Evaluation of histopathologic structures of colonic polyps

Abstract

Aim: Colon polyps generally represent the bulge from the colon mucosa towards the lumen. Mostly it does not cause a complaint, and when a large majority is benign, some have been found to be associated with cancer development. For this reason, removal and pathological diagnosis is recommended when they are detected. We aimed to reveal the results of histopathology of the polyps detected in the colonoscopy result in our clinic. Materials and Methods: The aim of our study was to evaluate the colonoscopic and histopathological findings of the patients who underwent colonoscopy and polypectomy after polyp detection in Saglik Bilimleri University, Haseki Health Application Research Center, Gastroenterology Clinic in the last year. Patients who admitted to our clinic between the dates of January 01st, 2016 and December 31st, 2015 were included in the study. Results: According to colonoscopy reports, a total of 320 colonoscopies were performed and 125 polyps were detected in the patient (39%). 49 patients were excluded from the study. Twenty-nine of the 54 patients (53.7%) were male and 25 (46.3%) were female. The mean number of polyps in the patients was 1.44 ± 0.69. Mostly polyps were seen in the ascending colon (28,2%). Tuberculous adenoma in 42 (53.8%), hyperplastic polyp in (17.9%), normal epithelium in 9 (11.5%), tubulovillous adenoma in 5 (3.8%) were inflamed polyp, one was serrated (1.3%) and the other was 4 (5.1%). 42% of the polyps of patients with single polyp were in the rectosigmoid region, while those with multiple polyp were 21% (p = 0.054). Malignant potential was found in 47% of polyps of patients with single polyp, which was 73% in those with multiple polyps and higher in malignancy potential with multiple polyp (p = 0.016). Dysplasia was present in 46.7% of the dimunitive polyps, whereas this proportion increased to 55.6% in the non-diminutive polyps (p = 0.508). Conclusion: Our study was retrospective and performed with relatively a few sample group. Therefore, a randomized prospective and retrospective studies involving a greater number of patients would be appropriate to obtain more accurate results that would affect current clinical practice in selected cases (28.2%). Tuberculous adenoma in 42 (53.8%), hyperplastic polyp in 14 (17.9%), normal epithelium in 9 (11.5%), tubulovillous adenoma in 5 (3,8%) were inflammatory polyps, one (1,3%) serrated and 4 (5,1%) were other

Keywords

• polyp
• polypectomy
• Histopathologic Distribution
• Colonoscopy
• Retrospective Analysis

Kolon poliplerinin histopatolojik dağılımları

Öz

Giriş ve Amaç: Kolon polipleri, çoğunlukla bir yakınmaya sebep olmayıp genellikle benign özellik gösterirken bazı polipler kanser gelişimiyle ilişkili görülmüştür. Bu nedenle tespit edildiklerinde çıkartılması ve patolojik tanısının konması önerilmektedir. Çalışmamızda kliniğimizde yapılan kolonoskopi sonucu saptanan poliplerin histopatolojik sonuçlarını ortaya koymayı amaçladık. Gereç ve Yöntem: Çalışmamızda Sağlık Bilimleri Üniversitesi, Haseki Sağlık Uygulama Araştırma Merkezi Gastroenteroloji Kliniği’nde 1 Ocak 2016 ve 31 Aralık 2016 tarihleri arasında kolonoskopi yapılan, polip tespit edilen ve polipektomi gerçekleştirilen hastalar incelendi. Hastaların kolonoskopik ve histopatolojik bulguları retrospektif olarak gözden geçirildi. Bulgular: Toplam 320 kolonoskopi yapılan hastanın 125 inde polip tespit edildi (%39). Dışlama kriterleri sebebiyle 49 hasta çalışmaya alınmadı. Çalışmaya alınan toplam 54 hastanın 29’u (%53,7) erkek ve 25’i (%46,3) kadındı. Hastaların ortalama yaşı 58,4±12,1 yıl olarak görüldü.. Hastaların ortalama polip sayısı 1,44±0,69 olarak izlendi. Çoğunlukla polipler çıkan kolonda görüldü. (%28,2). Poliplerin 42’si (%53,8) tubuler adenom, 14’ü (%17,9) hiperplastik polip, 9’u (%11,5) normal epitel, 5’i (%6,4) tubulovillöz adenom, 3’ü (%3,8) inflamatuvar polip, biri (%1,3) serrated ve 4’ü (%5,1) diğer idi. Sonuç: Bu çalışmada endoskopi ünitemizde çeşitli nedenlerle kolonoskopi yapılan hastalarımızdaki kolon poliplerinin prevalansı, lokalizasyonu ve histolojik sonuçları ortaya konmuştur. Ulaştığımız sonuçlar mevcut literatür ile kısmi uyumlu çıkmıştır.

