rectal polyps
Introduction
Introduction to rectal polyps Rectal polyps are a type of rectal benign tumor. They are mucosa-covered masses in the rectum. They are small nodular mucosal bulges or large pedicled masses. They are usually single and a few are many, if many polyps. Polyps that accumulate in the rectum or involve the colon, polyps called inflammatory polyps due to inflammation; no-nodular nodules with hyperplastic changes in the mucous membranes called hyperplastic polyps, adenomatous polyps grown from intestinal epithelium, velvet papilla Adenomatous polyps, such polyps are easy to malignant. basic knowledge Sickness ratio: 0.05%-0.08% Susceptible people: no specific population Mode of infection: non-infectious Complications: rectal cancer
Cause
Rectal polyps
Causes:
The etiology of rectal polyps is complicated, and its onset may be related to the following factors.
Genetic inheritance (40%):
For example, familial adenomatous polyposis is inherited by autosomal phenotype, and patients often have a familial history. Traditional Chinese medicine regards genetic factors as one of the factors of fetal transmission, and genetic factors are related to congenital endowments. Genetic factors affect the occurrence of disease in two ways. First, genetic factors affect the type of constitution. Different types of physique are different in susceptibility and tolerance to acquired evils, so the incidence of diseases is also different. Second, in the human genetic process, certain diseases that occur in the parental family are also inherited to the offspring.
Infection (20%):
Some polyps can be infected by bacteria, parasites and other rectal mucosa, and the intestinal inflammatory lesions proliferate and cause polyps, such as intestinal tuberculosis, intestinal schistosomiasis, ulcerative colitis and the like.
Abnormal organizational structure (40%):
Such as juvenile polyps, is a hamartomatous polyp.
Pathogenesis
Classification
Pathologically, polyps are often divided into two categories: neoplastic polyps and non-neoplastic polyps.
2. Pathology
(1) tubular adenomas: most common, mostly single, pedicled, generally less than 1cm in diameter, bulging on the surface of intestinal mucosa such as rice or soybeans, smooth or fine particles, color close to normal mucosa, soft; large Adenomas such as cherries or strawberries have shallow sulcus or lobulated surface, dark red color, rarely cancerous, and the morphology can be changed to different extents. Light is mild glandular enlargement, epithelial cells are not abnormal, and severe Glandular hyperplasia, epithelial cell morphology and staining also showed atypical changes, increased nuclear division, further development of glandular pleomorphism, interstitial infiltration, which is considered to be severe dysplasia or cancer.
(2) villous adenoma: also known as papillary adenoma, is fluffy, cauliflower-like protruding on the mucosal surface, the lesion is limited to the mucosal layer, the tumor is soft, the broad base is pedunculated, the volume is larger than the tubular adenoma, the mirror The inferior villi are branched, forming a slender papillary corolla mass, more common in the elderly, more men than women, about 90% in the lower rectum and sigmoid colon, easy to cancer.
(3) juvenile polyps: also known as congenital polyps, is a hamartomatous polyp, mainly occurs in children under 10 years old, 70% to 80% occur in the rectum, mostly single, less than 1cm, natural after puberty Disappearing tendency.
(4) Inflammatory polyps (pseudo polyps): occur in the stage of regeneration and repair of colitis of the large intestine, more common in ulcerative colitis, Crohn's disease, intestinal tuberculosis, schistosomiasis, etc., often multiple, no pedicle, volume Small, the diameter rarely exceeds 5mm, is its characteristics, the color is lighter, and some can also have pedicles. When the disease course is longer, it can be increased to several centimeters. Under the microscope, the gland becomes longer and the glandular cavity is reversed. Forming a serrated appearance, the increase in nuclear fission activity is only seen in the basal part, the epithelial cells have an inconspicuous nucleus located in the basal ganglia, the cytoplasm is rich, full of mucus, the subepithelial basement membrane is thickened, the surface epithelium is micro-nipple appearance, proliferative polyps (Chemical polyps), mostly in the rectum, more often after the age of 40, with increasing age, the incidence rate increases. Disease: It is an autosomal dominant hereditary disease. The large intestine is covered with polypoid adenomas. It can vary in size and can be pedunculated or pedunculated. It has a high tendency to cancer, and it usually occurs after the age of 12.
Prevention
Rectal polyps prevention
1, timely treatment of anus inside and outside the ankle, anal leakage, anal fissure, anal sinusitis and chronic enteritis and other diseases.
2, keep the perianal clean and hygienic, develop regular bowel habits.
