Download PDF
Endoscopy 2002; 34(3): 226-236
DOI: 10.1055/s-2002-20296
Review

© Georg Thieme Verlag Stuttgart · New York

Classification of Colorectal Polyps: Guidelines for the Endoscopist

C.  A.  Rubio 1 , E.  Jaramillo 2 , A.  Lindblom 3 , F.  Fogt 4
  • 1Gastrointestinal and Liver Pathology Research Laboratory, Department of Pathology, Karolinska Institute and Hospital, Stockholm, Sweden
  • 2Division of Gastroenterology and Hepatology, Karolinska Institute and Hospital, Stockholm, Sweden
  • 3Department of Molecular Medicine and Clinical Genetics, Karolinska Institute and Hospital, Stockholm, Sweden
  • 4Presbyterian Medical Center, University of Pennsylvania, Philadelphia, USA
Further Information

Publication History

Publication Date:
22 February 2002 (online)

Also available at
    Permissions and Reprints

Introduction

Polyp is a Greek word used to denote a protruding excrescence linked to a mucous membrane by a pedicle. Today we know that the pedicle evolves as a result of peristaltic activity which projects forward a protruding polyp of substantial size growing on loose submucosal tissue. On the basis of clinical data, colorectal polyps are classified as sporadic or hereditary. Sporadic colorectal polyps evolve after environmental insults of long duration. Consequently they are age-related and often seen in older patients. Polyps generated as a result of a genetic predisposition, are often found in younger patients.

