Intestinal Polyposis Syndromes Workup

  • Author: Evelyn K Hsu, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Jan 3, 2011
 

Laboratory Studies

The following studies are indicated in patients with intestinal polyposis syndromes:

  • CBC count with differential and platelets
  • Stools for occult blood
  • Prothrombin time/activated partial thromboplastin time (if significant bleeding is present)
  • Serum albumin levels (if weight loss is present)
  • Genetic testing, including band 5q21-22 for Gardner syndrome (ie, familial adenomatous polyposis [FAP]), band 7p22, 5q21-22, and 3p21.3 for Turcot syndrome, band 19q13.3-13.4 for Peutz-Jeghers syndrome (PJS), band 10q23.3 for Bannayan-Riley-Ruvalcaba syndrome (BRR) and Cowden disease, band 9q22.3-q31 for Gorlin syndrome (GS)
  • Fecal alpha1-antitrypsin or fecal calprotectin (if albumin is low and weight loss is present; to evaluate for protein-losing enteropathy)
  • Levothyroxine (T4), triiodothyronine (T3), thyroid-stimulating hormone (TSH), thyroid antimicrosomal or thyroid peroxidase antibody to exclude Hashimoto thyroiditis in individuals with symptomatic Bannayan-Riley-Ruvalcaba syndrome
  • Liver function tests and alpha-fetoprotein level to screen for hepatoblastoma in patients with suspected Gardner syndrome and an abdominal mass; electrolytes, plasma or urine cortisol, and adrenocorticotropic hormone (ACTH) in patients with suspected Gardner syndrome if Cushing syndrome is present
Next

Imaging Studies

The role of imaging studies in favor of endoscopic examination has not been well established for individuals with intestinal polyposis syndromes.[48] Examples of endoscopic findings are shown in the images below.

Hamartomatous polyp, as seen in the stomach. (EndoHamartomatous polyp, as seen in the stomach. (Endoscopic image). Colon in familial adenomatous polyposis (FAP). (EnColon in familial adenomatous polyposis (FAP). (Endoscopic image). Multiple large polyps in the colon. The polyp in tMultiple large polyps in the colon. The polyp in the center of the image is situated on a stalk. (Endoscopic image).

Upper GI with small bowel followthrough (SBFT) can be used to evaluate for polyps.

Video capsule endoscopy is an emerging modality used to evaluate for small bowel polyps that spares radiation for the patient (see the image below).[49, 50]

Small bowel polyp. (Video capsule image). Small bowel polyp. (Video capsule image).

Air-contrast barium enema (BE) can be used to evaluate for colonic polyps in patients who are not candidates for colonoscopic examination.

Additional imaging studies in patients with Gardner syndrome may include the following:

  • Radiographs of the skull, teeth, and mandible to screen for osteomas and plan management of dental anomalies
  • CT scanning, ultrasonography, or MRI of the abdomen to evaluate abdominal masses (hepatoblastoma, adrenal carcinoma, mesenteric fibromas/desmoids)

In patients with Turcot syndrome, CNS imaging, GI imaging, and other imaging modalities are indicated if Gardner syndrome is suspected, as clinically warranted.

For patients with known PJS, perform routine screening, mammogram, and breast ultrasound for early detection of occult neoplasms. Perform ultrasonography or CT scanning of the pelvis or testicles to screen for possible malignancies in patients with conditions such as gynecomastia and precocious puberty.

For patients with known PTEN- hamartomatous syndrome imaging studies include the following:

  • Routine breast imaging to screen for neoplasia (Seventy five percent of females develop breast neoplasia.)
  • Imaging of the thyroid, if suggestive of malignancy
  • Imaging of the ovaries, if suggestive of malignancy
  • MRI of the head, if symptomatic
  • Radiography of the spine to monitor for scoliosis

For patients with known GS, perform radiography of the mandible, ribs, and spine to diagnose and treat anomalies. Perform CNS imaging to exclude hydrocephalus and medulloblastoma if warranted by clinical evaluation. Perform imaging of the ovaries to exclude pathologic conditions of the ovaries in women with suggestive symptoms.