Children's rectal polyps mainly occur in children aged 5-10 years, most of them are less than 1cm, single, with pedicles, will fall off on their own, due to inflammation and gland obstruction and retention, there is no major problem except for blood in the clinic, adult rectal polyps There are many types of pathology, and there is a tendency to become cancerous. Therefore, once diagnosed, it is necessary to perform surgical resection early.
Rectal polyps, especially adenomatous polyps, have been recognized by scholars as precancerous lesions, so regular follow-up of patients with rectal polyps has been raised to recognize the height of early colorectal cancer. Therefore, rectal polyps, especially adenomatous polyps, are regularly followed up. It is an important part of preventing the malignant transformation of polyps.
The re-detection rate of polyps is relatively high, ranging from 13% to 86% in foreign countries. The newly detected polyps are partially recurrent polyps of residual polyps, some are large intestine newborn polyps and missing polyps, in order to maintain intestinal tract. Polyp status, to prevent the occurrence of rectal cancer, it is necessary to develop a cost-effective follow-up time. Currently, a variety of options for adenoma follow-up have been proposed internationally, including the colorectal adenoma group at the third international colorectal cancer conference in Boston. The proposed protocol is more detailed. They point out that patients with adenomas have different risk of recurrence of new adenomas and local adenomas after adenoma resection. Therefore, they should be treated differently: any single, pedicle (or broad base but <2cm) Tubular adenomas, adenocarcinoma with mild or moderate dysplasia are in low-risk group, and one of the following conditions is a high-risk group: multiple adenomas, adenomas >2 cm in diameter, broad-based villi-like or mixed Adenoma, adenoma with severe dysplasia or carcinoma in situ, adenoma has invasive cancer, the high-risk group follow-up plan is adenoma resection, 3 to 6 months for endoscopy, such as negative compartment 6 Check again in September~, such as The second negative can be checked every other year. If it is still negative, check again every 3 years, but the fecal occult blood test should be performed every year. The low risk group adenoma should be reviewed 1 year after the adenoma is removed. The examination was performed once a year for 2 times, and then once every 5 years. However, during the follow-up period, the fecal occult blood test was performed every year. Once the polyps were found in the review, endoscopic removal was performed.
Complication
Rectal polyp complications Complications rectal cancer
Maybe rectal cancer.
Symptom
Rectal polyps symptoms Common symptoms in the urgency of the rectum and anal stenosis, blood in the stool, abnormal frequency, polypoid lesions, difficulty in defecation
Small polyps rarely cause symptoms. The most common symptoms after polyp enlargement are intrarectal hemorrhage. Most of them occur after defecation. They are bright red blood, not mixed with feces, mostly intermittent bleeding, and the amount of bleeding is small, rarely caused Anemia, the polyps at the lower end of the rectum can be removed from the anus at the time of defecation. It is bright red, cherries-like, and then retracted by itself. When the rectal polyps are infected, there may be mucus pus and blood, frequent stools, heavy and heavy, and there is a feeling of defecation. Figure 8), inflammatory polyps mainly show symptoms of the primary disease.
Diagnosis mainly depends on rectal examination and rectum, sigmoidoscopy, after the rectal polyps should be further examined all the large intestine, because polyps are often multiple, rectal or sigmoid colonoscopy to take a living tissue for pathological examination, is to determine the nature of polyps, An important way to determine the treatment.
Examine
Rectal polyps
It is a reliable method to determine the nature and type of polyps and whether it is cancerous by clamping the living tissue under direct vision of a proctoscope or a sigmoidoscope.
1. Rectal examination: in the rectum, the lower part of the polyps, fingertips can touch soft, smooth, active nodules.
2. Rectal microscopy: adenomatous polyps are round, the surface mucosa is reddish and shiny, and the villus papillary adenoma is lobulated, resembling cauliflower, soft as a sponge, and inflammatory polyp syrup red. Hyperplastic polyps are mostly mound-like bulging nodules.
3. Histopathological examination: determine the nature of the polyp.
Diagnosis
Diagnosis and identification of rectal polyps
Most polyps are insidious onset and can be clinically free of any symptoms. Some of the larger polyps can cause intestinal symptoms, mainly due to changes in bowel habits, increased frequency, mucus or mucus in the stool, occasional abdominal pain, and a small number of stools from the anus. Some patients may have long-term blood in the stool or anemia. Patients with a family history often have a suggestive role in the diagnosis of polyps.
Typical extraintestinal symptoms often suggest polypoid lesions. Multiple osteoma and soft tissue tumors should consider the possibility of Gardner syndrome, and skin mucosal pigmentation should consider PJ syndrome. For patients with polyposis, colonoscopy should be routinely performed to rule out the possibility of syndrome.
