presented by : dwi damar andriyani consultant : dr. edy moeljono, sp.rad (k)ra the large bowel...

Presented by : Dwi Damar Andriyani

Consultant : dr. Edy Moeljono, Sp.Rad (K)RA

THE LARGE BOWEL

COLORECTAL TUMOUR

(POLYPS)

BOOK READING DAVID SUTTON VOLUME 1 PAGE 637-647

Polyps

• Mucosal elevation• Some malignant potensials• Sporadically or part of polyposis syndrome• 50-65% : Adenomatous

10-30% : Metaplastic (hyperplastic)

10-30% : Inflamatory polyps

Another very rare : Hamarthoma, Lipoma

Colorectal polyps and corresponding polyposis syndromes

Hystology solitary Multiple (polyposis Syndrome)

I nflammatory I nflammatory I nflammatory, lymphoid

Hyperplastic (metaplastic)

HyperplasticSerrated adenoma

Hyperplastic polyposisSerrated adenomatous polyposis

Hamartoma j uvenile Juvenile polyposis, Peutz-jeghers syndrome, Cronkhite-Canada syndrome,Cowden's disease, Ruvalcaba-Myhre-Smith syndrome

Adenoma (benign) Adenoma Familial adenomatous polyposis

Adenoma (malignant) 'Malignant polyp' Familial adenomatous polyposis, Turcot's syndrome

Non-epithelial (benign) Lipoma, connective tissue(neuroma, fibroma, myoma)

Non-epithelial (malignant

Lymphoma, metastasis, stromal

Radiographyc Appearance

• Early lesion : Usually sessile• Double contrast barium:

– Barium-coated nodule projecting into lumen– Negative defect– Ring shadow

(Barium congregates in the angle polyps base with normal colonmeniscusring shadow)

– Density increased comparison to adjacent mucosa

Polyps

Fig. 21.7 A small polyp where the meniscal rim of barium between the polyp base and adjacent mucosa causes the 'bowler-hat' sign.

Inflammatory Polyps

• Produced by re-epithelialisastion ulseration colon (common follow ulcerative colitis)

• Dramatic in appearance• Only mucosal tag• No malignant risk• Can be so numerouscolonic obstruction• Filliform

Filiform polyposis

Fig. 21.1 Barium enema reveals two patches of filiform polyposis at thehepatic flexure in a patient with known Crohn's disease.

Adenomas

• Benigna neoplasm• Dysplastic• Potentially pre malignant

– Size– Dysplasia Predictor– Villlocity

Adenomas......cont

• Incidence increase with age• Classified

– Tubular– Tubulovillous– Villous

• Greatest malignant potential• Prospensity for rectosigmoid location• Characteristic

– Being broad based– Relatively large– Frond-like surface

Adenomas......cont

Fig. 21.3 A sigmoid villous adenoma, evidenced by a fine carpeting of frond-like projections.

Benigna or maligna?

• Can’t be done with its morphologhy

• Size : best predictor• (5-9) mm 0,9% malignant• (10-20)mm 5-10% malignant• >20 mm 10-50% malignant

Resume

Colorectal polyps• Classification

– Solitary– Polyposis

• Hyperplastic polyps (Filiform polyposis)• Adenomas

Quiz

• What kind of radiological examination that produce this picture?

• Please, describe this picture!

• What the most likely diagnosis for this picture?

Fig. 21.1 page 637

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