Patients with GS should not require SBFT or BE for detection of polyps (only gastric polyps have been reported). In a series of 105 patients with GS, Kimonis et al reported the following radiologic findings:[31]

  • Calcification of the falx cerebri (65%)
  • Bridged sella (68%)
  • Flame-shaped lucencies in the phalanges, carpals, and metacarpals (30%)
  • Bifid ribs (26%)
  • Calcification of the tentorium cerebri (20%)
  • Hemivertebrae (15%)
  • Fused vertebral bodies (10%)
Previous
Next

Other Tests

All patients with polyposis syndromes require serial endoscopy and colonoscopy to evaluate for the degree of polyposis and survey for malignant transformation.

Previous
Next

Procedures

Perform upper endoscopy or colonoscopy to evaluate GI polyposis and perform surveillance for malignant transformation.

In patients who have PJS and chronic sinusitis, endoscopic evaluation for possible nasal polyposis may be required. Squamous cell carcinoma has been reported in a patient with PJS and nasal polyps.

In patients with GS, skin biopsies may be required to exclude basal cell carcinomas.

In patients with Cowden disease, biopsies of suspicious lesions that show on the mammogram are warranted to exclude neoplasia, and biopsies of other suspicious areas are indicated to exclude malignancy.

Previous
Next

Histologic Findings

Gruber et al characterized PJS hamartomas with an elongated frondlike epithelium possessing cystic dilatation of glands containing hypermucinous goblet cells atop a network of smooth muscle bundles.[51] Patients with BRR syndrome and Cowden disease also present with hamartomatous intestinal polyps. In contrast, other forms of juvenile polyposis consist of abundant lamina propria without the presence of smooth muscle bundles. Inflammatory polyps contain a well-differentiated mature epithelial layer with a smooth dome but lobulated appearance due to cyst formation without smooth muscle bundles.

Adenomatous polyps, found in patients with FAP and its variants, vary in size, ranging from single crypt adenomas to microadenomas of 2-5 crypts in size to sessile tubular adenomas visualized at endoscopy. Adenomas are composed of immature epithelial cells with increased proliferation rates above crypt requirements. Increased growth in size of adenomas enhances the formation of dysplasia. No smooth muscle bundles are present in adenomatous polyps.

Examples of histologic findings are shown in the images below.

Pedunculated tubular adenoma. Note the contrast bePedunculated tubular adenoma. Note the contrast between the goblet cell-rich glands along the pedicle of the polyp and in the underlying normal colonic mucosa at the bottom and the dysplastic glands in the polyp proper. The dysplastic glands are more crowded and exhibit decreased mucin production. (Hematoxylin and eosin stain; 1X magnification). Sessile tubular adenoma. The glands on the superfiSessile tubular adenoma. The glands on the superficial aspect of the specimen are dysplastic and exhibit increased nuclear size, hyperchromasia, crowding, and decreased mucin production. (Hematoxylin and eosin stain, 4X magnification). Hamartomatous (Peutz-Jeghers) polyp, small bowel. Hamartomatous (Peutz-Jeghers) polyp, small bowel. This pedunculated polyp has a cerebriform appearance due to the arborizing frond-like growth with delicate finger-like projections of the stroma. (Hematoxylin and eosin stain, 1X magnification). Hamartomatous (Peutz-Jeghers) polyp, small bowel. Hamartomatous (Peutz-Jeghers) polyp, small bowel. Closer view of the fingerlike projections of the stroma demonstrates prominent smooth muscle fascicles between the glandular elements. (Hematoxylin and eosin stain, 4X magnification).
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Evelyn K Hsu, MD  Fellow in Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia

Disclosure: Nothing to disclose.