References

  • 1 Muto T, Kamiya J, Sawada T. et al . Small “flat adenoma” of the large bowel with special reference to its clinicopathologic features.  Dis Colon Rectum. 1985;  28 847-851
    CrossrefPubMedGoogle Scholar
  • 2 Watanabe T, Sawada T, Kubota Y. et al . Malignant potential in flat elevations.  Dis Colon Rectum. 1993;  36 584-593
    PubMedGoogle Scholar
  • 3 Rubio C A. Non-protruding colorectal neoplasms: epidemiologic viewpoint.  World J Surg. 2000;  24 1098-1103
    CrossrefPubMedGoogle Scholar
  • 4 Kudo S, Kashida H, Tamura T. et al . Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer.  World J Surg. 2000;  24 1081-1090
    CrossrefPubMedGoogle Scholar
  • 5 Kudo S, Rubio C A, Teixeira C R. et al . Pit pattern in colorectal neoplasia: endoscopic magnifying view.  Endoscopy. 2001;  33 367-373
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Mentzel D. De excrentiis verracosocristasis. Acta Med Berlin 1721; 9: 78. Cited by Bacon HE (ed) J Int Coll Surg 1957 28: 346-356
    Google Scholar
  • 7 Cripps W H. Two cases of disseminated polyps of the rectum.  Trans Pathol Soc London. 1882;  33 165-168
    PubMedGoogle Scholar
  • 8 Lockhart-Mummery J P, Dukes C. The precancerous changes in the rectum and colon.  Surg Gynecol Obstet. 1928;  46 591-596
    PubMedGoogle Scholar
  • 9 Swinton N W, Warren S. Polyps of the colon and rectum and their relationship to malignancy.  JAMA. 1939;  113 1927-1936
    PubMedGoogle Scholar
  • 10 Jackman R J, Mayo C W. The adenoma-carcinoma sequence in cancer of the colon.  Surg Gynecol Obstet. 1951;  93 327-330
    PubMedGoogle Scholar
  • 11 Morson C B. Precancerous lesions of the colon and rectum.  JAMA. 1962;  179 104-109
    PubMedGoogle Scholar
  • 12 Bartkova J, Thullberg M, Slezak P. et al . Genetic pathways in the evolution of morphologically distinct colorectal neoplasms.  Gastroenterology. 2001;  120 1680-1688
    PubMedGoogle Scholar
  • 13 Rubio C A, Befrits R. Colorectal adenocarcinoma in Crohn's disease. A retrospective histologic study.  Dis Colon Rectum. 1997;  40 1072-1078
    PubMedGoogle Scholar
  • 14 Jaramillo E, Watanabe M, Befrits R. et al . Small flat colorectal neoplasias in long&#-standing ulcerative colitis detected by high-resolution electronic video endoscopy.  Gastrointest Endosc. 1996;  44 15-22
    CrossrefPubMedGoogle Scholar
  • 15 Fogt F, Urbanski S J, Danders M E. et al . Distinction between dysplasia associated lesion or mass (DALM) and adenoma in patients with ulcerative colitis.  Hum Pathol. 2000;  31 288-291
    PubMedGoogle Scholar
  • 16 Fogt F, Vortmeyer A O, Goldman H. et al . Comparison of genetic alterations in colonic adenoma and ulcerative colitis-associated dysplasia and carcinoma.  Hum Pathol. 1998;  29 131-136
    CrossrefPubMedGoogle Scholar
  • 17 Rubio C A, Befrits R, Jaramillo E. et al . Villous and serrated adenomatous growth bordering carcinomas in inflammatory bowel disease.  Anticancer Res . 2000;  20 4761-4764
    PubMedGoogle Scholar
  • 18 Morson B, Pang L. Rectal biopsy as an aid to cancer control in ulcerative colitis.  Gut. 1967;  8 423-434
    CrossrefPubMedGoogle Scholar
  • 19 Muto T, Bussey H, Morson B C. The evolution of cancer of the colon and rectum.  Cancer. 1975;  36 2251-2270
    CrossrefPubMedGoogle Scholar
  • 20 Winawer S J, Fletcher R H, Miller L. et al . Colorectal cancer screening: clinical guidelines and rationale.  Gastroenterology. 1997;  112 594-642
    CrossrefPubMedGoogle Scholar
  • 21 Martínez M E, Sampliner R, Marshall J R. et al . Adenoma characteristics as risk factors for recurrence of advanced adenomas.  Gastroenterology. 2001;  120 1077-1083
    PubMedGoogle Scholar
  • 22 Rubio C A, Rodensjö M. p53 overexpression in flat serrated adenomas and flat tubular adenomas of the colorectal mucosa.  J Cancer Res Clin Oncol. 1995;  121 571-576
    CrossrefPubMedGoogle Scholar
  • 23 Kato Y, Yanagisawa A, Kubo K. et al . Histological diagnosis of serrated adenomas.  Stomach Intestine. 1998;  33 825-830
    PubMedGoogle Scholar
  • 24 Longacre T A, Fenoglio-Preiser C M. Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia.  Am J Surg Pathol. 1990;  14 524-537
    CrossrefPubMedGoogle Scholar
  • 25 Rubio C A, Rodensjö M. Flat serrated adenomas and flat tubular adenomas of the colorectal mucosa; differences in the pattern of cell proliferation.  Jpn J Cancer Res. 1995;  86 756-760
