Polyps

Question 1

Polyps classification:

Answer 1

1. Hamartomatous
2. Adenomatous
3. Inflammatory
4. Mixed polyposis syndrome

Question 2

Eg of hamartomatous polyps

Answer 2

1. Solitary Juvenile polyp
2. juvenile polyposis dyndrome
3. Peutz-Jeghers syndrome
4. Phosphatase and tensin homolog gene mutation (PTEN)
   a. Bannayan-Riley-Ruvalcaba syndrome
   b. Gorlin syndrome
   c. cowden syndrome

Question 3

Eg of adenomatous polyps

Answer 3

1. Familial adenomatous syndrome
2. Turcot syndrome
3. Gardner syndrome
4. Lynch syndrome
5. MYH-associated polyposis

Question 4

Solitary Juvenile polyp

Answer 4

painless rectal bleed
<5 in number
mean age 4, (2-6)
often rectosigmoid area
histo: dilated cysts filled with mucin, abundant lamina propria and inflammatory cells

Question 5

Juvenile polyposis dyndrome

Answer 5

> 5 polyps
genes: SMAD4, BMPR1A. ENG1

Risk of Ca: 68% by age of 60 yo

screen: all family members should be tested for the mutation

EGD/CS: at 10-15 yo e 2-3 yr
if polyp present, yearly until no polyps
then back to e 2-3 yr

Question 6

Peutz-Jeghers syndrome

Answer 6

AD, genes: STK11 (LKB1)

Dx:
1. 2 polyps with histology PJS
2. Any number polyp + family with PSJ
3. Mucocutanous pig. + family with PSJ
4. Any number polyp + mucocutanous pig.

Ca risk: colon, lungs, testes, breast, uterus, ovaries

Surveillance:
EGD/CS at 8 yo
if polyps seen –> e 3 yr
if no polyps –> start at 18 then e 3 yr
VCE at 8 yo then e 3 yr

Question 7

Familial adenomatous syndrome

Answer 7

AD, APC gene
EIM:
bone- osetomas, sclerosis
dental-unerupted, supernumery
connective tissue-desmoid tumor
eye-CHRPE
Ca-hepatoblastoma, thyroid, adenal and glioblastoma

Dx:
1. FHx + neg gene–> no f/u
2. FHx + known genotype –> at 10-14yo sigmoidoscopy e yr + CS e 5 yr
3. FH + unknown genotype –> at 10-14yosigmoidoscopy e yr + CS e 5 yr until rectal adenomas found. Then yearly EGD/CS

Question 8

Medical options for FAP

Answer 8

1. Sunlindac
2. NSAIDS
3. Vit C
   DNT replace surgery

Question 9

Polyps removal

Answer 9

5mm: biopsy forceps
>5mm: snare electrocautery
>2cm: piecemeal removal