Coauthor(s)

Petar Mamula, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine

Petar Mamula, MD, is a member of the following medical societies: American Academy of Pediatrics, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Eduardo D Ruchelli, MD  Associate Professor of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine; Attending Physician, Department of Pathology, Children's Hospital of Philadelphia

Eduardo D Ruchelli, MD is a member of the following medical societies: Society for Pediatric Pathology and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Jayant Deodhar, MD  Associate Professor in Pediatrics, BJ Medical College, India; Honorary Consultant, Departments of Pediatrics and Neonatology, King Edward Memorial Hospital, India

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Stefano Guandalini, MD  Director, Celiac Disease Center, Chief, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Chicago Medical Center; Professor, Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Stefano Guandalini, MD is a member of the following medical societies: American Gastroenterological Association, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, State University of New York Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

References

  1. Chargelaigue A. Des Polypes du Rectum. Thesis Paris. 1859.

  2. Turcot J, Despres JP, St Pierre F. Malignant tumors of the central nervous system associated with familial polyposis of the colon: report of two cases. Dis Colon Rectum. Sep-Oct 1959;2:465-8. [Medline].

  3. Baughman FA, List CF, Williams JR, et al. The glioma-polyposis syndrome. New England Journal of Medicine. 1969;281:1345-46. [Medline].

  4. Erdman SH. Pediatric adenomatous polyposis syndromes: an update. Curr Gastroenterol Rep. Jun 2007;9(3):237-44. [Medline].

  5. Peutz J. Very remarkable case of familial polyposis of mucous membrane of intestinal tract and nasopharynx accompanied by peculiar pigmentations of skin and mucous membrane. Nederl Maandschr Geneesk. 1921;10:1921.

  6. Jeghers H, McKusick VA, Katz KH. Generalized intestinal polyposis and melanin spots of the oral mucosa, lips and digits; a syndrome of diagnostic significance. N Engl J Med. Dec 22 1949;241(25):993, illust; passim. [Medline].

  7. Lloyd KM 2nd, Dennis M. Cowden's disease. A possible new symptom complex with multiple system involvement. Ann Intern Med. Jan 1963;58:136-42. [Medline].

  8. Weary PE, Gorlin RJ, Gentry WC Jr, Comer JE, Greer KE. Multiple hamartoma syndrome (Cowden's disease). Arch Dermatol. Nov 1972;106(5):682-90. [Medline].

  9. Padberg GW, Schot JD, Vielvoye GJ, Bots GT, de Beer FC. Lhermitte-Duclos disease and Cowden disease: a single phakomatosis. Ann Neurol. May 1991;29(5):517-23. [Medline].

  10. HD Riley WS. Macrocephaly, pseudopapilledema and multiple hemangiomata: a previously undescribed heredofamilial syndrome. Pediatrics. 1960;26:293-300.

  11. Bannayan GA. Lipomatosis, angiomatosis, and macrencephalia. A previously undescribed congenital syndrome. Arch Pathol. Jul 1971;92(1):1-5. [Medline].

  12. Lachlan KL, Lucassen AM, Bunyan D, Temple IK. Cowden syndrome and Bannayan Riley Ruvalcaba syndrome represent one condition with variable expression and age-related penetrance: results of a clinical study of PTEN mutation carriers. J Med Genet. Sep 2007;44(9):579-85. [Medline].

  13. Calva D, Howe JR. Hamartomatous polyposis syndromes. Surg Clin North Am. Aug 2008;88(4):779-817, vii. [Medline].

  14. Gorlin RJ. Nevoid basal-cell carcinoma syndrome. Medicine (Baltimore). Mar 1987;66(2):98-113. [Medline].

  15. Hamilton SR, Liu B, Parsons RE, Papadopoulos N, Jen J, Powell SM. The molecular basis of Turcot's syndrome. N Engl J Med. Mar 30 1995;332(13):839-47. [Medline].

  16. Tops CM, Vasen HF, van Berge Henegouwen G, et al. Genetic evidence that Turcot syndrome is not allelic to familial adenomatous polyposis. Am J Med Genet. Jul 15 1992;43(5):888-93. [Medline].

  17. Hemminki A, Markie D, Tomlinson I, et al. A serine/threonine kinase gene defective in Peutz-Jeghers syndrome. Nature. Jan 8 1998;391(6663):184-7. [Medline].

  18. Jenne DE, Reimann H, Nezu J, et al. Peutz-Jeghers syndrome is caused by mutations in a novel serine threonine kinase. Nat Genet. Jan 1998;18(1):38-43. [Medline].

