Presented by : Dwi Damar Andriyani Consultant : dr. Edy Moeljono, Sp.Rad (K)RA THE LARGE BOWEL...
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Transcript of Presented by : Dwi Damar Andriyani Consultant : dr. Edy Moeljono, Sp.Rad (K)RA THE LARGE BOWEL...
Presented by : Dwi Damar Andriyani
Consultant : dr. Edy Moeljono, Sp.Rad (K)RA
THE LARGE BOWEL
COLORECTAL TUMOUR
(POLYPS)
BOOK READING DAVID SUTTON VOLUME 1 PAGE 637-647
Polyps
• Mucosal elevation• Some malignant potensials• Sporadically or part of polyposis syndrome• 50-65% : Adenomatous
10-30% : Metaplastic (hyperplastic)
10-30% : Inflamatory polyps
Another very rare : Hamarthoma, Lipoma
Colorectal polyps and corresponding polyposis syndromes
Hystology solitary Multiple (polyposis Syndrome)
I nflammatory I nflammatory I nflammatory, lymphoid
Hyperplastic (metaplastic)
HyperplasticSerrated adenoma
Hyperplastic polyposisSerrated adenomatous polyposis
Hamartoma j uvenile Juvenile polyposis, Peutz-jeghers syndrome, Cronkhite-Canada syndrome,Cowden's disease, Ruvalcaba-Myhre-Smith syndrome
Adenoma (benign) Adenoma Familial adenomatous polyposis
Adenoma (malignant) 'Malignant polyp' Familial adenomatous polyposis, Turcot's syndrome
Non-epithelial (benign) Lipoma, connective tissue(neuroma, fibroma, myoma)
Non-epithelial (malignant
Lymphoma, metastasis, stromal
Radiographyc Appearance
• Early lesion : Usually sessile• Double contrast barium:
– Barium-coated nodule projecting into lumen– Negative defect– Ring shadow
(Barium congregates in the angle polyps base with normal colonmeniscusring shadow)
– Density increased comparison to adjacent mucosa
Polyps
Fig. 21.7 A small polyp where the meniscal rim of barium between the polyp base and adjacent mucosa causes the 'bowler-hat' sign.
Inflammatory Polyps
• Produced by re-epithelialisastion ulseration colon (common follow ulcerative colitis)
• Dramatic in appearance• Only mucosal tag• No malignant risk• Can be so numerouscolonic obstruction• Filliform
Filiform polyposis
Fig. 21.1 Barium enema reveals two patches of filiform polyposis at thehepatic flexure in a patient with known Crohn's disease.
Adenomas
• Benigna neoplasm• Dysplastic• Potentially pre malignant
– Size– Dysplasia Predictor– Villlocity
Adenomas......cont
• Incidence increase with age• Classified
– Tubular– Tubulovillous– Villous
• Greatest malignant potential• Prospensity for rectosigmoid location• Characteristic
– Being broad based– Relatively large– Frond-like surface
Adenomas......cont
Fig. 21.3 A sigmoid villous adenoma, evidenced by a fine carpeting of frond-like projections.
Benigna or maligna?
• Can’t be done with its morphologhy
• Size : best predictor• (5-9) mm 0,9% malignant• (10-20)mm 5-10% malignant• >20 mm 10-50% malignant
Resume
Colorectal polyps• Classification
– Solitary– Polyposis
• Hyperplastic polyps (Filiform polyposis)• Adenomas
Quiz
• What kind of radiological examination that produce this picture?
• Please, describe this picture!
• What the most likely diagnosis for this picture?
Fig. 21.1 page 637
Terimakasih