Résumé
La découverte d’une polypose colorectale diffuse en dehors de tout contexte personnel ou familial connu, implique forcément un diagnostic histologique qui fournit presque systématiquement le diagnostic. En dehors des polyposes adénomateuses largement majoritaires, il n’est pas rare de diagnostiquer des polyposes faites d’adénomes festonnés, des polyposes hyperplasiques, et bien plus rarement, les classiques polyposes hamartomateuses (la définition de l’hamartome est: tissue normal en position anormale, ce qui correspond en pratique à la présence de glandes épithéliales, parfois kystiques, de chorion et de muscle lisse plus ou moins arborisé). Dans cette dernière situation, une prise en charge optimale nécessite de faire un diagnostic précis de syndrome. Cette revue propose les grandes lignes du diagnostic et de la prise en charge dans chaque cas, prise en charge forcément très empirique en cas de polypose festonnée, ou hyperplasique en l’absence de syndrome identifié en particulier d’un point de vue génétique.
Abstract
The discovery of a diffuse colorectal polyposis in absence of any known personal or familial history absolutely requires performing histological analysis, which almost always provides a diagnosis. Besides adenomatous polyposis, which represents the vast majority, it is not uncommon to diagnose polyposes with serrated adenomas, hyperplastic polyposes and much more seldom the classical hamartomatous polyposis (the definition of a hamartoma is a normal tissue in an abnormal location, which in practice corresponds to the presence of epithelial glands, sometimes forming cysts, chorion and more or less arborized smooth muscle). In the latter case, optimal management requires an accurate diagnosis of the syndrome. This report is an overall review of the diagnosis and management for each case, the management being necessarily very empirical in case of serrated or hyperplastic polyposis in the absence of identified syndrome, especially from a genetic perspective.
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