Lipomas of the large intestine

The incidence of lipomas of the colon is difficult to evaluate due to lack of symptoms. They are often discovered by chance during endoscopic or radiological examination and sometimes display only obstructive symptoms. A barium enema may be useful for the preoperative diagnosis of lipoma of the colon. The difficulty of obtaining a clear preoperative diagnosis influences the type of surgical treatment undertaken. Thus, a resection is often preferred to the simple removal of the lipoma by colotomy or endoscopy.     

Nature of juvenile polyps in the large intestine

Forty-five juvenile polyps were found among approximately 390 mucosal polyps of the large intestine. Various degrees of epithelial pseudostratification were found among juvenile polyps and the larger-sized polyps of both juvenile type and adult one tended to have a more advanced degree of epithelial pseudostratification. The glands of both juvenile polyps and adult ones revealed a closely resembled or almost identical pattern of size-distribution-pattern of the glandular size in both normal mucosae and hyperplastic mucosae of long-standing ulcerative colitis. Transition of juvenile polyps into adult ones was suggested by the cases with increase in numbers of glands and their orifices to the surface of the polyp and there were some polyps showing an intermediate form between juvenile polyps and adult ones. On the basis of histologic characteristics and age incidence of the patients, it may be said that a juvenile polyp is an immature variant of an adult polyp.     

Neoplasms of the large intestine in elderly patients

The aim of the study was to compare 2 groups of patients with colorectal cancer treated between 1985-1995. The analysed group consisted of 228 patients aged over 70. Reference group consisted of 330 younger ones. The stage of colorectal cancer (Dukes classification) was similar in both groups. Complications of the colorectal cancer often occurred in the elderly patients (21.9% vs. 10%, respectively). The incidence of associated diseases was also higher (70.6% vs. 59.1%). Operability was similar in both groups (93% vs. 98.8%) but resectability was lower in the elderly group (67.4% vs. 80.1%, respectively). Postoperative complications were observed in the similar percent of cases except those aged over 70 (17.5% vs. 4.9%), especially after emergency operations (31.6% vs. 4.7%, respectively).     

Growth rate of malignant tumors of the large intestine

The rates of colonic tumor growth were studied on the basis of evaluation of the case histories of 19 cancer patients in whom dynamic endocolonoscopy had been carried out. In some cases, malignant tumors appeared in the colon within 12 months after previous colonoscopy. Tumors were under 2.0 cm in size and were not accompanied by any clinical symptoms. Repeated endoscopic examinations performed within a period of 1-3 years detected large tumors which caused the constriction of colonic lumen. Clinical symptoms developed in such patients approximately 1-4 months prior to tumor detection. It is concluded that although the rates of growth of colonic malignancies are rather high, tumorigenesis is preceded by a long-term stage of preclinical disease.     

Surgical treatment of villous tumors of the large intestine

During a period of 10 years 487 patients were under observation, in whom 528 glandular-villous and villous tumors of the rectum and colon were recognized. Malignancy was 11-12% in the colon and 26.3% in the rectum. Endoscopic removal of villous tumors was conducted in 78.9%, transanal excision in 6.5%, and resection of segments of the large intestine in 13.7% of patients. Large villous tumors of the large intestine must be managed by operations of a more radical character.     

Neoplastic polyp of the large intestine and polyposis (tubular adenoma and tubulovillous adenoma)

In a retrospective analytical study the authors evaluated in 86 patients, mean age 69 years (range 55-85 years), with a newly diagnosed untreated prostate carcinoma the sensitivity, specificity, positive and negative predictive value of specific prostatic antigen (PSA), acid phosphatase (AP), alkaline phosphatase (AP') and pain in relation to possible affection of bones by secondaries. The authors found a highly negative predictive value for assessment of bone metastases when PSA values were lower than 10 ng/ml (96%), at levels under 20 ng/ml (94%) and a highly positive predictive value at levels higher than 50 ng/ml (97%). When AP and AP' are negative and there is no pain the occurrence of secondaries is of low probability. These results make it possible to differentiate some patients where scintigraphy of the skeleton is not inevitable. This procedure can be applied above all in patients where radical prostatectomy is not indicated.     

Flat cancers do develop in the polyp-free large intestine

PURPOSE AND BACKGROUND: Qualitative and quantitative analysis of many flat early cancers that have been discovered during the last decade led us to recognize that a flat route of cancer development de novo is as important a route as the polypoid one. We aim to prove through a longitudinal study that these flat early cancers indeed develop in flat mucosa and not in an adenomatous polyp. METHODS: From January 1, 1990, to July 31, 1994, 554 patients underwent at least two colonoscopies. These patients consisted of 364 males, and average age was 59 years. We searched for flat early cancers developing in polyp-free colorectal mucosa on or after a second colonoscopy. Polyp-free mucosa here means an intestinal segment proved to possess no adenomatous polyp during the preceding colonoscopies, irrespective of the presence of polyps elsewhere. RESULTS: Four flat early cancers were found developing in polyp-free colonic mucosa in four patients. Average age of the patients was 67 years. Locations of the cancers were the transverse (3) and descending colons (1). The shapes were all depressed, and average size of the lesions was 11 mm. Two lesions were endoscopically resected, and two by surgery. CONCLUSION: These four depressed cancers developing in polyp-free mucosa show that flat early colorectal cancers do arise de novo and not from an adenomatous polyp having collapsed on itself.