Localización y tamaño de los adenomas del colon como factores asociados a displasia de alto grado / Localization and size of colon adenomas as factors related to high grade dysplasia

Objetivo: Determinar si la localización y el tamaño de los adenomas de colon se asocian con la presencia de displasia de alto grado en los pacientes de un hospital peruano. Materiales y Métodos: Se realizó un estudio trasversal mediante la revisión de informes de colonoscopías de los años 2014-2015 del Hospital Nacional Daniel Alcides Carrión, incluyéndose los pólipos de pacientes mayores de 18 años; y excluyéndose los de pacientes con cáncer de colon, antecedente de cirugía oncológica, enfermedad inflamatoria intestinal y poliposis (6 o más). Se extrajeron los datos de localización (colon proximal y distal, división a partir del ángulo esplénico), tamaño (menos de 10 mm y 10 mm o más), forma (pediculados y sésiles) y grado de displasia (bajo y alto grado). Se calculó la fuerza de asociación mediante OR, se determinó si existía asociación a través de la prueba Chi cuadrado, con nivel de significancia menor a 0,05. Resultados: De un total de 1710 informes de colonoscopías revisadas, 378 personas tuvieron pólipos, calculando una tasa de detección de adenomas de 22,1%. De los 458 pólipos encontrados 254 fueron adenomas. Se demostró una asociación significativa entre la localización en colon distal y displasia de alto grado (OR 2,68 IC 1,12-6,42, p<0.05); asimismo, los adenomas mayores o iguales a 10 mm tuvieron más riesgo de displasia de alto grado (OR 7,75 IC 3,05-19,69, p<0.05). No se encontró asociación entre la forma de los adenomas y grado de displasia. Conclusión: Se concluye que el tamaño de 10 mm o más y la localización en colon distal se asocian a displasia de alto grado en los adenomas.

Objective: To determine whether localization and size are related to the presence of high-grade dysplasia of colon adenomas in patients of a Peruvian hospital. Materials and methods: This is a descriptive transversal study. We checked colonoscopy reports of 2014-2015 years of Hospital Daniel Alcides Carrion, we included the polyps found in patients older than 18 years old, and excluded reports from patients with colorectal cancer, an antecedent of oncological surgery, inflammatory bowel disease and polyposis (6 or more). We used data based on localization (proximal and distal colon, based on the splenic angle), size (less than 10 mm and 10 mm or more), shape (pediculate and sessile) and grade of dysplasia (low and high-grade). We calculated the strength of association by OR, and we determined whether there was association by Chi-square test with a significance value less than 0.05. Results: We reviewed a total of 1710 of colonoscopy reports, 378 patients had polyps, so the adenoma detection rate was 22.1%. There were 458 polyps, from which 254 were adenomas. From these adenomas, we found an association between distal colon localization and high-grade dysplasia (OR 2.68 IC 1.12-6.42, p<0.05); likewise, there was an association between the size of the adenomas and high-grade dysplasia (OR 7.75 IC 3.05-19.69, p<0.05). We did not find any association between the shape and grade of dysplasia. Conclusion: This study concludes that there is an association between the size of 10 mm or more and localization in the distal colon with high-grade dysplasia of adenomas.

Intestinal intussusception in adults: tomographic findings and report of two cases / Intestinal intussusception in adults: tomographic findings and report of two cases.

Intestinal intussusception is infrequent in adults. Unlike what happens in kids, it shows a demonstrable etiology in most cases: polyps, lipomas, hamartomas, malignancies, etc. Among diagnostic methods, CT scan is the study that yields the best results for the diagnosis, giving forth pathognomonic signs and favoring therapeutic decision-making. Two cases of intestinal intussusception in adults secondary to benign pathology are analyzed, stressing mainly the tomographic findings and some considerations about therapeutic decision-making based on tomographic results.

Non-familial juvenile polyposis with histological evidence of adenomatous transformation.

A 14-year-old male presented with abdominal pain, diarrhoea and a sensation of something prolapsing through the anus during defecation, and was found to have diffuse colonic polyposis. There was no evidence of mucocutaneous hyperpigmentation and family history was negative, suggesting a diagnosis of non-familial juvenile polyposis. Histological analysis of multiple endoscopic biopsies showed features typical of juvenile or retention type (hamartomatous) lesions: dilated cystic glands lined by mucocus-secreting epithelium and prominent, inflamed and congested lamina propria. However, admixed with these features, focal areas of atypical adenomatous changes were recognized. Even the intervening normal-looking colonic mucosa showed some dysplastic changes. These findings indicate that hamartomatous and atypical adenomatous epithelial changes can co exist in non-familial juvenile polyposis and the latter may confer a risk of malignant transformation in this otherwise non-neoplastic disease.

Multiple lymphomatous polyposis of the gastrointestinal tract

CONTEXTO: A polipose linfomatosa múltipla gastrintestinal é tipo raro de linfoma maligno de comportamento biológico agressivo, com disseminação sistêmica precoce e prognóstico sombrio. A polipose linfomatosa múltipla gastrintestinal é considerada manifestação do linfoma não-Hodgkin e representa a contraparte gastrintestinal do linfoma nodal das células do manto. OBJETIVO: O presente estudo descreve caso de polipose linfomatosa múltipla gastrintestinal e discute os aspectos anatomopatológicos, clínicos, diagnósticos e terapêuticos desta inusitada neoplasia. RELATO DE CASO: Homem de 59 anos, branco, apresentou-se ao nosso serviço com queixa de astenia, suores noturnos, alteração do hábito intestinal e emagrecimento há dois meses. O exame físico mostrou mucosa descorada e massa palpável no epigástrio e mesogástrio. A endoscopia digestiva alta revelou pólipos gástricos e duodenais. O enema opaco mostrou lesões polipóides múltiplas, principalmente no ceco. A biópsia retal revelou infiltração da mucosa e submucosa por linfoma difuso de células pequenas clivadas. O estudo imuno-histoquímico mostrou linfócitos que expressavam o anticorpo CD20 (L26) e imunoglobulina de cadeia leve kappa (k), porém não expressava imunoglobulina de cadeia leve lambda (l). O doente apresentou abdome agudo obstrutivo devido a massa mesentérica formada por linfonodos aglutinados ao redor do íleo proximal e obstruindo seu lúmen. O enfermo foi submetido a enterectomia segmentar e gastrotomia com biópsias excisionais das lesões polipóides gástricas. Após dois ciclos de quimioterapia, houve piora do estado geral, com aumento das dimensões das massas abdominais e sepse, acompanhada por insuficiência respiratória progressiva e óbito.

Cronkhite-Canada syndrome with adenomatous and carcinomatous transformation of colonic polyp.

We describe a 70-year-old woman who presented with watery diarrhea and was found to have gastric and colonic polyposis, cutaneous hyperpigmentation, alopecia and onychodystrophy (Cronkhite-Canada syndrome). Histology of a polyp from the stomach showed features of juvenile or retention type (hamartomatous) polyp. One colonic polyp revealed features of tubular adenoma, with moderate dysplasia. Another large pedunculated colonic polyp showed a tubulovillous adenoma with a focus of well-differentiated adenocarcinoma confined to the submucosa of the stalk. Adenomatous and carcinomatous epithelial changes can occur in Cronkhite-Canada syndrome.