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05-30-2008, 09:24 AM
(I) Epithelial Tumors (Polyposis Coli)

a) True Polyps:
1- Juvenile polyps: (Retention polyps)
· Incidence: Affect children mainly.
· Site: Commonest in the rectum.
· Mac: Usually single, pedunculated.
· Cl. P.: Common cause of bleeding / rectum in children.
· Malignant change: Never turn malignant.
· Treatment: Ligation & excision.
2- Villous Adenoma:
· Incidence: Papillary adenoma affect 45 years of age.
· Site. : Commonest in rectum & sigmoid.
· Mac. : Multiple sessile polyps with velvety surface.
· Cl. P. : Usually presents with bleeding / rectum.
Rarely, in hyperseceting adenoma , loss of 1-3 liters of mucus rich in electrolytes / day ® severe muscle weakness and loss of weight.
· Malignant change: It is often turn malignant.
· Treatment:
1- High in the rectum ® anterior resection.
2- Low in the rectum or anal canal local excision or abdomino perineal resection.
3- Adenomatous Polyp:
· Incidence and Site: The commonest neoplasm affect colon and rectum.
· Mac: Usually multiple, pedunculated with lobulated surface.
· Cl. P.: Bl. / rectum, anemia.
· Malignant change: Rare to turn malignant.
· Treatment: Excision by fiber-optic endoscopic polypectomy.
4- Familial Polyposis:
· Incidence: Rare herditary disease transmitted by both sexes to both sexes.
· Site: At puberty the polyps appear at pelvic colon and rectum at age of
21 the polyps affect the entire length of the colon.
·Cl.P: Bl./rectum, lower abdominal pain, diarrhea, tenesmus and loss of weight.
·Malignant change: Is inevitable.
· Treatment: Total coloproctectomy & terminal ileostomy before the age of 30 years. Alternatively, subtotal colectomy with ileo-proctostomy and endoscopic regular observation of rectal stump.
5- Gardner's Syndrome:
· Incidence: rare syndrome.
· Site and Mac: variant of familial polyposis but with
- Mandible & skull osteomata.
- Multiple sebaceous cysts.
- Desmoid tumors.
- Postoperative mesenteric fibromatasis.
And differ from familial polyposis in
* Polyps are more scattered and affect small intestine.
*May appear after the age of 40 & also malignant change appear later
in life.
· Treatment: The same as familial polyposis
B) False Polyps:
·Aetiology: Hyperplastic epithelium as occurred in
- Bilharziasis. - Ulcerative colitis - Edge of T.B. ulcers.

F N.B. Other connective tissue tumors: Rare e.g. Lipoma, Leiomyoma, fibroma and haemangioma. The lipoma commonest to affect the caecum (usually submucus and cause intussusception)
F N.B. Benign tumours of the small intestine is rare. Peutz Jegher’s syndrome is a polyposis of the small intestine accompanied by circumoral pigmentation. It is rarely turn malignant.

SOURCE: DR. AYMAN SALEM'S BOOK
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