Gardner's syndrome: report of two unrelated cases and discussion of management of the disease

Gardner's syndrome. Recent developments in research and management

In recent years, a number of comprehensive reviews have been written on inherited intestinal polyposis syndromes (1-7), but none has dealt specifically with Gardner's syndrome and none has focused on basic research being carried out in an attempt to understand this syndrome and to improve the medical management of affected patients. A better understanding of this rare genetic disorder is essential for surgeons, gastroenterologists, cancer researchers, and geneticists alike. To the clinician, it poses difficult challenges in management; to the cancer researcher, it presents a rare opportunity to study very early premalignant transformations; and to the geneticist, it poses exciting questions at the cellular, chromosomal, and molecular levels.

The occurrence of desmoids in patients with familial polyposis coli

Four cases of desmoid tumour are reported in conjunction with familial polyposis coli, and the salient clinical features of patients with this combination of conditions are examined in the literature and tabulated.

Desmoids occur very rarely in the general population but they are comparatively common in people with familial polyposis, in whom they may be situated in the abdominal wall, within the abdomen, or occasionally in other sites remote from the abdomen. They may antedate the discovery of polyposis by months or years. Any patient who is found to have a desmoid should therefore be examined for polyposis coli.

Intra-abdominal desmoids by virtue of their size and situation are often of serious significance to the patient, and their effects may belie the benign histological picture they present. Renal function may be impaired by pressure on the ureters, whilst surgical removal of the lesion, which is the principal method of treatment of desmoids, may be crippling to the patient or technically impossible. Radiotherapy seems to be of limited value in the management of these tumours.

No mass occurring within the abdomen or in the abdominal wall after surgery for polyposis coli should be regarded as a recurrent adenocarcinoma until proved to be so by adequate biopsy.

A new form of diffuse familial polyposis: a probable genetic explanation

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