ABSTRACT
Fundamento: Es de todos bien conocido, que los adenomas representan morfológicamente la lesión precursora de la gran mayoría de cánceres colorrectales. Sin embargo, las lesiones neoplásicas no polipoides tienen vías diferentes a la secuencia adenoma-carcinoma que podrían resultar más agresivas, siendo crucial la detección temprana para intervenir la historia natural de estas lesiones. Objetivo: En nuestro estudio identificamos lesiones neoplásicas no polipoides de colon sin magnificación, usando cromoendoscopia convencional con azul de metileno e índigo carmín y cromoendoscopia electrónica con el sistema Narrow Band Imaging (NBI) de Olympus. Todas las lesiones fueron tratadas mediante resección endoscópica mucosa (REM), siendo esta técnica segura, efectiva y en la cual se puede obtener el espécimen completo para su estudio histopatológico Diseño: De un total de 1.234 colonoscopias en el periodo entre los años 2006 y 2010, encontramos 155 (12,6%) lesiones neoplásicas no polipoides de acuerdo a la clasificación de París. Todas fueron removidas por técnica de mucosectomía en una sola sesión sin complicaciones. Limitaciones: El estudio fue realizado en un solo centro y consideramos como otra limitación el tamaño de la muestra. Conclusiones: Los resultados sugieren que la endoscopia sin magnificación es útil en la identificación de lesiones neoplásicas no polipoides de colon. Es importante reconocer que un número no despreciable de lesiones fueron encontradas en colon derecho tal como lo reporta la literatura. Consideramos que la resección endoscópica mucosa sigue siendo un procedimiento seguro, mínimamente invasivo y que permite la obtención del espécimen en su totalidad para estudio histológico y podría ser utilizada ampliamente en el tratamiento de estas lesiones.
Rationale. It is well known that adenomas are the morphological precursors of the vast majority of colorectal cancers. Nevertheless, nonpolypoid lesions follow pathways which differ from the known sequence from adenoma to carcinoma. Since these pathways appear to be more aggressive, early detection is crucial for definition of the natural history of these cancers. Objective. In our study we used both conventional chromoendoscopy with blue methylene and indigo carmine and electronic chromoscopy with the NBI (Olympus) system to identify nonpolypoid neoplastic colorectal lesions without magnification. All lesions were treated by endoscopic mucosal resection since this technique is safe and effective and allows the complete specimen to be saved for histopathological study. Design. We found 155 (12.6%) cases of nonpolypoid neoplastic colorectal lesions as defined by the Paris classification in a total of 1,234 colonoscopies performed between 2006 and 2010. All were removed through EMR in single sessions without complications.Limitations. There were two limitations: the study was carried out in only one medical center and the sample size was limited. Findings. The results suggest that endoscopy without magnification was useful and sensitive for identification of nonpolypoid lesions in the colon. It is important to note that a significant number of lesions were found in the right colon. Endoscopic mucosal resection is a safe, minimally invasive procedure that can be performed widely. In addition it allows the physician to obtain the complete specimen for histological study.
Subject(s)
Humans , Male , Adult , Female , Colorectal Neoplasms , Precancerous ConditionsABSTRACT
Introduction: Colorectal cancer is a rising disease worldwide. In Chile, it is the third leading cause of death associated to gastrointestinal cancer. Optimal preventive management requires surveillance of precursor lesions or early-stage tumors. Laterally spreading tumors (LST) are categorized as nonpolypoid colorectal neoplasms. Since there are no demographic data on these lesions in our country, the aim of our study was to describe the characteristics of LSTs based on our departments data. Methods: We reviewed the departments colonoscopy database from 1996 to 2006 to obtain clinical, endoscopic and histological data. We excluded patients with family history of polyposis, prior colorectal cancer and inflammatory bowel disease. Results: Out of 3713 colonoscopies performed, 364 (9.8 percent) adenoma cases were detected; 42 (1.2 percent) of them were catalogued as LSTs. Thirty-three LST patients had complete data and were included in the study. The gender proportion was similar between male and female. Ages ranged from 35 and 92 years (mean +/- SD 66.7 +/- 13.7). The tumor size ranged from 10 to 120 mm (mean +/- SD 28.2 +/- 28.3). According to distribution along the large bowel, 19 (57.5 percent) LSTs were located distally and 14 (42.5 percent) were proximal to the splenic flexure. Histology showed 26 adenomas (14 of them with high-grade dysplasia), 5 adenocarcinomas and 2 hyperplastic lesions. Conclusion: In Chile, LSTs are mainly found in the elderly. It is important to detect these lesions because most of them contain cancer or high-grade dysplasia. Therefore, during colonoscopy, we should focus not only on polypoid lesions, but also on flat lesions.