  19. Volikos E, Robinson J, Aittomäki K, Mecklin JP, Järvinen H, Westerman AM. LKB1 exonic and whole gene deletions are a common cause of Peutz-Jeghers syndrome. J Med Genet. May 2006;43(5):e18. [Medline].

  20. Podsypanina K, Ellenson LH, Nemes A, Gu J, Tamura M, Yamada KM. Mutation of Pten/Mmac1 in mice causes neoplasia in multiple organ systems. Proc Natl Acad Sci U S A. Feb 16 1999;96(4):1563-8. [Medline].

  21. Jones KL, Smith DW, Harvey MA, Hall BD, Quan L. Older paternal age and fresh gene mutation: data on additional disorders. J Pediatr. Jan 1975;86(1):84-8. [Medline].

  22. Bisgaard ML, Fenger K, Bülow S, Niebuhr E, Mohr J. Familial adenomatous polyposis (FAP): frequency, penetrance, and mutation rate. Hum Mutat. 1994;3(2):121-5. [Medline].

  23. Paraf F, Jothy S, Van Meir EG. Brain tumor-polyposis syndrome: two genetic diseases?. J Clin Oncol. Jul 1997;15(7):2744-58. [Medline].

  24. Krush AJ, Giardiello FM. Development of a genetics registry: Hereditary intestinal polyposis and hereditary colon cancer registry at the Johns Hopkins Hospital, 1973-1988. In: Herrera L. Familial Adenomatous Polyposis. New York, NY: Alan R. Liss Inc; 1990.

  25. Farndon PA, Del Mastro RG, Evans DG, Kilpatrick MW. Location of gene for Gorlin syndrome. Lancet. Mar 7 1992;339(8793):581-2. [Medline].

  26. Burn J, Chapman P, Delhanty J, Wood C, Lalloo F, Cachon-Gonzalez MB. The UK Northern region genetic register for familial adenomatous polyposis coli: use of age of onset, congenital hypertrophy of the retinal pigment epithelium, and DNA markers in risk calculations. J Med Genet. May 1991;28(5):289-96. [Medline].

  27. Rustgi AK. The genetics of hereditary colon cancer. Genes Dev. Oct 15 2007;21(20):2525-38. [Medline].

  28. Nelen MR, Kremer H, Konings IB, Schoute F, van Essen AJ, Koch R. Novel PTEN mutations in patients with Cowden disease: absence of clear genotype-phenotype correlations. Eur J Hum Genet. Apr 1999;7(3):267-73. [Medline].

  29. Van Meir EG. "Turcot's syndrome": phenotype of brain tumors, survival and mode of inheritance. Int J Cancer. Jan 5 1998;75(1):162-4. [Medline].

  30. Giardiello FM, Brensinger JD, Petersen GM. AGA technical review on hereditary colorectal cancer and genetic testing. Gastroenterology. Jul 2001;121(1):198-213. [Medline].

  31. Kimonis VE, Goldstein AM, Pastakia B, Yang ML, Kase R, DiGiovanna JJ. Clinical manifestations in 105 persons with nevoid basal cell carcinoma syndrome. Am J Med Genet. Mar 31 1997;69(3):299-308. [Medline].

  32. Klemmer S, Pascoe L, DeCosse J. Occurrence of desmoids in patients with familial adenomatous polyposis of the colon. Am J Med Genet. Oct 1987;28(2):385-92. [Medline].

  33. Bell B, Mazzaferri EL. Familial adenomatous polyposis (Gardner's syndrome) and thyroid carcinoma. A case report and review of the literature. Dig Dis Sci. Jan 1993;38(1):185-90. [Medline].

  34. Hanssen AM, Fryns JP. Cowden syndrome. J Med Genet. Feb 1995;32(2):117-9. [Medline].

  35. Distante S, Nasioulas S, Somers GR, Cameron DJ, Young MA, Forrest SM. Familial adenomatous polyposis in a 5 year old child: a clinical, pathological, and molecular genetic study. J Med Genet. Feb 1996;33(2):157-60. [Medline].

  36. Fernandez Seara MJ, Martinez Soto MI, Fernandez Lorenzo JR, Trabazo S, Gamborino E, Forteza Vila J. Peutz-Jeghers syndrome in a neonate. J Pediatr. Jun 1995;126(6):965-7. [Medline].

