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Patterns of polyp histology: predictors of peril in the mucosa
- Source :
- ANZ Journal of Surgery. 90:807-811
- Publication Year :
- 2020
- Publisher :
- Wiley, 2020.
-
Abstract
- Background Precursor colonic polyps of varied subtypes correlate with the known neoplastic pathways. When patients present with synchronous pre-malignant polyps of multiple histologies, multiple genetic mechanisms are likely to be active, potentially resulting in a more unstable, tumourigenic mucosa. Methods We hypothesized that patients with a combination of sessile serrated adenomas/polyps (SSA/Ps), hyperplastic (HP) polyps and adenomas would be at highest risk of developing dysplasia/cancer compared to SSA/Ps alone, due to the synergistic effect of multiple active carcinogenic pathways. A prospective colonoscopy database was examined for patients with a history of SSA/P. Patients were placed into four groups based on patterns of polyp histology as follows: (i) only SSA/Ps; (ii) SSA/P + HP; (iii) SSA/Ps + adenomas; and (iv) SSA/Ps + HP + adenomas. These groups were compared in terms of the numbers, size, location and histology of polyps and personal or family history of colorectal cancer. Results A total of 374 patients were included. The average age was 70 years (range 21-88), and 43% were male. There was a trend towards the most aggressive neoplastic pattern in group 4, associated with a tendency to larger SSA/Ps, more villous architecture in the adenomas and more high-grade dysplasia in both types of polyps. It was also associated with multiplicity of both SSA/Ps and adenomas. No SSA/Ps existing in the absence of adenomas had cytological dysplasia. Conclusion The combination of SSA/Ps, HP and adenomas in the colorectal epithelium seems to be a marker for aggressive carcinogenesis and suggests that accurate and effective surveillance is important to manage this risk.
- Subjects :
- Adenoma
Adult
Male
medicine.medical_specialty
Colorectal cancer
Colonic Polyps
Colonoscopy
medicine.disease_cause
Gastroenterology
Young Adult
03 medical and health sciences
0302 clinical medicine
stomatognathic system
Internal medicine
medicine
Humans
Prospective Studies
Family history
Aged
Aged, 80 and over
Mucous Membrane
medicine.diagnostic_test
business.industry
Cancer
Histology
General Medicine
Middle Aged
medicine.disease
digestive system diseases
stomatognathic diseases
Dysplasia
030220 oncology & carcinogenesis
Female
030211 gastroenterology & hepatology
Surgery
Colorectal Neoplasms
Carcinogenesis
business
Subjects
Details
- ISSN :
- 14452197 and 14451433
- Volume :
- 90
- Database :
- OpenAIRE
- Journal :
- ANZ Journal of Surgery
- Accession number :
- edsair.doi.dedup.....e0f31f53927dbd8f628d226dfdec59f6