Intestinal polyps refer to bulging lesions on the surface of the rectal mucosa protruding into the intestinal lumen, including adenomas (among them, villous adenomas), childhood-type polyps, inflammatory polyps and polyposis. Pathologically, their content varies from benign tumors to the consequences of inflammatory hyperplasia. However, the name “polyp” has been customarily used because of its general similarity to the naked eye. The rectum is a common site for polyps and is valued for its ease of detection and management.
Classification
1, juvenile polyps: about 90% occur in children under 10 years of age, boys are more common. They are round or ovoid in appearance, with smooth surface. 90% grow within 25 cm from the anus, most of them are less than 1 cm in diameter, most of them have tips, about 25% are multiple, histologically they are well differentiated and irregularly sized glands, some of them form cystic expansion, store mucus, interstitial hyperplasia, and have more inflammatory cell infiltration, and sometimes ulcers are formed on the surface. Sub-type polyps generally do not occur malignant change.
2, proliferative polyps: proliferative polyps are the most common type of polyps, also known as saprophytic polyps. The distribution of the distal colon is more, generally smaller, rarely more than 1 cm in diameter, the shape of the mucosal surface of a small drop-like projection, smooth surface, wider base, multiple is also common, the histology of the last polyp is formed by the enlarged and regular glands.
The epithelial cells of the gland are increased resulting in a jagged skin wrinkling, the nuclei are regularly arranged, their size and chromatin content vary very little, and the nuclear division phase is rare. The important feature is the presence of mature cells in both the middle and lower segments of the intestinal glandular crypts. Hyperplastic polyps do not undergo malignant transformation.
3, lymphoid polyps: lymphoid polyps, also known as benign lymphomas, are mostly found in adults aged 20-40 years, but also in children, slightly more in men, mostly in the rectum, especially the lower rectum, most of them are solitary, but also multiple, varying in size, from a few millimeters to 2-5 cm in diameter. The surface is smooth or lobulated or with superficial ulcer formation. Most of them are non-tipped, and when tipped, they are also short and thick. Histologically, they appear as well-differentiated lymphoid follicular tissue confined to the submucosa and covered by normal mucosa.
The center of the growth can be seen, often enlarged, with nuclear schizophrenia, but there is no nuclear schizophrenia in the surrounding lymphocytes, and the proliferating follicles are clearly demarcated from the surrounding tissue. Lymphatic polyps are not carcinogenic. Less common is benign lymphoid polyposis. It manifests as a large number of lymphatic polyps. They are small, spherical polyps of 5-6 cm in size and most often develop in children. Histological changes are the same as lymphatic polyps.
4, inflammatory polyps: inflammatory polyps, also known as pseudopolyposis, is a long-term chronic inflammation of the intestinal mucosa caused by polypoid granulomas, such polyps are mostly seen in ulcerative colitis, chronic schistosomiasis, amebic dysentery and intestinal tuberculosis and other diseases of the lesion intestine. They are often multiple, mostly small, often less than 1 cm in diameter, and can increase in size in those with longer disease duration. The shape is mostly narrow, long, with a broad tip and distal irregularity. Sometimes they are bridge-shaped, with the ends attached to the mucosa and the middle part free. Histological manifestation is fibrous granulation tissue, epithelial components can also be mesenchymal-like changes, is not certain.
5.Adenoma: Colonic adenoma is a benign epithelial tumor of the large intestine. According to the histological structure, there are three types of adenomas, namely tubular adenoma, villous adenoma and mixed adenoma.
(1) Tubular adenoma: It is a round or oval polyp with smooth or lobed surface, varying in size, but most of them are less than 1 cm in diameter. 80% have a tip. Histologically, they appear as mostly tubular glands with immature cells distributed at all levels of the gland. There may be varying degrees of mesenchymal changes and sometimes a small amount of papillary hyperplasia. The carcinoma rate is around 1-5%.
(2) Choroidal adenoma: It is less common than tubular adenoma, and most of them are solitary. Most of them are broad-based, and about 10-20% of them can have a tip. The surface is dark red, rough, or in the form of villi-like protrusions or small nodules, soft and friable, movable when touched, and if hard nodules or fixed when touched, it indicates the possibility of cancer.
The distribution is most frequent in the rectum, followed by the sigmoid colon. Histologically, the epithelium grows in a papillary pattern, and the center is vascular connective tissue interstitial, which also grows together with the epithelium, and the epithelial cells grow in a papillary pattern. Its cancer rate is 10 times greater than that of tubular adenoma.
(3) Mixed adenoma: It is an adenoma with both of the above structures. Its cancer rate is between tubular adenoma and villous adenoma.
6.Familial colonic polyp
Familial colon polyps with blood in stool belongs to adenomatous polyp syndrome, is an autosomal dominant disease, occasionally seen in people without family history, the whole colon and rectum can have multiple adenomas, most adenomas have a tip, papillary is less common, the number of polyps from about 100 to thousands, from the size of a soybean to several centimeters in diameter, often densely arranged, sometimes in bunches, its tissue structure is no different from the general adenoma.
Treatment.
1.Single polyp can be resected and examined at the same time.
2, multiple polyps or polyps with signs of malignancy can be pathological biopsy by anal anoscopy to exclude malignant changes.
3.Low or long-tipped prolapsed polyps can be removed by anal speculum, rectoscopy, ligation or direct excision through the anus.
4.Wide based or multiple polyps can be excised through the abdomen, perineum, sacrococcygeal part of the intestinal wall.
5, high polyps feasible fiber colonoscopy high-frequency electrosurgery.
6, polyps with cancer should be radical resection according to the tumor.
Familial colon polyps treatment.
What are the treatment methods for familial colon polyp disease, today we will talk specifically about the specific methods of familial colon polyps.
1, simple colon or colon polyp-based, feasible total colectomy, ileal abdominal fistula or ileal storage pouch forming rectal anastomosis, regular follow-up, check the mucosal condition of the rectal stump.
2.Total colectomy with rectal mucosal debridement, ileal pouch formation and rectal intrasheath anal anastomosis.
3.With total gastrointestinal polyps that cannot be cured, partial bowel resection can be performed when complications such as intussusception and hemorrhage occur.
4.Allopathic support therapy.
5.Chinese herbal medicine internal and external treatment enema.
6.For those who cannot be operated, gentamicin, methotrexate, general hemostatic drugs, vitamins and Chinese herbal medicine can be used for oral and enema treatment.