  37. Blumenthal GM, Dennis PA. PTEN hamartoma tumor syndromes. Eur J Hum Genet. Nov 2008;16(11):1289-300. [Medline].

  38. Talbot I. Pathology. In: Phillips RKS SA, Thompson JPS. Familial Adenomatous Polyposis and Other Polyposis Syndrome. Oxford UP; 1994:15-35.

  39. Hemminki A. The molecular basis and clinical aspects of Peutz-Jeghers syndrome. Cell Mol Life Sci. May 1999;55(5):735-50. [Medline].

  40. Tan WH, Baris HN, Burrows PE, Robson CD, Alomari AI, Mulliken JB. The spectrum of vascular anomalies in patients with PTEN mutations: implications for diagnosis and management. J Med Genet. Sep 2007;44(9):594-602. [Medline].

  41. Genevieve D, Walter E, Gorry P, Jacquemont ML, Dupic L, Layet V. Gorlin syndrome presenting as prenatal chylothorax in a girl. Prenat Diagn. Nov 2005;25(11):997-9. [Medline].

  42. Sachatello CR, Hahn IS, Carrington CB. Juvenile gastrointestinal polyposis in a female infant: report of a case and review of the literature of a recently recognized syndrome. Surgery. Jan 1974;75(1):107-14. [Medline].

  43. Peifer M. Cancer, catenins, and cuticle pattern: a complex connection. Science. Dec 10 1993;262(5140):1667-8. [Medline].

  44. Arch EM, Goodman BK, Van Wesep RA, Liaw D, Clarke K, Parsons R. Deletion of PTEN in a patient with Bannayan-Riley-Ruvalcaba syndrome suggests allelism with Cowden disease. Am J Med Genet. Sep 5 1997;71(4):489-93. [Medline].

  45. Hahn H, Wicking C, Zaphiropoulous PG, Gailani MR, Shanley S, Chidambaram A. Mutations of the human homolog of Drosophila patched in the nevoid basal cell carcinoma syndrome. Cell. Jun 14 1996;85(6):841-51. [Medline].

  46. Johnson RL, Rothman AL, Xie J, et al. Human homolog of patched, a candidate gene for the basal cell nevus syndrome. Science. Jun 14 1996;272(5268):1668-71. [Medline].

  47. Bale AE. Variable expressivity of patched mutations in flies and humans. Am J Hum Genet. Jan 1997;60(1):10-2. [Medline].

  48. Winawer SJ, Zauber AG, Fletcher RH, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. May 2006;130(6):1872-85. [Medline].

  49. Sidhu R, Sanders DS, McAlindon ME, Thomson M. Capsule endoscopy and enteroscopy: modern modalities to investigate the small bowel in paediatrics. Arch Dis Child. Feb 2008;93(2):154-9. [Medline].

  50. de' Angelis GL, Fornaroli F, de' Angelis N, Magiteri B, Bizzarri B. Wireless capsule endoscopy for pediatric small-bowel diseases. Am J Gastroenterol. Aug 2007;102(8):1749-57; quiz 1748, 1758. [Medline].

  51. Gruber SB, Entius MM, Petersen GM, et al. Pathogenesis of adenocarcinoma in Peutz-Jeghers syndrome. Cancer Res. Dec 1 1998;58(23):5267-70. [Medline].

  52. Bulow S. Results of national registration of familial adenomatous polyposis. Gut. May 2003;52(5):742-6. [Medline].

  53. Howe JR, Mitros FA, Summers RW. The risk of gastrointestinal carcinoma in familial juvenile polyposis. Ann Surg Oncol. Dec 1998;5(8):751-6. [Medline].

  54. Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J. Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology. Feb 2003;124(2):544-60. [Medline].

  55. Attard TM, Cuffari C, Tajouri T, Stoner JA, Eisenberg MT, Yardley JH. Multicenter experience with upper gastrointestinal polyps in pediatric patients with familial adenomatous polyposis. Am J Gastroenterol. Apr 2004;99(4):681-6. [Medline].

