Diagnostic Considerations

The differential diagnosis of colonic polyps varies, depending on the age of the patient and the presenting symptoms. A family history of polyposis is very significant because it raises the possibility of an inherited susceptibility, such as familial adenomatous polyposis (FAP) or other polyposis syndromes. Moreover, the differential diagnosis can be broad if the patient presents with rectal bleeding or diarrhea.

Conditions to consider in the differential diagnosis include the following:

Sporadic polyps associated with aging
Benign adenoma/hyperplastic polyp
Pseudopolyps associated with mucosal inflammation
Juvenile polyposis
Basal cell nevus syndrome (includes basal cell carcinomas and colonic hamartomatous polyps)
Turcot syndrome (includes polyps, medulloblastoma, congenital hypertrophy of the retinal pigmented epithelium [CHRPE], and glioblastoma multiforme)
Cowden syndrome (includes polyps, fibrocystic disease, breast cancer, and thyroid cancer)
Hereditary nonpolyposis colorectal cancer (HNPCC)/Lynch syndrome
Hyperplastic polyposis

Differential Diagnoses

Workup

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Media Gallery

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.
Multiple large polyps in the colon. The polyp in the center of the image is situated on a stalk. (Endoscopic image).

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Author

Gregory H Enders, MD, PhD Gastroenterologist, Moses Taylor Hospital, Regional Hospital of Scranton, and Physicians Health Alliance

Gregory H Enders, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American Gastroenterological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Wafik S El-Deiry, MD, PhD Rose Dunlap Professor of Medicine, Chief, Division of Hematology and Oncology, Penn State Hershey Medical Center

Wafik S El-Deiry, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society for Clinical Investigation, American Society of Gene and Cell Therapy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Manoop S Bhutani, MD Professor, Co-Director, Center for Endoscopic Research, Training and Innovation (CERTAIN), Director, Center for Endoscopic Ultrasound, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch; Director, Endoscopic Research and Development, The University of Texas MD Anderson Cancer Center

Manoop S Bhutani, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Institute of Ultrasound in Medicine, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Research on colon neoplasia in the author's laboratory has been supported by NIH grant #R01DK64758.

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