Cases reported "Colonic Polyps"

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1/6. Laparoscopic colon resection with intraoperative polyp localisation with high resolution ultrasonography coupled with colour power Doppler.

    A 40-year-old woman with a 3 cm sigmoid polyp lesion who underwent a laparoscopic colon resection after intraoperative localisation of the lesion using laparoscopic ultrasonography coupled with colour power Doppler is described. She has successful intraoperative detection of the polyp followed by radical laparoscopic removal of the lesion. The advantage of using laparoscopic high resolution ultrasonography coupled with colour power Doppler to locate colonic polyp lesions during a laparoscopic colon resection is that intraoperative colonoscopy can be avoided. Intraoperative ultrasonography of the colon can accurately localise colonic polyp lesions that are not detectable during laparoscopy and represents a quick and effective alternative to other imaging techniques.
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2/6. Colocolic intussusception in a three-year-old child caused by a colonic polyp.

    Colocolic intussusception is an uncommon cause of pediatric intestinal obstruction in north america; 95% of cases are ileocolic in location, with an equal percentage in which no pathologic lead point is evident on barium enema or laparotomy. In the last 20 years less than 3% of approximately 32,500 reported cases of intussusception originated in the colon. In a significant number of these cases juvenile polyps were identified as leading points. The majority of juvenile polyps occur in the rectosigmoid colon within the reach of a standard pediatric sigmoidoscope. These tumors most often cause painless hematochezia. Occasionally, juvenile polyps may grow large and serve as lead points for colocolic intussusception when located in the proximal colon. Pediatric patients presenting with documented colocolic intussusception should suggest the possibility of a colonic polyp or other mass lesion. Careful physical examination and barium studies should provide important diagnostic clues. Treatment is aimed at removing the lead point in patients presenting with intestinal obstruction. Colonoscopic polypectomy performed by an experienced endoscopist may serve as an alternative to surgical removal of the polyp. We report a case in a three-old-child of colocolic intussusception caused by a colonic polyp, and review some of the salient features of this clinical entity.
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3/6. Early malignant lesions of the colorectum at autopsy.

    Examination of 1014 consecutive autopsies revealed four early malignant lesions, comprising: 1) a carcinoma in situ arising from a large (2.5 cm) pedunculated adenomatous polyp; 2) a carcinoma in situ arising from a small (0.8 cm) flat adenoma; 3) an early invasive carcinoma arising from a flat (2.5 cm) adenoma, and 4) an early invasive polypoid adenocarcinoma (0.7 cm) with no identifiable remnants of adenoma. The early malignant lesions encountered in this study reaffirm the importance of the adenoma-cancer sequence in the pathogenesis of colorectal cancers in man. The malignant potential of flat adenomas is emphasized. The occurrence of small carcinomas without evidence of adenomatous elements raises the possibility of de novo origin as an alternative pathway. In the present study, one of four early colorectal cancers may have a de novo origin.
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4/6. Total colectomy with mucosal protectomy and ileoanal anastomosis--an important surgical option in the aviator with premalignant disease of the colon.

    Total proctocolectomy with cutaneous ileostomy has been the standard therapy for many years for premalignant mucosal diseases of the colon, such as ulcerative colitis and familial polyposis. While this procedure relieves the patient of the risk of malignancy, it leaves him with the problem of the management of the ileostomy as well as exposing him to the risk of damage to the nerve supply of the bladder and genitalia during the dissection. Within the military population, the ileostomy is a particularly devastating problem as it disqualifies the individual from worldwide duty and requires him to meet a Medical Evaluation Board for discharge from the service. Over the last several years, total colectomy with mucosal proctectomy and ileoanal anastomosis (TCMPIA) has emerged as a viable surgical alternative in these conditions. The benefits of this procedure in the military population are multiple. It allows the individual to continue on active duty, fulfilling his desire to pursue his career as well as keeping the position filled for the military. The time and cost of a medical board are avoided, the military's investment in the individual's training is protected, and the need to train a new individual for the position is avoided.
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5/6. Mixed epithelial polyps in association with hereditary non-polyposis colorectal cancer providing an alternative pathway of cancer histogenesis.

    A member of a hereditary non-polyposis colorectal cancer (HNPCC) family developed two colorectal cancers and multiple polyps within four years of a negative colonoscopic examination. One of the cancers was only 4 mm in diameter and showed the gross and endoscopic appearances of a de novo carcinoma. Microscopic examination of multiple levels revealed a mixed hyperplastic polyp/adenoma (mixed polyp) in contiguity with the cancer. The colon harboured additional polyps of which five were tubular adenomas, seven were hyperplastic polyps and seven were mixed polyps (architecturally compatible with hyperplastic polyps but with atypical cytology). Atypical features of the mixed polyps included tripolar mitoses, bizarre chromatin aggregations and multinucleation. One mixed polyp showed dna microsatellite instability. Under the influence of the mutator defect, hyperplastic polyps may develop atypical or adenomatous features and show progression to carcinoma. Such an alternative morphogenetic pathway could explain the differing molecular and pathological profiles of cancers showing dna microsatellite instability.
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6/6. A case of pyoderma gangrenosum stabilized with lymecycline, topical benzoyl peroxide and treated by autograft.

    pyoderma gangrenosum is a chronic inflammatory ulcerative skin disease of unknown etiology, often associated with various systemic disorders such as inflammatory bowel disease, rheumatoid arthritis, chronic active hepatitis, diabetes mellitus and hematologic malignancies. The ulcers are characterized by their undermined violaceous borders. The disease remains a therapeutic challenge. Corticosteroids are the mainstay of therapy; however, side effects from this treatment and recalcitrant pyoderma gangrenosum require therapeutic alternatives. We report the case of a large subacute pyoderma gangrenosum stabilized with lymecycline, topical benzoyl peroxide and successfully treated by an autograft. This observation supports the opinion that the risk of pathergy of a graft can be avoided by the stabilization of the disease.
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