Anahtar Kelimeler

• polip
• polipektomi
• histopatolojik dağılım
• kolonoskopi
• retrospektif analiz

Kaynakça

1. 1. Itzkowitz SH, Potack J. Colonic polyps and polyposis syndromes. In:Sleisenger MH, Fordtran JS. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philedeplhia. Saunders. 2006; 2713-36.
2. 2. T.C. Sağlık Bakanlığı, Sağlık İstatistikleri Yıllığı 2015. Bölüm 3: Morbidite; Cinsiyete Göre En Sık Görülen 10 Kanser Türünün İnsidansı. Sağlık Bakanlığı, Yayın No:1054. Ankara, 2016, ss. 35-36.
3. 3. Winawer SJ, Sherlock P. Best practice and research clinical gastroenterology. Colorectal cancer screening, 2007; vol. 21, 6: 1031—dünyada krk insidansı
4. 4. Chan AT, Giovannucci EL. Primary prevention of colorectal cancer. Gastroenterology 2010; 138:2029
5. 5. Wei EK, Giovannucci E, Wu K. Comparison of risk factors for colon and rectal cancer. Int J Cancer 2004; 108:433.
6. 6. Edwards BK, Ward E, Kohler BA. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 2010; 116:544.
7. 7. Burt RW, DiSario JA, Cannon-Albright L. Genetics of colon cancer: impact of inheritance on colon cancer risk. Annu Rev Med 1995; 46:371.
8. 8. Ben Q, An W, Jiang Y, et al. Body mass index increases risk for colorectal adenomas based on meta-analysis. Gastroenterology 2012; 142:762.

9. 9. Ökten A. (editör). Gastroenterohepatoloji. In: Beşışık F. Kolorektal Tümörler. 1 nci baskı. İstanbul: Nobel Tıp Kitabevi, 2001: 257-262.
10. 10. Bahçecioğlu İH, Güzel Z, Çelebi H, Karaoğlu A, Dönder E. 1990-1995 Yılları Arasında Kliniğimizde Yapılan Rektoskopi ve Kolonoskopi Sonuçlarının Değerlendirilmesi. Gastroenteroloji, 1996; 7 (1 Ek):107.
11. 11. Dolar ME, Gültekin M, Nak SG, ve ark. Kolonoskopik incelemenin değerlendirilmesi. 9. Ulusal Türk Gastroenteroloji Kongresi. 1994, P: 410.
12. 12. İşler M, Koçer M, Bahçeci M, Özelsancak R, Aygündüz M. Tanısal Rektosigmoidoskopi Olgularımızın Değerlendirilmesi. XIV. Ulusal Gastroenteroloji Kongresi. 1998, P:125.
13. 13. Williams AR, Balasoorriya BAW, Day DW. Polyp and cancer of the largebovel: A necropsy study in Liverpool. Gut 1982; 23: 835-42.
14. 14. Vatn MH, Staisberg H. The prevalence of polyps of the large intestine inOsio: An autopsy study. Cancer 1982; 49: 819-25. EPAGE-II in the Spanish region of Catalonia BMC Fam Pract. 2015; 16: 154.
15. 15. Markowitz AJ, Winawer SJ. Management of colorectal polyps. CA Cancer J Clin 1997;47:93-112.
16. 16. Eminler, A. T., et al. "Colonoscopic polypectomy results of our gastroenterology unit." The Journal of Academic Gastroenterology 10.3 (2011): 112-115.
17. 17. Dölek Y, Yuyucu Karabulut Y, Topal F, Kurşun N. Evaluation of gastrointestinal polyps according to their size, localization and histopathologic types. Endoscopy Gastrointestinal 2013;21:31-5.
18. 18. Heitman SJ, Ronksley PE, Hilsden RJ, et al. Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009;7:1272-8.
19. 19. Coşkun A , Kandemi̇r A . Kolonoskopik polipektomi sonuçlarımızın analizi. Endoskopi Gastrointestinal. 2017; 25(3): 66-69.