/0.238 mm<sup>2</sup>. | |||
#Extensive submucosal invasion. | |||
#*>= 4 mm width ''or'' >= 2 mm depth. | |||
If none of the above factors is present the risk of [[lymph node]] metastasis is < 1%. The presence of one risk factor increases the risk to ~20%. If multiple risk factors are present the chance of [[lymph node metastases]] is greater than 35%.<ref name=pmid15300569/> | |||
==Traditional adenoma== | ==Traditional adenoma== | ||