GI POLYPS

types of polyps.
1)inflamatory 2)hyperplastic 3)hamartomatous 4)neoplastic
1)inflamatory lo ulcerative colitis, segmantal colitis, chrons, diverticulitis and dysenteric colitis
3)hamartomatous polyps is imp ra. they asked many times which of the folloing is not
hamartomatous polyp
hamartomatous polyps are peutz jehher syndrome, juvenile polyp and chronchite canada syndrome


Neoplastic polyps are adenomatous polyps and carcinomatp[us polyps
yes.

i will explain hemartomatous polyps first.
1)juvenile polyps
these are never malignant ra.
(very very imp point)
commoest polyp in colorectum of infants and children
Now, juvenile polyp vs juvenile polyposis syndrome

juvenile polyposis syndrome lo juvenile word has nothing to do with age. here juvenile means the size of
the polyp is small

and juvenie polyposis syndrome will lead to adenocarcinoma later but juvenile polyp will never turn
malignant
now this is the question in aiims 2007 papaer All of the following are premalignant except
1
-juvenile polyposis syndrome, juvenile polyps, peutz jehger, FAP

one is premalignant, other is not
Now peutz jegher syndrome
polyps here are common in small intestine(jejunum) but colon polyps also can occur rarely

here melanosis is seen in oral mucosa, lips digits.

in peutz jehger syndrome which is not present
pigmentation of oral mucosa, pigmentation of lips, pigmentation of digits, pigmentation of tongue.

tongue is never pigmented

peutz jehger chusinava?

now chronkite canada syndrome:
here polyps are seen in stomach, duodenum and colorectum.
mcq: in chronkite canada sundrome, polyps are absent in --stomach, esophagus colon, duodenum (all
india)
it occurs in females, its premalignant.
cachexia,alopecia, onychodystrophy, diarrhoea and pigmentation
ONYCHODYSTROPHY
Hamartomatpus polyps are over

now adenoma of colon:
adenomas of colon are 3types

tubular, villous and tubulovillous
tubular is most common.
villous has poor prognosis
malignant potentia untadhi and is determined by 4factors
size, sessile,villous archetecture,dysplasia

now features:

sessile are malignant
as they can metastasise

chronic bleeding, anemia etc etc untai telisindhe.
prolapse is common in tubular type.
diarrhoea common in villous type.
tubuar lo tube bayitiki osthadhi.
diarrhoea indicates bad prognosis.
(villous)
diarrhoea is bad

diarhea die arhea
bad

hypokalemia is the electrolyte abnormality
Inv:colonoscopy biopsy

obvious potasium loss
RAAS also

Rx colonoscopic polypectomy, sigmoidoscopic diathermy/excision, peranal polypectomy, open abd
colostomy nd polypectomy(if big)
total colectomy/ segmental resection if many

Now FAP.

FAP:
Aut dominant, chromosome 5
YOUNGER AGE.
(if there is no adenoma at 30years, then it is never FAP)

apc

FAP has high malignant potential., multiple polyps (>100) - mcq
screening of FAP:
screen all family members

PJS chromosme 19

pigment spots in retina(CHIRPES)
NA tests

STk11 gene

DNA
FAP chusinava points.

(>100 polyps)
Rx of FAP:

<30 years is key

Proctocolectomy with ileoanal anastomosis with ileal pouch
this procedure is done in 2conditions.
1)FAP 2) UC

now associations of FAP (very imp)

associated with 1)duodenal/ampullary carcinoma 2)Gardners syndrome 3)Turcot syndrome 4)Bone
sarcoma
deenni koncham change chesi mcq laaga ivochu

now a few points about gardners suyndrome.
ass with MEN 2b
abd desmoid tumors
Bone osteomas
Epidermoid cysts
Cong hypertrophy of pigment layer or retina***
ivanni gardners syndrome points


turcots
Turcots is the only polyposis condition which is autosomal recessive (as per srb)
colon polyps +braintumors like medullobastoma and gliomas


So gardners syndrome lo pigment layer hypertrophy is imp ra.

cong hypertrophy of retina is gardners then

and due to this there are pigment spots in retina. w
thats the reason ,, in screening of FAP, CHIRPES is done (pigment spots in retina
along with DNA tests
as gardners is ass with FAP

ok so imp things to remember are FAP associations.
they are gardners, turcots, Duodenal and ampulary carcinoma, bone sarcoma
Gardners features: men2b, abd desmoid, bone osteomas, epidermoid cysts cong retina pigment
hypertrophy

cowden syndrome:
also called multiple hemartoma-neoplasia syndrome)

i remembered it has a cow with a large head, whose age is 20 but will tell it as 10yrs, it has thyroid and
breast carcinoma but no GI malignancy
but has GI polyps.
AD,
Macrocephaly
pnetrance at age 20, pTEN supressor gene
GI polyps but no carcinoma
thyroid carcinoma
breast ancer


so till now we got 2 conditions with no GI malignancy potential

juvenilapolyp

now Bannayan - riley-ruvalacaba syndrome

GI HAMARTOMATOUS polyp

strange neme
see features. imagine a person with these features.
veelaithe draw a person like this.
macrocephaly. mental retardation.
hashimotothyroiditis
Hyperpigmented penile skin
NO risk og GI malignancy but hamartomatous polyps seen.

macro is also seen in
alexander?

So 3conditions with no GI malignancy
cowdens, juvenile polyp and this one

so ipudu nenu konni case scenarios cheptha ra. tell me diagnosis and any other points you remember.


females with GI malignancy, polyps in stomach, duodenum colon and onychodystrophy
ok another point. hamartomatopus polys

FAP

chronkite canada syndrome

stomach is unique here
onychodystrophy also

and no polyps in esophagus
autosomal recessive with GI polyps + FAp association
+brain gliomas


proctocolectomy with ileoanal anastomosis with ileal pouch is a surgical option for?


FAP?
.
ok 4 unnai ra.
1)juvenile polyp
2)peutz jehger
3)chronkite canada synd
4)bunnayan reiley etc etc syndrome


so juvenile polyp and that bunnayan are not premalignant. in these
also cowdens is not GI premalignant
but causes thyroid nd breast malignancy
thyroid disease ass with bunnayan etc etc syndrome
hashimoto.