[Gardner's syndrome and mediastinal sarcoma. Description of a clinical case and review of the literature]

The incidence of the colonic and rectal polyps cancerisation in patients with Gardner's syndrome is very high. In these patients, on the other hand, the extraintestinal tumours very rarely degenerative in cancer. A case of mediastinal sarcoma in a patient with Gardner's syndrome is reported.

Colorectal cancer. Risk factors and screening strategies

Colorectal cancer is common in the United States and frequently discovered too late for cure. Epidemiologic studies suggest a complex relationship between animal fat intake, fecal flora, and risk of development of colorectal cancer, but the actual mechanism of carcinogenesis is still unknown. Early detection might increase the proportion of patients who could be cured of the disease. Screening of asymptomatic subjects over the age of 40 years for fecal occult blood seems to detect cancers before they become invasive. Efforts are needed to ensure that all subjects with positive tests for occult blood are completely examined. We prefer colonoscopy as a single test in that it is both diagnostic and curative early in the disease. The cost-effectiveness of mass screening and its ability to reduce colorectal cancer mortality in our society require further prospective study.

Intussusception of the appendix

Two cases of intussusception of the appendix are reported--one caused by adenocarcinoma and adenomatous polyp and the other by an endometrioma. Appendiceal intussusception and adenocarcinoma are both uncommon entities and this is the first report of the two occurring concomitantly. Due to variable symptoms, the correct diagnosis of appendiceal intussusception has rarely been made preoperatively. Classification, symptoms, radiographic appearance, and differential diagnosis are discussed, and the authors suggest a new classification for intussusception of the appendix.

Treatment of small colorectal polyps: a population-based study of the risk of subsequent carcinoma

We conducted a retrospective cohort study of 751 residents of Rochester, Minnesota, whose small (1 cm or less) colorectal polyps had been treated without biopsy. Eighteen colorectal carcinomas were found in this group in the course of more than 10,000 person-years of follow-up, whereas 15.27 cases were expected (relative risk, 1.2). The overall rate for the development of cancer and the relative risks for various subgroups of the cohort were not significantly elevated, and survival in this cohort was not impaired. We conclude that fulguration of selected small colorectal polyps without prior biopsy does not subject patients to an unusual risk for development of colorectal carcinoma. Customary periodic medical examination should suffice for patients with these lesions.

Multiple duodenal polyps in uraemia: a little known clinical entity

Multiple duodenal polyps were found by endoscopy in five out of 33 patients with chronic renal failure and in one of 300 controls. In the uraemic cases the polyps were caused by circumscribed nodular hyperplasia of Brunner's glands. One of these five patients later underwent surgery for duodenal obstruction caused by the polyps; the other patients were asymptomatic. One of the controls had multiple duodenal polyps. The recorded incidence of multiple duodenal polyps was significantly higher among patients with chronic renal failure than in patients without renal disease. Patients with chronic renal failure and polyps did not differ significantly from the other renal patients in the comparison of variables such as gastric acid secretion, serum concentrations of gastrin and group I pepsinogens or mean length of dialysis treatment. The mean pH of gastric resting juice was significantly higher, however, in uraemic patients with polyps than in those without. Uraemic patients displayed a gastric acid secretion capacity within normal range, and significantly raised serum gastrin and group I pepsinogen concentrations.

Mandibular osteomas in familial polyposis coli

Orthopantomograms of the mandible were performed on 46 patients with familial polyposis coli having no clinical signs of Gardner's syndrome and on 46 control patients matched according to age and sex. Thirty-five patients (76.1 per cent) and two (4.3 per cent) controls had osteomas (P less than 0.0005). It is concluded that orthopantomography of the mandible is a valuable diagnostic supplement to prophylactic proctosigmoidoscopic examination of first-degree relatives of polyposis patients. Due to the frequent occurrence of mandibular osteomas in polyposis patients without clinically detectable extracolonic manifestations, it is suggested that "Gardner's syndrome" is no longer considered a clinical entity.

Is colonoscopy necessary in diverticular disease?

Colonoscopy was carried out in 65 patients in whom double-contrast barium enemas for bowel symptoms had shown sigmoid diverticular disease. In 19 of these, barium enemas had shown neoplastic lesions--polyps in 17 and carcinoma in 2; but colonoscopy showed no polyps in 9 of the 17. In 1 a carcinoma not a polyp was found, and of the 2 carcinomas only 1 was confirmed. In 46 patients the barium enemas showed diverticular disease only, but colonoscopy revealed polyps in 8 and carcinoma in 3. Thus in 23 patients (35%) the barium enema was inaccurate. 13 of 20 patients with neoplasia but only 11 of 45 without had rectal bleeding, but the numbers in the two groups who had abdominal pain or change in bowel habit were similar in the two groups. Colonoscopy revealed neoplastic lesions in 20 of the 65 patients (31%), an incidence great enough to recommend routine colonoscopy in patients with symptomatic diverticular disease, especially those with rectal bleeding.