  56. Barnard J. Screening and surveillance recommendations for pediatric gastrointestinal polyposis syndromes. J Pediatr Gastroenterol Nutr. Apr 2009;48 Suppl 2:S75-8. [Medline].

  57. Hughes LJ, Michels VV. Risk of hepatoblastoma in familial adenomatous polyposis. Am J Med Genet. Aug 1 1992;43(6):1023-5. [Medline].

  58. Burt RW. Colon cancer screening. Gastroenterology. Sep 2000;119(3):837-53. [Medline].

  59. Church JM, McGannon E, Burke C, Clark B. Teenagers with familial adenomatous polyposis: what is their risk for colorectal cancer?. Dis Colon Rectum. Jul 2002;45(7):887-9. [Medline].

  60. Howe JR, Roth S, Ringold JC, et al. Mutations in the SMAD4/DPC4 gene in juvenile polyposis. Science. May 15 1998;280(5366):1086-8. [Medline].

  61. Howe JR, Ringold JC, Hughes JH, Summers RW. Direct genetic testing for Smad4 mutations in patients at risk for juvenile polyposis. Surgery. Aug 1999;126(2):162-70. [Medline].

  62. Jänne PA, Mayer RJ. Chemoprevention of colorectal cancer. N Engl J Med. Jun 29 2000;342(26):1960-8. [Medline].

  63. Yang K, Yang W, Mariadason J, Velcich A, Lipkin M, Augenlicht L. Dietary components modify gene expression: implications for carcinogenesis. J Nutr. Nov 2005;135(11):2710-4. [Medline].

  64. Macrae F. Wheat bran fiber and development of adenomatous polyps: evidence from randomized, controlled clinical trials. Am J Med. Jan 25 1999;106(1A):38S-42S. [Medline].

  65. Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Stampfer MJ, Rosner B. Dietary fiber and the risk of colorectal cancer and adenoma in women. N Engl J Med. Jan 21 1999;340(3):169-76. [Medline].

  66. Giardiello FM, Hamilton SR, Krush AJ, et al. Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis. N Engl J Med. May 6 1993;328(18):1313-6. [Medline].

  67. Ruhswurm I, Zehetmayer M, Dejaco C, Wolf B, Karner-Hanusch J. Ophthalmic and genetic screening in pedigrees with familial adenomatous polyposis. Am J Ophthalmol. May 1998;125(5):680-6. [Medline].

  68. Watanabe K, Kawamori T, Nakatsugi S, Ohta T, Ohuchida S, Yamamoto H. Role of the prostaglandin E receptor subtype EP1 in colon carcinogenesis. Cancer Res. Oct 15 1999;59(20):5093-6. [Medline].

 
Previous
Next
 
Familial adenomatous polyposis, total colectomy specimen. The colonic mucosa is studded with innumerable sessile and small pedunculated polyps, which involve the entire length of the specimen.
Pedunculated tubular adenoma. Note the contrast between the goblet cell-rich glands along the pedicle of the polyp and in the underlying normal colonic mucosa at the bottom and the dysplastic glands in the polyp proper. The dysplastic glands are more crowded and exhibit decreased mucin production. (Hematoxylin and eosin stain; 1X magnification).
Sessile tubular adenoma. The glands on the superficial aspect of the specimen are dysplastic and exhibit increased nuclear size, hyperchromasia, crowding, and decreased mucin production. (Hematoxylin and eosin stain, 4X magnification).
Hamartomatous (Peutz-Jeghers) polyp, small bowel. This pedunculated polyp has a cerebriform appearance due to the arborizing frond-like growth with delicate finger-like projections of the stroma. (Hematoxylin and eosin stain, 1X magnification).
Hamartomatous (Peutz-Jeghers) polyp, small bowel. Closer view of the fingerlike projections of the stroma demonstrates prominent smooth muscle fascicles between the glandular elements. (Hematoxylin and eosin stain, 4X magnification).
Hamartomatous polyp, as seen in the stomach. (Endoscopic image).
Colon in familial adenomatous polyposis (FAP). (Endoscopic image).
Small bowel polyp. (Video capsule image).
Multiple large polyps in the colon. The polyp in the center of the image is situated on a stalk. (Endoscopic image).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.