1. 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

2. 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

3. Colorectal polyps and corresponding polyposis syndromes HystologysolitaryMultiple (polyposis Syndrome) I nflammatory I nflammatory, lymphoid Hyperplastic (metaplastic) Hyperplastic Serrated adenoma Hyperplastic polyposis Serrated adenomatous polyposis Hamartomaj uvenileJuvenile polyposis, Peutz-jeghers syndrome, Cronkhite-Canada syndrome, Cowden's disease, Ruvalcaba- Myhre-Smith syndrome Adenoma (benign)AdenomaFamilial 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

4. 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 colon  meniscus  ring shadow) –Density increased comparison to adjacent mucosa

5. 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.

6. Inflammatory Polyps Produced by re-epithelialisastion ulseration colon (common follow ulcerative colitis) Dramatic in appearance Only mucosal tag No malignant risk Can be so numerous  colonic obstruction Filliform

7. Filiform polyposis Fig. 21.1 Barium enema reveals two patches of filiform polyposis at the hepatic flexure in a patient with known Crohn's disease.

8. Adenomas Benigna neoplasm Dysplastic Potentially pre malignant –Size –Dysplasia Predictor –Villlocity

9. 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

10. Adenomas......cont Fig. 21.3 A sigmoid villous adenoma, evidenced by a fine carpeting of frond-like projections.

11. 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

12. Resume Colorectal polyps Classification –Solitary –Polyposis Hyperplastic polyps (Filiform polyposis) Adenomas

13. 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