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P. POLYPES AND Tumors of the Large Intestine

1. Benign polyps, polyposis and tumors.

The etiology and pathogenesis, as well as tumors, in general, have not yet been sufficiently studied. Benign tumors (according to WHO, Geneva, 1981) are divided into three groups:

1). epithelial;

2). carpinoid;

3). non-epithelial tumors.

Among the epithelial tumors of the colon, which make up the vast majority of all its tumors, distinguish between adenoma and adenomatosis.

Adenoma (tubular, villous, tuberous villous adenoma) is a benign tumor of the glandular epithelium on the leg or wide base, having the form of a polyp. There is a clear relationship between different types of adenomas: most often, adenoma per

initially has a tubular structure and small size. As growth and size increase, villi increases and the malignancy index sharply increases - from 2% in tubular adenoma to 40% in villous.

If multiple adenomas are found in the colon, but not less than 100, then, according to the WHO international histological classification, this process should be classified as adenomatosis. With a smaller number, we can talk about multiple adenomas. With adenomatosis, usually all adenomas have a predominantly tubular structure. The degree of dysplasia can be different.

A carcinoid is second in frequency among colon tumors; morphologically, it is no different from carcinoid of the small intestine, but is less common in the colon.

Non-epithelial benign tumors of the colon can have the structure of leiomyomas, leiomyoblastomas, neurilemomas, lipomas, hem and lymphangiomas, fibromas, etc.

All of them are extremely rare, localized in any layers of the wall, but more often in the mucous membrane of the submucosal layer and during endoscopic examination they look like polyps.

However, a polyp is a collective term used to refer to pathological formations of various origins that rise above the surface of the mucous membrane. In addition to tumors, these formations can be tumor-like processes that are different in etiology and origin. These include gamar toms, in particular the Peitz-Jägers-Touraine polyp and the juvenile polyp, similar in structure to similar formations in the colon.

Especially often in the colon there is a hyperplastic (metalloplastic) polyp, which has recently been attributed to pre-tumor formations, since it is most often found next to a malignant tumor of the rectum and colon, as well as in connection with the possibility of its transformation into cancer.

An inflammatory polyp is a nodular polypoid formation with inflammatory stromal infiltration, covered with normal or regenerating epithelium, often ulcerated.

In addition to dividing all of the above polyps by etiology and histological structure, the size of the polyps, the presence and nature of the legs of the polyp, and finally the number of polyps are important for the clinic.

CLINIC. For a long time, benign tumors and colon polyps can be asymptomatic. Only when the tumor reaches a sufficiently large size do symptoms of colon obstruction arise, and when a part of the tumor or polyp breaks up, intestinal bleeding occurs. Colon polyps in more than half the cases cause colon cancer. Most often, malignancy of the so-called villous polyp appears.

The diagnosis is made using colonoscopy or irrigoscopy. The treatment of benign tumors or polyps of the colon is most often surgical. However, small tumors and polyps can be removed with modern endoscopic techniques (electrocoagulation, laser coagulation, removal with a special “loop” and DR -) -

2.
Hereditary familial polyposis of the gastrointestinal tract.

a) Diffuse (familial) polyposis is a hereditary disease manifested by a clinical triad:

the presence of many polyps (of the order of several hundred) from the epithelium of the mucous membrane;

the family nature of the lesion;

localization of the lesion throughout the gastrointestinal tract.

The disease ends with the obligatory development of cancer as a result of malignancy of polyps.

b) Gardner's syndrome (illness) is a disease characterized by multiple skin and subcutaneous lesions that occur simultaneously with tumor lesions of the bones and tumors of soft tissues in combination with polyposis of the gastrointestinal tract. This is a pleiotropic dominant-hereditary disease, with a varying degree of penetrance, based on mesenchymal dysplasia. The first manifestations of the disease are usually detected in people over 10 years old, often after 20 years. This is a multiple polyposis of the colon (sometimes also the 12 ™ duodenum and stomach) with a tendency to cancerous degeneration, multiple osteomas and osteofibromas of the bones of the skull and other parts of the skeleton, multiple atheromas, dermoid cysts, subcutaneous fibromas, leiomyomas, premature tooth loss.

The main diagnostic method is irrigoscopy; to detect bone lesions - radiography or scintigraphy of the bone skeleton. Of the bones, the upper and lower jaw are most often affected. Surgical treatment: total colectomy with pleostomy.

c) Kronkhait-Canada syndrome - which is a complex of congenital anomalies; generalized polyposis of the gastrointestinal tract (including the stomach and duodenum), nail atrophy, alopecia, skin hyperpigmentation, sometimes in combination with exudative enteropathy, malabsorption syndrome, hypocalcemia, potassium and magnesium.

d) Generalized gastrointestinal juvenile polyposis. It is characterized by the early - in adolescence - the development of multiple polyps throughout the digestive tract, starting from the stomach and ending with the rectum. With this form of polyposis, no extraintestinal manifestations are observed, as well as malignancy of polyps.

e) Tarkot syndrome. In 1959, Y. Tarcot and MPDespire described in the brother and sister cancer of the central nervous system associated with familial colon polyposis. f) Peitz-Jägers-Touraine syndrome, which is characterized by a triad:

gastrointestinal polyposis;

hereditary nature of the disease;

age spots on the skin and mucous membranes. Women get sick more often, inherited in an autosomal dominant manner.

g) Familial (juvenile) colon polyposis is a hereditary disease with an autosomal dominant transmission path.

Polyps are found in adolescence, but they are found in early childhood, and even in old age. It is believed that this type of familial polyposis is extremely conducive to the development of a cancerous tumor: the transformation of a colon polyp into a cancerous tumor is possible in 95% of cases. Cancer usually develops early, up to 40 years. Describes the combination of polyposis of the colon with cancer of the stomach, small intestine.

The knowledge of hereditary polyps of the digestive tract is not only of purely scientific importance, but also allows doctors in each case to accurately determine the prognosis of the disease and, at high risk of malignancy of polyps with certain, most life-threatening forms of multiple hereditary polyposis, recommend the only possible remedy to patients , although morally difficult and technically quite complex, total colectomy, if possible, with the application of an ileorectal anastomosis.
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P. POLYPES AND Tumors of the Large Intestine

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  8. Colon Syndromes
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