Introducción: El cáncer colorrectal es una enfermedad emergente a nivel mundial. En nuestro país es la tercera causa de muerte por cáncer del tubo digestivo. Un óptimo manejo preventivo implica la detección y tratamiento de las lesiones precursoras y los cánceres incipientes. Los tumores de expansión lateral (Laterally spreading tumors-LST) se consideran lesiones precursoras no polipoídeas. En Chile no existen datos demográficos de estas lesiones, por lo que el objetivo de este estudio es caracterizar los LST en nuestra población. Métodos: Revisamos la base de datos de las colonoscopias realizadas en nuestro Instituto desde 1996 al 2006, obteniendo datos clínicos y las características endoscópicas e histológicas. Excluimos los pacientes con historia de poliposis familiar, cáncer colorrectal y enfermedad inflamatoria intestinal. Resultados: De 3.713 colonoscopias, se detectaron 364 (9,8 por ciento) casos diagnosticados como adenoma, lesiones planas o LST, de los cuales 42 (1,2 por ciento) se catalogaron como LST. Sólo 33 pacientes con LST tenían disponible el estudio histológico. La proporción por género fue similar entre hombres (17) y mujeres (16). El rango de edad se distribuyó entre 35 y 92 años (promedio +/- DE 66,7 +/- 13,7); el tamaño tumoral fue de 10 a 120 mm (promedio +/- DE 28,2 +/- 28,3). De acuerdo a la distribución en el colon y recto, 19 (57,5 por ciento) LST se localizaron distales al ángulo esplénico y 14 (42,5 por ciento) proximales. El estudio histológico demostró 26 adenomas, 14 de los cuales presentaban displasia de alto grado, 5 adenocarcinomas y 2 lesiones hiperplásicas. Conclusión: En nuestra población los LST se presentan mayoritariamente en la tercera edad. Es importante la detección de estas lesiones, dado que en su mayoría contienen un cáncer o son adenomas con displasia de alto grado. Durante la colonoscopia no solamente debemos enfocarnos en los pólipos sino también en las lesiones planas.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Colonoscopy/statistics & numerical data , Colonic Neoplasms/epidemiology , Colonic Neoplasms/pathology , Adenoma/epidemiology , Adenoma/pathology , Chile , Age and Sex DistributionABSTRACT
Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited colon cancer-predisposing disorder, characterized by the development of innumerable adenomas in the large intestine. Polyps are present in the upper gastrointestinal tract in almost all FAP patients and there is a peculiar predilection for adenomatous change in the duodenum. Colonic adenomas in FAP are commonly observed as polyps but nonpolypoid adenomas can also be seen in the upper gastrointestinal tract. Careful endoscopic examination is needed for detecting such nonpolypoid lesions. At present, the adenoma-carcinoma sequence is thought to exist also in the duodenum, and malignancy of the duodenum represents one of the most common causes of mortality among patients with FAP. Therefore, careful periodic follow-up of upper intestinal endoscopies are recommended in patients with this disease, in consideration to the possible development of duodenal nonpolypoid adenomatous lesions. A case involving an experience of antral and duodenal nonpolypoid adenomas in a patient with FAP is herein reported.
Subject(s)
Humans , Adenoma , Adenomatous Polyposis Coli , Colon , Duodenum , Follow-Up Studies , Intestine, Large , Mortality , Polyps , Pyloric Antrum , Upper Gastrointestinal TractABSTRACT
PURPOSE: Growth patterns of colorectal carcinomas can be divided into polypoid growth (PG) and nonpolypoid growth (NPG). This study was intended to find characteristic clinicopathologic features and the expression status of p53, p21, and p16 with relation to growth patterns in colorectal carcinomas. METHODS: Sixty-one surgically resected colorectal carcinomas including 43 PG and 18 NPG carcinomas were reviewed in this study. Immunohistochemical stains for p53, p21, and p16 were done, and the results were analyzed with respect to growth patterns, and other prognosic parameters. RESULTS: PG carcinomas were significantly correlated with adenoma (p=0.0001), and with favorable histology group (p=0.04). On the contrary, NPG carcinomas were significantly correlated with unfavorable histology group (p=0.04). In NPG carcinomas, the frequency of positive expression of p53 was higher and the expression of p16 was lower than that of PG carcinomas. But there was no statistical significance (p=0.150, 0.210 respectively). The expression of p21 has no difference between NPG and PG carcinomas (p=0.953). CONCLUSIONS: As a result, it can be thought that the tendency of higher expression of p53 and lower expression of p16 in NPG carcinomas than in PG carcinomas may suggest more aggressive biologic behavior of NPG carcinomas.