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High-grade dysplasia in giant tubular adenoma

Yıl 2023, Cilt: 3 Sayı: 3, 29 - 33, 22.12.2023
https://doi.org/10.58961/hmj.1354554

Öz

Rectal adenomas with a high risk of cancer frequently occur in anal bleeding and mucus discharge. The risk of malignancy is greater than 50% in polyps larger than 2 cm and includes areas of dysplasia, and the likelihood of dysplasia is correlated with the excess of the villous component ratio, the proximity of the polyp to the anal region, and the increase in size. Large, lumen-encircling polyps are difficult to treat with endoscopic or transanal intervention and necessitate surgical intervention. In this article, we present a female patient who had rectal mucus discharge and had a lower anterior resection and coloanal anastomosis after developing a tubular adenoma with high-grade dysplasia and no villous component.

Etik Beyan

Not applicable, because this article does not contain any studies with human or animal subjects. An informed consent was obtained from the patient for this case report.

Destekleyen Kurum

This study is entirely author's own work and no other author contribution.

Teşekkür

Thanks to Dr Nurten Küçükmetin for his support in the treatment process of the patient. Thanks to Dr Sevil Karabağ for his support in the pathology images of the specimen. Thanks to Dr Hadi Sasani for his support in the radiology images of the case.

Kaynakça

  • Carlsson G, Petrelli NJ, Nava H, Herrera N, Mittelman A. The value of colonoscopicsurveillance after curative resection for colorectal cancer or synchronous adenomatouspolyps. Arch Surg 1987; 122:1261.
  • Heitman SJ, Ronksley PE, Hilsden RJ, Manns BJ, Rostom A, HemmelgarnBR. Prevalence of adenomas and colorectal cancer in average risk individuals: a systematicreview and meta-analysis. Clin Gastroenterol Hepatol 2009; 7:1272.
  • Pendergrass CJ, Edelstein DL, Hylind LM, Phillips BT, Lacobuzio – DonahueC, Romans K, et al. Occurrence of colorectal adenomas in younger adults: anepidemiologic necropsy study. Clin Gastroenterol Hepatol 2008; 6:1011. Ben Q, An W, Jiang Y, Zhan X, Du Y, Cai Cai Q, et al. Body mass index increasesrisk for colorectal adenomas based on meta-analysis. Gastroenterology 2012; 142:762.
  • Bersentes K, Fennerty MB, Sampliner RE, Garewal HS. Lack of spontaneousregression of tubular adenomas in two years of follow-up. Am J Gastroenterol 1997; 92:1117.
  • Lieberman D, Moravec M, Holub J, Michaels L, Eisen G. Polyp size and advancedhistology in patients undergoing colonoscopy screening: implications for CTcolonography. Gastroenterology 2008; 135:1100.
  • Shinya H, Wolff WI. Morphology, anatomic distribution and cancer potential ofcolonic polyps. Ann Surg 1979; 190:679 – 683
  • Kaltenbach T, Anderson JC, Burke CA, Dominitz JA, Gupta S, Lieberman D, et al. Endoscopic Removal of Colorectal Lesions-Recommendations by the USMulti-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020; 91:486.
  • Rickenbacher A, Bauerfeind P, Rössler F, Turina M. Sequential endoscopicandsurgical removal of giant rectal adenomas extending to the dentate line. TechColoproctol. 2018;22(5):379–81.
  • Sullivan BA, Noujaim M, Roper J. Cause, Epidemiology, and Histology of Polyps andPathways to Colorectal Cancer. Gastrointest Endosc Clin N Am. 2022;32(2):177-194. 11. Shussman N, Wexner SD. Colorectal polyps and polyposis syndromes. Gastroenterol Rep (Oxf). 2014;2(1):1–15.
  • Bains L, Lal P, Vindal A, Singh M. Giant villous adenoma of rectum- what is themalignant potential and what is the optimal treatment? A case and reviewof literature. World J Surg Oncol. 2019; 25;17(1):109.
  • Featherstone JM, Grabham JA, Fozard JB. Per-anal excision of large, rectal, villousadenomas. Dis Colon Rectum. 2004;47(1):86–9.
  • Carditello A, Milone A, Paparo D, Anastasi G, Mollo F, Stilo F. Tubulo-villous rectal tumours. Results of surgical resection in relation to histotype (30 years-experience). Chir Ital. 2004;56(4):517–21.
  • Bertelson NL, Kalkbrenner KA, Merchea A, Dozois EJ, Landmann RG, De PetrisG, et al. Colectomy for endoscopically unresectable polyps: how often is it cancer?DisColon Rectum. 2012; 55:1111–6.

