Rectal Polyps and Other Neoplasms

  • Kelli M. Bullard DunnEmail author


Although adenomas, adenocarcinoma and epidermoid carcinoma compose the majority of anorectal tumors, there are a variety of other rarer lesions that occur in the anorectum. In many cases, diagnosis may be challenging, especially because many patients and their care givers attribute anorectal symptoms to hemorrhoidal disease. In this chapter, we will review the diagnosis and treatment of both the common and the more unusual neoplasms.


Carcinoid Melanoma Gastrointestinal Stromal Tumors (GIST) Lipoma 


  1. 1.
    O'Brien MJ, Winawer SJ, Zauber AG, et al. The national polyp study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology. 1990;98:371–9.CrossRefGoogle Scholar
  2. 2.
    Whitlow CB, Opelka FG. Other rectal neoplasms. In: Beck DE, Wexner SD, editors. Fundamentals of anorectal surgery. 2nd ed. London: W B Saunders; 1998. p. 382–99.Google Scholar
  3. 3.
    Fenoglio-Prieser CM, Pascal RR, Perzin KH. Adenomas. In: Hartman WH, editor. Tumors of the intestines. Washington, DC: Armed Forces Institute of Pathology; 1990. p. 69–150.Google Scholar
  4. 4.
    Fenoglio-Prieser CM. Colonic polyp histology. Semin Colon Rectal Surg. 1990;2:234–45.Google Scholar
  5. 5.
    Wise PE. Polyps. In: Beck DE, Roberts PL, Saclarides TJ, Senagore AJ, Stamos MJ, Wexner SD, editors. The ASCRS textbook of colon and rectal surgery. 2nd ed. New York: Springer; 2011. p. 636.Google Scholar
  6. 6.
    Muto T, Bussey HJR, Morson BE. The evolution of cancer of the colon and rectum. Cancer. 1975;36:2251–70.CrossRefGoogle Scholar
  7. 7.
    Tierney RP, Ballantyne GH, Modlin M. The adenoma to carcinoma sequence. Surg Gynecol Obstet. 1990;171:81–94.PubMedGoogle Scholar
  8. 8.
    Silverberg SG. Focally malignant adenomatous polyps of the colon and rectum. Surg Gyneeol Obstet. 1970;131:103–14.Google Scholar
  9. 9.
    Grinnell RS, Lane N. Benign and malignant adenomatous polyps and papillary adenomas of the colon and rectum. An analysis of 1856 tumors in 1335 patients. Surg Gynecol Obstet. 1958;106:519–38.Google Scholar
  10. 10.
    Stryker JS, Wolff BG, Culp CE, et al. Natural history of untreated colonic polyps. Gastroenterology. 1987;93:1009–13.CrossRefGoogle Scholar
  11. 11.
    Waye JO, O’Brien MJ. Cancer in polyps. In: Cohen AT, Winawer SJ, editors. Cancer of the colon, rectum and anus. New York: McGraw-Hill; 1995. p. 456–76.Google Scholar
  12. 12.
    Pollard CW, Nivatvongs S, Rojanasakul A, et al. The fate of patients following polypectomy alone for polyps containing invasive carcinoma. Dis Colon Rectum. 1992;35:933–7.CrossRefGoogle Scholar
  13. 13.
    Whitlow CB, Gathright JB, Hebert SJ, et al. Long-term survival after treatment of malignant colonic polyps. Dis Colon Rectum. 1997;40:929–34.CrossRefGoogle Scholar
  14. 14.
    Haggitt RC, Glotzbach RE, Soffer EE, Wruble LE. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology. 1985;89:328–36.CrossRefGoogle Scholar
  15. 15.
    Nivatvongs S, Rojanasakul A, Reiman HM, et al. The risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma. Dis Colon Rectum. 1991;34:323–8.CrossRefGoogle Scholar
  16. 16.
    Opelka FG, Hicks TE. Management of malignant polyps. Semin Colon Rectal Surg. 1991;2:296–304.Google Scholar
  17. 17.
    Whitlow CB, Beck DE, Gathright JB. Surgical excision of large rectal villous adenomas. Surg Oncol Clin N Am. 1996;5:723–34.CrossRefGoogle Scholar
  18. 18.
    Galandiuk S, Fazio VW, Jagelman OG, et al. Villous and tubulovillous adenomas of the colon and rectum. Am Surg. 1987;153:41–7.CrossRefGoogle Scholar
  19. 19.
    Nivatvongs S, Nicholson JO, Rothenberger OA. Villous adenomas of the rectum: the accuracy of clinical assessment. Surgery. 1980;87:549–5l.PubMedGoogle Scholar
  20. 20.
    Wheat MW, Ackerman LV. Villous adenomas of the large intestine. Ann Surg. 1958;147:476–87.CrossRefGoogle Scholar
  21. 21.
