Pathologically, they can be divided into.
1, adenomatous polyps: including tubular, villous, and tubular choroidal adenomas.
2, inflammatory polyps: including mucosal inflammatory hyperplasia, schistosomal ovarian, benign lymphoid polyps.
3.mismatous polyps: juvenile polyps, melanotic polyposis (Peutz-Jeghers).
4.Other: septic polyp and mucosal hypertrophic redundancy.
5.Multiple adenomas are called adenomatosis.
Disease classification
Intestinal polyp can occur in any part of the intestine, although it is a polyp visually and pathologically, but clinically diagnosed as a different disease. The prognosis and treatment of polyps of different nature are very different.
Clinically, polyps are divided into the following three categories: tumor polyps, non-tumor polyps, and intestinal polyposis.
1, tumor polyp.
Common sites: colon, rectum. They include tubular adenoma, villous adenoma, and tubular villous adenoma (mixed type adenoma). Among them, tubular adenomas are the most common, with incidence rates of 75% to 90%, 7% to 15%, and 5% to 10%, respectively. The cancer rate of broad-based adenoma is higher than that of tipped adenoma. The larger the adenoma, the greater the possibility of cancer, and the more villous components in the adenoma structure, the greater the possibility of cancer.
2.Non-neoplastic polyps.
(1) Juvenile polyps, common in young children, mostly under 10 years old, adults can also be seen. 60% occur in the rectum within 10 cm from the anus, are round and spherical, mostly solitary, pathologically characterized by retention cystic cavity of varying sizes, a kind of misshapen tumor.
(2) Inflammatory polyps.
Most often seen in ulcerative colitis, Crohn’s disease, schistosomiasis, intestinal tuberculosis intestinal ameba and other chronic inflammatory stimuli formed.
3) Intestinal polyposis.
In the intestinal tract widely appear more than 100 polyps, and has its own special clinical manifestations, called intestinal polyposis. The common ones are.
(1) Black spot polyposis ( Peutz-Jeghers)
It is a rare dominantly inherited disease characterized by multiple polyps in the gastrointestinal tract with melanin deposits on the oral mucosa, lips, perioral, perianal, and palms of both hands and soles of the feet. Small intestinal polyps predominate, and about 30% of patients have colon and rectal polyps. The nature of polyps is misshapen polyp.
(2) Familial adenomatous polyposis
It is an autosomal dominant disease, often appearing in the development of youth, colonic and rectal adenomas, and can even cover all the colonic and rectal mucosa, if not treated in time, cancer will eventually occur.
The disease sometimes presents with the following two syndromes.
a. Familial adenomatous polyposis with multiple osteomas and multiple soft tissue tumors (Gardner’s syndrome Gardner)
b. Familial adenomatous polyposis with malignant tumors of the central nervous system (Turcot syndrome)
These two syndromes, are not metastases of familial adenomatous polyposis. [1][2]
Clinical manifestations
1, Some patients with intestinal polyps and intestinal polyposis have no specific clinical manifestations and are often found unintentionally during colonoscopy or barium enema.
2.Some patients may have frequent stool, blood in stool, incomplete bowel movement, mucus stool, and a few have intestinal obstruction and perforation. Adenomatous polyps have the tendency to become cancerous, and carcinoma may occur in late stage.
3.Patients with familial and legacy polyps or polyposis should have family screening and follow-up.
4.Fiber colonoscopy, sampling and pathological diagnosis are especially important and are key factors to determine further treatment.
Disease treatment
The treatment plan is decided according to the site, nature, size, number, presence of complications and pathological nature of the polyps.
1, small polyps are removed by colonoscopy and sent for pathological examination.
2.Non-adenomatous polyps larger than 2 cm in diameter can be removed by colonoscopy in blocks. Adenomas larger than 2cm in diameter, especially villous adenomas, should be surgically removed: those below the peritoneal reflex should be locally removed through the anus, and those above the peritoneal reflex should be removed openly or under laparoscopy.
If adenoma penetrates the mucosal muscle layer or infiltrates the submucosa, it is invasive cancer and should be treated according to the principles of colorectal cancer treatment. If the adenoma malignant lesion does not penetrate the mucosal muscle layer, does not invade small blood vessels and lymph, has good differentiation and has no residue on the cutting edge, it is not necessary to perform surgery after removal, but should be closely observed.
4.Familial adenomatous polyposis may eventually become cancerous if left untreated, so it should be diagnosed and undergo radical surgery within adolescence as much as possible. The most thorough surgical procedure is resection of the middle and upper part of the colon and rectum, mucosal debridement of the lower part, and ileoanal anastomosis through the rectal muscle sheath.
5, the polyps of melanotic polyposis are multiple and scattered, multiple intestinal misshapen tumors of the stomach, generally not cancerous, and difficult to remove all. Asymptomatic can do follow-up observation, if symptoms feasible polypectomy or intestinal segment resection.
6, inflammatory polyps to treat the primary intestinal disease, inflammatory stimuli subsided, polyps can disappear on their own; proliferative polyps symptoms are not obvious, no special treatment.