Yüksek Derece Displazili Dev Tubüler Adenom

Yıl 2023, Cilt: 3 Sayı: 3, 29 - 33, 22.12.2023
https://doi.org/10.58961/hmj.1354554

Öz

Malignite riski yüksek olan rektal adenomlar sıklıkla anal kanama ve mukus akıntısıyla görülür. Displazi alanları içeren 2 cm'den büyük poliplerde malignite riski %50'den fazladır ve displazi olasılığı villöz komponent oranının fazlalığı, polipin anal bölgeye yakınlığı ve polip boyutunun artışı ile displazi olasılığı korele seyreder. Büyük, lümeni çevreleyen poliplerin endoskopik veya transanal girişimle tedavisi zordur ve cerrahi müdahale gerektirir. Bu yazıda; rektal mukus akıntısı ile başvuran tetkiklerinde yüksek dereceli displazili ve villöz komponent içermeyen tübüler adenomu olan kadın hastamızı, alt anterior rezeksiyon ve koloanal anastomoz yaparak tedavi ettiğimiz olguyu sunuyoruz.

Kaynakça

  • Carlsson G, Petrelli NJ, Nava H, Herrera N, Mittelman A. The value of colonoscopicsurveillance after curative resection for colorectal cancer or synchronous adenomatouspolyps. Arch Surg 1987; 122:1261.
  • Heitman SJ, Ronksley PE, Hilsden RJ, Manns BJ, Rostom A, HemmelgarnBR. Prevalence of adenomas and colorectal cancer in average risk individuals: a systematicreview and meta-analysis. Clin Gastroenterol Hepatol 2009; 7:1272.
  • Pendergrass CJ, Edelstein DL, Hylind LM, Phillips BT, Lacobuzio – DonahueC, Romans K, et al. Occurrence of colorectal adenomas in younger adults: anepidemiologic necropsy study. Clin Gastroenterol Hepatol 2008; 6:1011. Ben Q, An W, Jiang Y, Zhan X, Du Y, Cai Cai Q, et al. Body mass index increasesrisk for colorectal adenomas based on meta-analysis. Gastroenterology 2012; 142:762.
  • Bersentes K, Fennerty MB, Sampliner RE, Garewal HS. Lack of spontaneousregression of tubular adenomas in two years of follow-up. Am J Gastroenterol 1997; 92:1117.
  • Lieberman D, Moravec M, Holub J, Michaels L, Eisen G. Polyp size and advancedhistology in patients undergoing colonoscopy screening: implications for CTcolonography. Gastroenterology 2008; 135:1100.
  • Shinya H, Wolff WI. Morphology, anatomic distribution and cancer potential ofcolonic polyps. Ann Surg 1979; 190:679 – 683
  • Kaltenbach T, Anderson JC, Burke CA, Dominitz JA, Gupta S, Lieberman D, et al. Endoscopic Removal of Colorectal Lesions-Recommendations by the USMulti-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020; 91:486.
  • Rickenbacher A, Bauerfeind P, Rössler F, Turina M. Sequential endoscopicandsurgical removal of giant rectal adenomas extending to the dentate line. TechColoproctol. 2018;22(5):379–81.
  • Sullivan BA, Noujaim M, Roper J. Cause, Epidemiology, and Histology of Polyps andPathways to Colorectal Cancer. Gastrointest Endosc Clin N Am. 2022;32(2):177-194. 11. Shussman N, Wexner SD. Colorectal polyps and polyposis syndromes. Gastroenterol Rep (Oxf). 2014;2(1):1–15.
  • Bains L, Lal P, Vindal A, Singh M. Giant villous adenoma of rectum- what is themalignant potential and what is the optimal treatment? A case and reviewof literature. World J Surg Oncol. 2019; 25;17(1):109.
  • Featherstone JM, Grabham JA, Fozard JB. Per-anal excision of large, rectal, villousadenomas. Dis Colon Rectum. 2004;47(1):86–9.
  • Carditello A, Milone A, Paparo D, Anastasi G, Mollo F, Stilo F. Tubulo-villous rectal tumours. Results of surgical resection in relation to histotype (30 years-experience). Chir Ital. 2004;56(4):517–21.
  • Bertelson NL, Kalkbrenner KA, Merchea A, Dozois EJ, Landmann RG, De PetrisG, et al. Colectomy for endoscopically unresectable polyps: how often is it cancer?DisColon Rectum. 2012; 55:1111–6.
Toplam 13 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi (Diğer)
Bölüm Olgu Sunumu/Olgu Serisi
Yazarlar

Sami Açar 0000-0003-4096-3963

Çağıl Karaevli 0000-0002-4280-7430

Yayımlanma Tarihi 22 Aralık 2023
Gönderilme Tarihi 3 Eylül 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 3 Sayı: 3

Kaynak Göster

Vancouver Açar S, Karaevli Ç. High-grade dysplasia in giant tubular adenoma. HTD / HMJ. 2023;3(3):29-33.

e-ISSN: 2791-9935