Abstract
Gastrointestinal polyp is a descriptive concept—observation of an elevated broad-based or stalked lesion which can be defined exactly only when examined histologically. Therefore, all polyps must, in principle, be snared or excised to achieve a final diagnosis. Nonneoplastic polyps or tumor-like lesions were formerly considered innocent findings with no malignant potential, while neoplastic adenomas with dysplasia are well-known premalignant lesions. This view of the totally harmless nature of nonneoplastic polyps is no longer true. At least the dominantly inherited juvenile polyposis and Peutz-Jeghers polyposis syndromes definitely have malignant potential through adenomatous change in the originally hamartomatous lesions. Consequently, juvenile polyposis is best treated with colectomy and ileorectal anastomosis, and repeated multiple polypectomies are now recommended in Peutz-Jeghers polyposis, in combination with laparotomy when feasible. In addition, hyperplastic gastric polyps may reflect an underlying atrophic gastritis implying increased risk of gastric carcinoid tumors and cancer. Furthermore, even colorectal hyperplastic polyps may undergo adenomatous change, and thus represent, theoretically, a reservoir from which adenomas arise.
Résumé
Le polype gastrointestinal correspond à une entité descriptive, à savoir l'existence d'une lésion surélevée, à base soit large (sessile) soit pédiculée, dont la nature exacte dépend uniquement de l'examen histologique. Par conséquence, tout polype doit Être biopsié, soit par l'anse diathermique, soit par biopsie chirurgicale, enfin de poser le diagnostic. Les polypes non-néoplasiques étaient considérés autrefois comme non significatifs, sans potentiel malin, alors que les adénomes néoplasiques avec dysplasie sont des lésions prémalignes bien reconnues. Penser que les polypes non-néoplasiques ne sont pas dangereux n'est plus de mise. Ceci est vrai au moins pour les lésions hamartomateuses du syndrome de Peutz-Jeghers et la polypose juvénile héréditaire à trait dominant où la transformation adénome-lésion maligne est bien prouvée. Par conséquent, la polypose juvénile doit Être traitée par colectomie totale et anastomoses iléorectale, et, dans le syndrome de Peutz-Jeghers, on recommande la polypectomie répétée, au besoin, combinée avec la laparotomie exploratrice. Qui plus est, les polypes hyperplasiques gastriques peuvent Être le reflet d'une gastrite atrophique latente, qui comporte un risque accru de tumeur carcinoÏde et de cancer. Enfin, mÊme les polypes hyperplasiques colorectaux peuvent subir une évolution adénomateuse et représentent donc un réservoir potentiel d'adénomes.
Resumen
Pólipo gastrointestinal es un concepto descriptivo que corresponde a la observación de una lesión de base amplia o pedunculada, cuya naturaleza sólo puede ser definida con exactitud cuando es examinada histológicamente. Por consiguiente, en principio todos los pólipos deben ser removidos con el asa de electrocauterio o resecados para lograr el diagnóstico definitivo. Pólipos no neoplásicos o lesiones pseudotumorales fueron previamente considerados como hallazgos inocentes sin potencial de malignidad, en tanto que los adenomas con displasia son reconocidos como lesiones premalignas. Esta visión de una naturaleza totalmente inocua de los pólipos no neoplásicos dejó de ser válida. Por lo menos la poliposis juvenil de dominación hereditaria y el síndrome de Peutz-Jeghers definitivamente poseen potencial maligno a través del cambio adenomatoso en las lesiones que originalmente son de tipo hamartomatoso. Por lo tanto, la poliposis juvenil debe ser tratada con colectomía y anastomosis ileorrectal, y actualmente se recomiendan polipectomías repetidas en la poliposis de Peutz-Jeghers, en combinación con laparotomía en cuanto sea factible. Por lo demás, pólipos gástricos hiperplásicos pueden reflejar una gastritis atrófica que conlleva un riesgo aumentado de tumores carcinoides y de cáncer gástrico. Además, aÚn los pólipos hiperplásicos colorrectales pueden sufrir alteración adenomatosa y, entonces, teóricamente pasan a representar un reservorio desde el cual pueden originarse adenomas.
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Järvinen, H.J. Other gastrointestinal polyps. World J. Surg. 15, 50–56 (1991). https://doi.org/10.1007/BF01658961
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DOI: https://doi.org/10.1007/BF01658961