    Keck JO, Schoetz OJ Jr, Roberts PL, et al. Rectal mucosectomy in the treatment of giant rectal villous tumors. Dis Colon Rectum. 1995;38:233–8.CrossRefGoogle Scholar
  22. 22.
    Sakamoto GO, Mackeigan JM, Senagore AJ. Transanal excision of large, rectal villous adenomas. Dis Colon Rectum. 1991;34:880–5.CrossRefGoogle Scholar
  23. 23.
    Buess G, Kipfmuller K, Ibald R, et al. Clinical results of transanal endoscopic microsurgery. Surg Endosc. 1988;2:245–50.CrossRefGoogle Scholar
  24. 24.
    Saclarides TJ, Smith L, Ko S, et al. Transanal endoscopic microsurgery. Dis Colon Rectum. 1992;35:1183–91.CrossRefGoogle Scholar
  25. 25.
    Jorgensen SJ, Ottsen M. Posterior rectotomy for villous tumors of the rectum. Acta Chir Scand. 1975;141:680–2.PubMedGoogle Scholar
  26. 26.
    Wilson SE, Gordon HE. Excision of rectal lesions by thoe Kraske approach. Am J Surg. 1969;118:213–7.CrossRefGoogle Scholar
  27. 27.
    Thompson BW, Tucker WE. Transsphincteric approach to lesions of the rectum. South Med J. 1987;80:41–3.CrossRefGoogle Scholar
  28. 28.
    Redmond HP, Austin OMB, Clery AP, Deasy JM. Safety of double-stapled anastomosis in low anterior resection. Br Surg. 1993;80:924–7.CrossRefGoogle Scholar
  29. 29.
    Franklin R, McSwain B. Juvenile polyps of the colon and rectum. Ann Surg. 1992;216:432–7.CrossRefGoogle Scholar
  30. 30.
    Cohen AM, Enker WE, Monsky BD. Protectomy and coloanal construction for rectal cancer. Dis Colon Rectum. 1990;33:40–3.CrossRefGoogle Scholar
  31. 31.
    Enker WE, Steams MW Jr, Janov AJ. Peranal coloanal anastomosis following low anterior resection for rectal carcinoma. Dis Colon Rectum. 1985;28:576–81.CrossRefGoogle Scholar
  32. 32.
    Chiu YS, Spencer RJ. Villous lesions of the colon. Dis Colon Rectum. 1978;21:493–5.CrossRefGoogle Scholar
  33. 33.
    Fenoglio-Prieser CM, Pascal RR, Perzin KH. Nonneoplastic polyps. In: Hartman WH, editor. Tumors of the intestines. Washington, DC: Armed Forces Institute of Pathology; 1990. p. 31–67.Google Scholar
  34. 34.
    Mazier WI, Mackeigan JM, Billinghan RP, Dignan RD. Juvenile polyps of the colon and rectum. Surg Gynecol Obstet. 1982;154:829–32.PubMedGoogle Scholar
  35. 35.
    McColl I, Bussey HJ, Veale AMO, Be M. Juvenile polyposis coli. Proc R Soc Med. 1964;57:896–7.PubMedGoogle Scholar
  36. 36.
    Haggitt RC, Pitcock JA. Familial juvenile polyposis of the colon. Cancer. 1970;26:1232–8.CrossRefGoogle Scholar
  37. 37.
    Grosfield JL, West KW. Generalized juvenile polyposis coli. Clinical management based on long-term observations. Arch Surg. 1986;121:530–4.CrossRefGoogle Scholar
  38. 38.
    Cronkhite LW Jr, Canada WJ. Generalized gastrointestinal polyposis. An unusual syndrome of polyposis, pigmentation, alopecia and onychotrophia. N Engl J Med. 1955;252:1011–5.CrossRefGoogle Scholar
  39. 39.
    Peutz JLA. Very remarkable case of familial polyposis of mucous membrane of intestinal tract and nasopharynx accompanied by peculiar pigmentations of skin and mucous membrane. Nederl Maandschr V Geneesk. 1921;10:134–46.Google Scholar
  40. 40.
    Jeghers H, McKusick VA, Katz KH. Generalized intestinal polyposis and melanin spots of the oral mucosa, lips and digits: a syndrome of diagnostic significance. N Engl J Med. 1949;241:993–1005.CrossRefGoogle Scholar
  41. 41.
    Utsunomiya J, Gocho H, Miyanaga T, et al. PeutzJeghers syndrome: its natural course and management. Johns Hopkins Med J. 1975;136:71–82.PubMedGoogle Scholar
  42. 42.
    Konishi F, Wyse NE, Muto T, et al. Peutz-Jeghers polyposis associated with carcinoma of the digestive organs: report of three cases and review of the literature. Dis Colon Rectum. 1987;30:790–9.CrossRefGoogle Scholar
  43. 43.
    Spigelman AD, Arese P, Phillips RKS. Polyposis: the Peutz-Jeghers syndrome. Br J Surg. 1995;82:1311–4.CrossRefGoogle Scholar
  44. 44.
    Giardiello FM, Welsh SB, Hamilton SR, et al. Increased risk of cancer in the Peutz-Jeghers Syndrome. N J Med. 1987;316:1511–4.CrossRefGoogle Scholar
  45. 45.
