A 42-year-old man has had bouts of intermittent crampy

Discussion in 'MRCS Forum' started by Heena., Apr 1, 2008.

  1. Heena.

    Heena. Guest

    A 42-year-old man has had bouts of intermittent crampy abdominal pain and diarrhea. Colonoscopy is performed. You must discuss the problem with the patient. Which of the following colonic pathologies is thought to have no malignant potential?
    a- Ulcerative colitis
    b- Villous adenomas
    c- Familial polyposis
    d- Peutz-Jeghers syndrome
    e- Crohn’s colitis
  2. Heena.

    Heena. Guest

    Answer: d. (Zinner, 10/e, pp 1286-1300) Cancer of the colon in patients with chronic ulcerative colitis is 10 times more frequent than in the general population. Duration of disease is very important; the risk of developing cancer is low in the first 10 years but thereafter rises about 4% per year. The average age of cancer development in patients with chronic ulcerative colitis is 37 years; idiopathic carcinoma of the colon, however, develops at an average age of 65 years. Crohn’s colitis is currently felt to be a precancerous condition as well. The chance of development of carcinoma of the colon in patients with familial polyposis is essentially 100%. Treatment of the patient with familial polyposis generally consists of subtotal colectomy with ileoprostomy and regular Proctoscopic examination of the rectal stump. Villous adenomas have been demonstrated to contain malignant portions in about one-third of affected persons and invasive malignancy in another one-third of removed specimens. Anterior resection is performed for large lesions or those containing invasive carcinomas when the lesion is above the peritoneal reflection. Abdominoperineal resection is indicated for low-lying rectal villous adenomas when they have demonstrated invasive carcinomas. Transrectal excision with regular follow-up examinations is sufficient for lesions without invasive carcinomas. Peutz-Jeghers syndrome is characterized by intestinal polyposis and melanin spots of the oral mucosa. Unlike the adenomatous polyps seen in familial polyposis, the lesions in this condition are hematomas, which have no malignant potential.

Share This Page