VILLOUS ADENOMAS OF THE RIGHT COLON

Prerenal uremia induced by severe diarrhea due to colon adenoma: a case of McKittrick-Wheelock syndrome in an elderly patient

McKittrick-Wheelock syndrome can be successfully treated by emergent dialysis, prescription of bicarbonate, and endoscopic submucosal dissection, which allow elderly people suffering from this syndrome to maintain their activities of daily living. In patients with this syndrome, a large colonic villous adenoma secretes excessive amounts of mucus and causes severe electrolyte depletion and dehydration. An 81-year-old man who had been suffering from chronic renal failure (creatinine 256.4 μmol/L), hypertension, and arrhythmia presented with frequent mucous diarrhea for a month. He was hospitalized for appetite loss, vomiting, general fatigue, and acute renal failure. His blood tests and blood gas analysis revealed urea nitrogen 58.9 mmol/L, creatinine 954.7 μmol/L, pH 7.13, and a base excess of -20.1 mmol/L. Although his symptoms were improved by the emergent dialysis and rehydration, he suffered a relapse only 4 days after he was discharged. At the second admission, a near-circumferential tumor was found in the rectum by the colonoscopy, which was pathologically confirmed as a villous adenoma. Considering his age and complications, endoscopic submucosal dissection was selected, and internal use of sodium bicarbonate was prescribed. Diarrhea and appetite loss were improved by these treatments, and the creatinine level was also improved to 168.0 μmol/L.

Tubulovillous adenoma of the appendix: a case report and review of the literature

We report the case of a young woman hospitalized for a chronic appendicular syndrome. The histological examination of the resected specimen revealed a rare tumor: tubulovillous adenoma, discovered in 0.02% of all appendectomy procedures. Treatment is most often limited to appendectomy, but in the event of incomplete excision or associated adenocarcinoma, right hemicolectomy may be required. After surgery, a follow-up colonoscopy is recommended due to the higher risk of second gastrointestinal neoplasms in patients with appendicular tumors.

Isolated adenomatous polyposis of the appendix: report of a case

This case study describes a 61-year-old patient who had previously undergone sigmoid polypectomy. A follow-up colonoscopy revealed a polyp prolapsing into the colonic lumen through the base of the appendix. A laparoscopic-assisted appendectomy was performed, in which the cecum was exteriorized through the trocar hole so that a wide excision of the base could be performed. Fifty-eight polyps were observed in the appendix, but the base was free of polyps. Histologic studies reveal well-differentiated villous adenomatous polyposes. The patient was symptom free four years after surgery.

A case of cecocolic intussusception with complete invagination and intussusception of the appendix with villous adenoma

Villous adenoma of the appendix is a rare neoplasm and intussusception of the appendix is a rare pathologic condition. A very rare case seen in a 35-year-old male with pain in the right lateral abdomen is reported. In this patient, the appendix along with the villous adenoma intussuscepted and invaginated into the cecal lumen, and presented as cecocolic intussusception. A polypoid lesion was diagnosed in the cecum by fiberoptic colonoscopy. Unlike polypoid lesions at other sites in the large intestine, polypoid lesions of the cecum may accompany intussusception and invagination of the appendix. Consequently, caution is required in performing endoscopic polypectomy in cases of polypoid lesions of the cecum.

Preoperative colonoscopic diagnosis of villous adenoma of the appendix. Report of a case and review of the literature

This case of villous adenoma of the appendix reported is unique by virtue of its having been diagnosed preoperatively using colonoscopy. Only 45 such lesions have been described previously, and a review of those cases reveals that 93 percent were discovered at appendectomy performed either incidentally or for acute appendicitis. The malignant potential of this entity is unknown and its treatment is controversial. Because of a report association between adenomas of the appendix and other gastrointestinal neoplasms, long-term surveillance is recommended.

Villous adenoma of the appendix: report of a case and review of the literature

This report presents a case of a 23-year-old white woman who presented with symptoms of acute appendicitis, confirmed at laparotomy. The appendectomy specimen revealed an isolated, noninvasive villous adenoma of the appendix. Appendectomy was judged to be sufficient treatment in this case since the base of the organ was not involved, and there was no submucosal spread of the villous adenoma. Literature on the subject is reviewed, and modalities of surgical treatment of "invasive" villous adenoma of the appendix are discussed.

Villous adenoma causing acute appendicitis

Acute appendicitis is the most common of surgical emergencies. However, it is very unusual to find a benign neoplastic lesion causing appendicitis. Adenomas of the caecum or the appendix are rare and very few cases of these associated with appendicular inflammation have been described. This report presents a case of acute appendicitis with perforation resulting from obstruction by an adenoma. The management of the condition is discussed.

Definitive treatment of "malignant" polyps of the colon

There has been an unremitting rise in incidence of colonic cancer in this country with no recent improvement in cure rate. As a result the evolution of colorectal cancer has been the focus of considerable attention with an enlarging body of evidence pointing to the common neoplastic polyp as a precursor to malignancy. "Neoplastic" polyps include "adenomatous polyps," "villous adenomas" and, lately recognized, "villo-glandular polyps." Experience with endoscopic removal of over 2,000 colonic polyps (with no mortality) has introduced two questions of prime concern to the surgeon: (1) What constitutes clinical malignancy in a polyp? AND, (2) When should laparatomy supplant or follow endoscopic removal? Eight hundred and ninety-two consecutive adenomatous (tubular), villous, villoglandular (villo-tubular) and "polypoid cancer" polyps are analyzed, 855 of which have been followed for 6 months to 4 years. Support is offered to the concept that villous and tubular growth patterns are merely variants of a similar base disturbance in cell renewal. Superficial cancer (carcinoma-in-situ) occurred in 6.6% of neoplastic polyps and represents no threat if the polyp is completely removed. Only when the cancer penetrates the muscularis mucosae should it be regarded as "invasive." The term "malignant polyp" should be reserved for this form. Invasive cancer was found in 5.0% of neoplastic polyps in this series. Only in this group need the question of further surgical intervention be raised. Major considerations influencing a decision for subsequent laparotomy are polyp size and gross morphology (i.e. sessile or pedunculated), histologic type (of the polyp and of the cancer itself), adequacy of clearance between depth of invasion and plane of polyp resection, and the patient's age and general condition. These are analyzed. Twenty-five of 46 patients with "malignant polyps" were subjected to abdominal exploration: 17 showed no residual cancer, whereas 8 (5 with recognized incomplete endoscopic removal) had tumor in the bowel wall. Of the remaining 21 patients, for whom endoscopic polypectomy alone was deemed appropriate, none have shown residual or recurrent cancer on clinical and endoscopic followup. Colonoscopy appears to be a most promising approach in terms of the goals of cancer programs, offering both prophylaxis and opportunity for treatment at a favorable stage of disease.

Villous papilloma of the appendix associated with mucocoele and intussusception

A case of villous papilloma of the appendix, associated with mucocoele formation and intussusception, is described. The literature is reviewed and it appears that there is no previous report of this association. It is suggested that so-called malignant mucocoeles of the appendix arise from pre-existing villous papillomas.

Inflammatory masses of the cecum

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