Colorectal polyps1.pptx

polyps

1. Colorectal polyps DONE BY : Dr. Yasser Muthana 3 rd grade general surgery. Under supervision of : Dr. kamal abd al- hussien Senior of general surgery

2. Genetic Activation of K-Ras and inhibition of tumor suppressor genes

3. Definition Polyp is a nonspecific clinical term that describes any projection from the surface of the intestinal mucosa regardless of its histologic nature.

4. Colorectal polyps may be classified as neoplastic (tubular adenoma, villous adenoma, tubulovillous adenomas, serrated adenomas/ polyps), hyperplastic, hamartomatous (juvenile, Peutz-Jeghers , Cronkite-Canada), inflammatory ( pseudopolyp , benign lymphoid polyp)

5. Neoplastic Polyps

6. Neoplastic Polyps Adenomatous polyps are common, occurring in up to 25% of older than 50 years in the United States. The risk of malignant degeneration is related to both the size and type of polyp. Tubular adenomas are associated with malignancy in only 5% of cases, whereas villous adenomas may harbor cancer in up to 40%. Tubulovillous adenomas are at intermediate risk (22%). Invasive carcinomas are rare in polyps smaller than 1 cm ; the incidence increases with size . The risk of carcinoma in a polyp larger than 2 cm is 35% to 50%.

7. Complications include perforation and bleeding . A small perforation ( microperforation ) in a fully prepared, stable patient may be managed with bowel rest, broadspectrum antibiotics, and close observation. Signs of sepsis, peritonitis , or deterioration in clinical condition are indications for laparotomy. Bleeding may occur immediately after polypectomy or may be delayed.

8. Hyperplastic Polyps

9. Hyperplastic Polyps Hyperplastic polyps are extremely common in the colon. These polyps are usually small (<5 mm) and show histologic characteristics of hyperplasia without any dysplasia . They are not considered premalignant , but cannot be distinguished from adenomatous polyps colonoscopically and are therefore often removed. In contrast , large hyperplastic polyps (>2 cm) may have a slight risk of malignant degeneration .

10. Sessile Serrated polyp Serrated polyps: umbrella term for hyperplastic polyps, sessile serrated lesions, traditional serrated adenomas and mixed polyps

11. Sessile Serrated polyp Serrated polyps are a recently recognized, histologically distinct group of neoplastic polyps.

12. Hamartomatous Polyps (Juvenile Polyps)

13. In contrast to adenomatous and serrated polyps, hamartomatous polyps (juvenile polyps) usually are not premalignant. These lesions are the characteristic polyps of childhood but may occur at any age. Bleeding is a common symptom, and intussusception and/or obstruction may occur. Because the gross appearance of these polyps is identical to adenomatous polyps, these lesions should also be treated by polypectomy. In contrast to adenomatous polyposis syndromes, these conditions are often associated with mutation in PTEN

14. Familial juvenile polyposis is an autosomal dominant disorder in which patients develop hundreds of polyps in the colon and rectum. Unlike solitary juvenile polyps, these lesions may degenerate into adenomas and eventually carcinoma. Annual screening should begin between the ages of 10 and 12 years. Treatment is surgical and depends in part on the degree of rectal involvement. If the rectum is relatively spared, a total abdominal colectomy with ileorectal anastomosis may be performed with subsequent close surveillance of the retained rectum.

15. Peutz-Jeghers syndrome

16. Psudopolyp

17. Inflammatory Polyps ( Pseudopolyps ) . Inflammatory polyps occur most commonly in the context of inflammatory bowel disease, but may also occur after amebic colitis, ischemic colitis, and schistosomal colitis. . These lesions are not premalignant, but they cannot be distinguished from adenomatous polyps based on gross appearance and therefore should be removed. Polyposis may be extensive, especially in patients with severe colitis, and may mimic FAP.

18. Malignant polyp

19. Level 1 (carcinoma limited to the head of the polyp). Level 2 is where carcinoma invades to the level of the neck (the junction of the head and stalk) of the adenoma. Level 3 is carcinoma invading any part of the stalk . Level 4 is where carcinoma invades into the submucosa of the bowel wall below the level of the stalk. In the sessile adenoma a stalk is absent and so, by definition, the lesion is defined as being level 4 . divided according to Kikutchi

20. kikuchi levels

21. Surveillance after adenoma detection

22. Definitions: Serrated polyps : umbrella term for hyperplastic polyps, sessile serrated lesions, traditional serrated adenomas and mixed polyps Premalignant polyps : serrated polyps (excluding diminutive [1-5mm] rectal hyperplastic polyps) and adenomatous polyps Advanced colorectal polyps : serrated polyp ≥10mm , serrated polyp with dysplasia , adenoma ≥10mm , adenoma with high-grade dysplasia (L)NPCP : ( Large; ≥20mm ) non-pedunculated colorectal polyp

23. High-risk findings

24. Treatment of malignant polyp

25. In situ Polyps containing carcinoma in situ (high-grade dysplasia) carry no risk of lymph node metastasis. However, the presence of high-grade dysplasia increases the risk of finding an invasive carcinoma within the polyp. For this reason, these polyps should be excised completely , and pathologic margins should be free of dysplasia . Most pedunculated polyps and many sessile polyps may be completely removed endoscopically . In cases where the polyp cannot be removed entirely , a segmental resection is recommended.

26. Invasive Occasionally a polyp that was thought to be benign will be found to harbor invasive carcinoma after polypectomy. Treatment of a malignant polyp is based on the risk of local recurrence and the risk of lymph node metastasis . The risk of lymph node metastases depends primarily on the depth of invasion .

27. Indications of segmental resection Lymphovascular invasion, poorly differentiated histology, tumor budding, tumor within 1 mm of the resection margin greatly increases the risk of local recurrence and metastatic spread. Invasive carcinoma arising in a sessile polyp extending into the submucosa

28. Thank You