Benign polyps of the colon

NATALIA STELSON

Pedunculated adenoma ( adenomatous polyp)

Globe-like

Attached to mucous membrane

Thin stalk Mostly in the distal colon

Single\multiple
0,5-1,0 cm (rarely 4-5cm) Histology proliferating glands

More than 1cm and multiple should be removed

Juvenile polyp
Mostly in kids less than 10 y/o

Large
Vascular Long pedicles

Smooth surface
Inflammatory Can bleed or prolapsed through anus

Often localized in rectum or sigmoid

Villous adenoma (papilloma, sessile adenoma)

Broad-based

Papillary surface
Histology fingerlike projections Large more than 5 cm

25% - malignancy

Adenoma-adenocarcinoma transformation
- adenoma diagnosis is 10 years earlier than with carcinoma, and progression to carcinoma takes a minimum of 4 years. - Patients who refuse polypectomy for adenomas develop colon cancer at a rate of about 4% after 5 years and 14% after 10 years.

Genetic of transformation
accumulation of lesions in a variety of genes, with activation of oncogenes and inactivation of tumor suppressor genes K-ras - 9% of small adenomas, 58% of adenomas larger than 1 cm APC gene mutated in 30-60% in sporadic adenomas and adenocarcinomas early in adenoma (often found in aberrant crypt foci) loss TP53 gene - adenomas (50%) and occurs in more than 75% adenocarcinomas loss DCC in 50% adenomas and 70% carcinomas (important in the transition from an intermediate adenoma to a late adenoma).