    PubMedGoogle Scholar
  • 26 Yashiro M, Carathers J, Laghi L. et al . Genetic pathways in the evolution of morphologically distinct colorectal neoplasms.  Cancer Res. 2001;  61 2676-2683
    PubMedGoogle Scholar
  • 27 Kudo S. Endoscopic mucosal resection of flat depressed types of early colorectal cancer.  Endoscopy. 1993;  25 455-461
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Hamilton S, Rubio C A, Vogelstein B. et al .Carcinoma of the colon and rectum. In: Hamilton SR, Aaltonen LA (eds) WHO Classification of Tumours. Pathology and Genetics. Tumours of the Digestive System. Lyon; IARC Press 2000: 105-119
    Google Scholar
  • 29 Hemminski A. The molecular basis and clinical aspects of Peutz-Jeghers syndrome.  Cell Mol Life Sci. 1999;  55 735-750
    CrossrefPubMedGoogle Scholar
  • 30 Giardiello F, Brensinger J, Tersmette A. et al . Very high risk of cancer in familial Peutz-Jeghers syndrome.  Gastroenterology. 2000;  119 1447-1453
    CrossrefPubMedGoogle Scholar
  • 31 Howe J R, Roth S, Ringhold J C. et al . Mutations in the SMADD4/DPC4 gene in juvenile polyposis.  Science. 1998;  280 1086-1088
    CrossrefPubMedGoogle Scholar
  • 32 Woodford-Richens K, Williamson J, Bevan S. et al . Allelic loss at SMAD4 in polyps from juvenile polyposis patients and use of fluorescence in situ hybridization to demonstrate clonal origin of the epithelium.  Cancer Res. 2000;  60 2477-2482
    PubMedGoogle Scholar
  • 33 Katayama Y, Kimura M, Konn M. Cronkhite-Canada syndrome associated with rectal cancer and adenomatous changes in colonic polyps.  Am J Surg Pathol. 1985;  9 65-71
    PubMedGoogle Scholar
  • 34 Jass J, lino H, Ruszliewics A. et al . Neoplastic progression occurs through mutator pathways in hyperplastic polyposis of the colorectum.  Gut. 2000;  47 43-49
    CrossrefPubMedGoogle Scholar
  • 35 Lynch H T, Rozen P, Schuelke G S. Hereditary colon cancer: Polyposis and non-polyposis variants.  Cancer J Clin. 1985;  35 95-114
    PubMedGoogle Scholar
  • 36 Lindgren G, Liljegren A, Rubio C. et al . Adenoma prevalence and cancer risk in familial non-polyposis colorectal cancer.  Gut. 2002;  50 228-234
    CrossrefPubMedGoogle Scholar
  • 37 Lindblom A. Different mechanisms in the tumorogenesis of proximal and distal colon cancers.  Curr Opin Oncol. 2001;  13 63-69
    CrossrefPubMedGoogle Scholar
  • 38 Vasen H F, Watson P, Mecklin J P. et al . New clinical criteria for hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) proposed by the International Collaborative group on HNPCC.  Gastroenterology. 1999;  116 1453-1456
    PubMedGoogle Scholar
  • 39 Tannegård P, Liu T, Nordenskjöld M, Lindblom A. Tumorogenesis in colorectal tumors from patients with hereditary non-polyposis colon cancer.  Hum Genetics. 1997;  101 51-55
    PubMedGoogle Scholar
  • 40 Bussey H J. Gastrointestinal polyposis syndromes. In: Anthony PP, MacSween SN (eds) Recent advances in gastrointestinal pathology. Edinburgh; Churchill Livingstone 1984: 169-177
    Google Scholar
  • 41 Abraham S C, Nobukawa B, Giardiello F M. et al . Fundic gland polyps in familial adenomatous polyposis: neoplasms with frequent somatic adenomatous polyposis coli gene alterations.  Am J Pathol. 2000;  157 747-754
    PubMedGoogle Scholar
  • 42 Lynch H T, Smyrk T, McGinn T. et al . Attenuated familial adenomatous polyposis (AFAP). A phenotypically and genotypically distinctive variant of FAP.  Cancer. 1995;  76 2427-2433
    CrossrefPubMedGoogle Scholar
  • 43 Lynch H, Smyrk T, Lanspa S. et al . Hereditary flat adenoma syndrome: a variant of familial adenomatous polyposis?.  Dis Colon Rectum. 1992 ;  35  411-421
    PubMedGoogle Scholar
  • 44 Warthin A. Heredity with reference to carcinoma: as shown by the study of the cases examined in the pathological laboratory of the University of Michigan, 1985 - 1913.  Arch Intern Med. 1913;  12 546-555
    PubMedGoogle Scholar
  • 45 Hauser J, Weller C. A further report on the cancer family of Warthin.  Am J Cancer. 1936;  27 434-449
    PubMedGoogle Scholar
  • 46 Lynch H. Cancer family “G” revisited: 1895 - 1970.  Cancer. 1971;  27 1505-1511
    PubMedGoogle Scholar

C. A. Rubio, M.D., Ph.D.

Gastrointestinal and Liver Pathology Research Laboratory · Department of Pathology Karolinska Institute

17176 Stockholm · Sweden

Fax: + 46-8-51774524

Email: Carlos.Rubio@onkpat.ki.se

      >