    Dozois HK Judd ES, Dahlin DC, et al. The Peutz-Jeghers syndrome. Is there a predisposition to the development of intestinal malignancy? Arch Surg. 1969;98:509–17.CrossRefGoogle Scholar
  46. 46.
    Williams CB, Goldblatt M, Delaney PV. Top and tail endoscopy’ and follow up in Peutz-Ieghers syndrome. Endoscopy. 1982;14:82–4.CrossRefGoogle Scholar
  47. 47.
    Bullard Dunn KM, Rothenberger DA. Colon, rectum, and anus. In: Brunicardi C, editor. Schwartz’s principles of surgery. 10th ed. New York: McGraw Hill; 2014. p. 1175–240.Google Scholar
  48. 48.
    Silverstein FE, Tytgat GNJ, Polyps CI. Tumors in gastrointestinal endoscopy. 3rd ed. London: Mosby; 1997. p. 268–9.Google Scholar
  49. 49.
    Ghanem OM, Slater J, Singh P, Heitmiller RF, DiRocco JD. Pedunculated colonic lipoma prolapsing through the anus. World J Clin Cases. 2015;3(5):457–61.CrossRefGoogle Scholar
  50. 50.
    Silverstein FE, Tytgat GNJ, Polyps CI. Tumors in gastrointestinal endoscopy. 3rd ed. London: Mosby; 1997. p. 340–1.Google Scholar
  51. 51.
    Londono-Schimmer EE, Ritchie JK, Hawley PR. Coloanal sleeve anastomosis in the treatment of diffuse cavernous hemangioma of the rectum: long term results. Br J Surg. 1994;81:1235–7.CrossRefGoogle Scholar
  52. 52.
    Ugolini G, Rosati G, Montroni I, Manaresi A, Blume JF, Taffurelli M. Diffuse cavernous haemangioma of the rectum and anus: an unusual case of rectal bleeding with challenging management. BMJ Case Rep. 2009;2009:bcr02.2009.1545.CrossRefGoogle Scholar
  53. 53.
    Nivatvongs S. Benign neoplasms of the colon and rectum. In: Gordon PH, Nivatvongs S, editors. Principles and practice of surgery for the colon, rectum, and anus. 2nd ed. St. Louis: Quality Medical Publishing; 1999. p. 567–8.Google Scholar
  54. 54.
    Whitlow CB, Opelka FG. Other rectal neoplasms. In:Fundamentals of anorectal surgery. 2nd ed. Philadelphia: WB Saunders; 1998.Google Scholar
  55. 55.
    Nivatvongs S. Benign neoplasms of the colon and rectum. In: Gordon PH, Nivatvongs S, editors. Principles and practice of surgery for the colon, rectum, and anus. 2nd ed. St. Louis: Quality Medical Publishing; 1999. p. 695–6.Google Scholar
  56. 56.
    NCCN Task Force Report. Update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Cancer Netw. 2010;8(2):S1–S44.Google Scholar
  57. 57.
    Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, Pisters PWT, Raut CP, Riedel RF, Schuetze S, Sundar HM, Trent JC, Wayne JD, Kwaan MR, Goldberg JE, Bleday R. Rectal carcinoid tumors: review of results after endoscopic and surgical therapy. Arch Surg. 2008;143:471–5.CrossRefGoogle Scholar
  58. 58.
    Barakat MT, Meeran K, Bloom SR. Neuroendocrine tumors. Endocr Relat Cancer. 2004;11:1–18.CrossRefGoogle Scholar
  59. 59.
    Nivatvongs S. Benign neoplasms of the colon and rectum. In: Gordon PH, Nivatvongs S, editors. Principles and practice of surgery for the colon, rectum, and anus. 2nd ed. St. Louis: Quality Medical Publishing; 1999. p. 693–5.Google Scholar
  60. 60.
    Merchea A, Dozois EJ. Lesions originating within the retrorectal space. J Gastrointest Surg. 2014;18(12):2232–3.CrossRefGoogle Scholar
  61. 61.
    Dozois EJ, Jacofsky DJ, Billings BJ, Privitera A, Cima RR, Rose PS, Sim FH, Okuno SH, Haddock MG, Harmsen WS, Inwards CY, Larson DW. Surgical approach and oncologic outcomes following multidisciplinary management of retrorectal sarcomas. Ann Surg Oncol. 2011;18(4):983–8.CrossRefGoogle Scholar
  62. 62.
    Merchea A, Larson DW, Hubner M, Wenger DE, Rose PS, Dozois EJ. The value of preoperative biopsy in the management of solid presacral tumors. Dis Colon Rectum. 2013;56(6):756–60.CrossRefGoogle Scholar
  63. 63.
    Chen H, Cai Y, Liu Y, He J, Hu Y, Xiao Q, Hu W, Ding K. Incidence, surgical treatment, and prognosis of anorectal melanoma from 1973 to 2011: a population-based SEER analysis. Medicine. 2016;95(7):e2770.CrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.SurgeryUniversity of LouisvilleLouisvilleUSA

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