Polypectomy in the presence of portal hypertension--an increased risk of bleeding?

A report is presented on 58 polypectomies performed in the stomach and colorectum in 46 patients. Twenty-five patients had portal hypertension consequent on liver cirrhosis, while 21 patients had healthy livers. The question as to whether haemorrhage occurred immediately after polypectomy or within the next 24 hours, was investigated. Furthermore, either the stalk (of pedunculated polyps), or the polyp itself (when sessile) was investigated pathologically-anatomically, with respect to its vascularity pattern. The submucosal and intramucosal vascularity patterns were classified in 4 categories, I to IV. A tentative interpretation of the results obtained indicates, on the basis of their mucosal and submucosal vascularity patterns, that patients with portal hypertension developing from a cirrhosis of the liver, are not at any higher risk of haemorrhage than patients with no portal hypertension.

Inflammatory fibroid polyp of the small intestine: report of two cases and review of the literature

Two cases of inflammatory fibroid polyp of the ileum presenting clinically as intestinal obstruction due to intussusception are described. The presence of smooth muscle cells within the lesions raises the possibility that some cases of inflammatory fibroid polyp are leiomyomas that have undergone degenerative and secondary inflammatory changes.

Biliary involvement in familial adenomatosis coli

Two patients with polypoid bile duct tumors associated with familial adenomatosis coli are presented. A jaundiced man, aged 63, had polypoid masses identified as adenocarcinoma in the common and hepatic ducts. The other patient, a 38-year-old woman undergoing surgery for duodenal adenomas, had a solitary benign adenoma of the distal common duct in addition to duodenal adenocarcinoma. Only one earlier report of bile duct polyps could be found in association with familial adenomatosis. These cases support the view that familial gastrointestinal adenomatosis is a systemic disease, which is not restricted to the colon and rectum.

Complete remission in Cronkhite-Canada syndrome

A case of Cronkhite-Canada syndrome, where there was complete remission confirmed by radiology, endoscopy, and histology, is reported. On presentation, there was generalized gastrointestinal polyposis, hypoalbuminemia, skin pigmentation, onycho-dystrophy, and alopecia. Enteral nutrition alone was administered for 10 wk, with resolution of the ectodermal features and disappearance of the polyps within 4 mo of commencement of the treatment. This report of complete remission supports the generally accepted nonneoplastic and essentially inflammatory nature of the polyps in Cronkhite-Canada syndrome. Consideration needs to be given to nutritional deficiency as a cause of the syndrome.

Ruvalcaba-Myhre-Smith syndrome: a case with probable autosomal-dominant inheritance and additional manifestations

We report on a 7 1/2-year-old boy with macrocephaly, hamartomatous intestinal polyps, and café-au-lait spots on the penis. These abnormalities were reported in two other individuals thought to have the Sotos syndrome. We think that this triad of abnormalities represents a new disorder, the Ruvalcaba-Myhre-Smith syndrome. Prominent Schwalbe lines, prominent corneal nerves, and lipid storage myopathy also appear to be part of the syndrome. Macrocephaly, similar facial appearance, and a hamartomatous polyp in the mother suggest dominant inheritance.

Filiform polyposis of the colon presenting as massive hemorrhage: an uncommon complication of Crohn's disease

A case of localized filiform polyposis of the colon is presented. This lesion was part of a more generalized inflammatory bowel disease with clinicopathological features indicative of Crohn's disease. An unusual feature of this case was profuse rectal bleeding, initially from a solitary sigmoid ulcer and later from the area of filiform polyposis. A step by step clinicopathological follow-up emphasizing the development of filiform polyps is provided.

Cronkhite-canada syndrome associated with gastric cancer: report of a case

A 71-year-old man with characteristic clinical and pathological pictures of Cronkhite-Canada syndrome associated with gastric cancer is presented. Histological examinations of gastric and colonic polyps which resembled juvenile type revealed no malignant cells. The patient slowly recovered after subtotal gastrectomy and elemental diet supplement with antiplasmin agents. As for as is known to the authors, a total of 69 cases with this syndrome were reported in Japan including our patient. Of these cases 8 had cancer of the gastrointestinal tract. Two of them, including our case, had gastric cancer. Another one was associated with gastric cancer but not intestinal polyposis. The remaining 5 cases were associated with colonic cancer. Caution must be paid to the fact that cachexia or malabsorption in some patients with this syndrome results from gastrointestinal malignancy. The prognosis of this syndrome consisted of 20 deaths including 2 postoperative deaths, 33 of improvement including 4 of natural remission and 4 of remission after gastrectomy or colectomy, 7 unchanged and the remainder not described.

Jejunal carcinoma in a child

A case of Peutz-Jeghers Syndrome in an 8-yr-old girl with an adenocarcinoma arising in the duodenum and jejunum is herein reported with a 9-yr follow-up. This carcinoma fulfills histologic criteria for malignancy in the Peutz-Jeghers Syndrome. We suggest that this represents a documented case of malignancy arising in a Peutz-Jeghers polyp.