Hyperplastic Polyposis Coli Syndrome and Colorectal Carcinoma

 

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Background: Patients with hyperplastic polyposis coli syndrome (HPCS) have a propensity to develop colorectal carcinoma (CRC).
Patients and Methods: Details were retrieved from the files of patients attending our hospital between 1988 and 2004 who fulfilled the World Health Organization criteria for HPCS.
Results: Over a period of 16 years, 10 cases of HPCS were identified at our hospital (0.625 cases/year or one case every 1.6 years). A mean of 40.3 hyperplastic polyps per patient were found (range 6 - 159). Other colorectal lesions were found as follows: two patients each had one mixed polyp; there were 15 serrated adenomas in eight patients; and there were 30 tubular, tubulovillous, or villous adenomas in eight patients. Among the 10 patients with HPCS, seven developed a CRC. Of the four villous adenomas, three were associated with a CRC, but only one of the 15 serrated adenomas was associated with a CRC. The pathway of cancer evolution in HPCS patients remains unresolved.
Conclusions: Similarly to our results, a review of the literature indicates a high incidence of CRCs in HPCS patients. These patients are at a high risk of developing a CRC and should therefore receive regular colonoscopic surveillance.

References

• 1 Jörgensen H, Mogensen A M, Svendsen L B. Hyperplastic polyposis of the large bowel. Three cases and a review of the literature [review].  Scand J Gastroenterol. 1996;  31 825-830
  PubMedGoogle Scholar
• 2 Williams G, Arthur J, Bussey H, Morson B. Metaplastic polyps and polyposis of the colorectum.  Histopathology. 1980;  4 155-170
  CrossrefPubMedGoogle Scholar
• 3 Rashid A, Houlihan P S, Booker S. et al . Phenotypic and molecular characteristics of hyperplastic polyposis.  Gastroenterology. 2000;  119 323-332
  CrossrefPubMedGoogle Scholar
• 4 Young J, Biden K G, Simms L A. et al . HPP1: a transmembrane protein-encoding gene commonly methylated in colorectal polyps and cancers.  Proc Natl Acad Sci USA. 2001;  98 265-270
  CrossrefPubMedGoogle Scholar
• 5 Wynter C V, Walsh M D, Higuchi T. et al . Methylation patterns define two types of hyperplastic polyp associated with colorectal cancer.  Gut. 2004;  53 573-580
  CrossrefPubMedGoogle Scholar
• 6 Oberschmid B I, Dietmaier W, Hartmann A. et al . Distinct secreted Frizzled receptor protein 1 staining pattern in patients with hyperplastic polyposis coli syndrome.  Arch Pathol Lab Med. 2004;  128 967-973
  PubMedGoogle Scholar
• 7 Spjut H, Estrada R G. The significance of epithelial polyps of the large bowel.  Pathol Annu. 1977;  12 147-170
  PubMedGoogle Scholar
• 8 Cooke S A. Polyposis coli. The clinical spectrum in adults.  S Afr Med J. 1978;  53 454-457
  PubMedGoogle Scholar
• 9 Cooper H S, Patchefsky A S, Marks G. Adenomatous and carcinomatous changes within hyperplastic colonic epithelium.  Dis Colon Rectum. 1979;  22 152-156
  PubMedGoogle Scholar
• 10 Sumner H, Wassweman N, McLain C. Giant hyperplastic polypsis of the colon.  Dig Dis Sci. 1981;  26 85-89
  CrossrefPubMedGoogle Scholar
• 11 Cohen S M, Brown L, Janover M L, McCready F J. Multiple metaplastic (hyperplastic) polyposis of the colon.  Gastrointest Radiol. 1981;  6 333-335
  CrossrefPubMedGoogle Scholar
• 12 Tulman A, Bradford S, Lee E, Brady P. Giant hyperplastic polyps associated with vasculitis of colon.  J Fla Med Assoc. 1982;  69 380-383
  PubMedGoogle Scholar
• 13 Bengoechea O, Martinez-Penuela J M. et al . Hyperplastic polyposis of the colorectum and adenocarcinoma in a 24-year-old man.  Am J Surg Pathol. 1987;  11 323-327
  PubMedGoogle Scholar
• 14 McCann B. A case of metaplastic polyposis of the colon associated with focal adenomatous change and metachronous adenocarcinomas.  Histopathology. 1988;  13 700-702
  PubMedGoogle Scholar
• 15 Teoh H, Delahunt B, Isbister W. Dysplastic and malignant areas in hyperplastic polyps of the large intestine.  Pathology. 1989;  21 138-142
  PubMedGoogle Scholar
• 16 Kusunoki M, Fujita S, Sakanoue Y. et al . Disappearance of hyperplastic polyposis after resection of rectal cancer. Report of two cases.  Dis Colon Rectum. 1991;  34 829-832
  PubMedGoogle Scholar
• 17 Shepherd N. Inverted hyperplastic polyposis of the colon.  J Clin Pathol. 1993;  46 56-60
  PubMedGoogle Scholar
• 18 Warner A S, Glick M E, Fogt F. Multiple large hyperplastic polyps of the colon coincident with adenocarcinoma.  Am J Gastroenterol. 1994;  89 123-125
  PubMedGoogle Scholar
• 19 Lieverse R J, Kibbelaar R E, Griffioen G, Lamers C B. Colonic adenocarcinoma in a patient with multiple hyperplastic polyps [review].  Neth J Med. 1995;  46 185-188
  PubMedGoogle Scholar
• 20 Beusnel C, Le Berre N, Pagenault M. et al . Giant hyperplastic polyposis with adenomatous tissue.  Gastroenterol Clin Biol. 1996;  20 294-297
  PubMedGoogle Scholar
• 21 Torlakovic E, Snover D C. Serrated adenomatous polyposis in humans.  Gastroenterology. 1996;  110 748-755
  CrossrefPubMedGoogle Scholar
• 22 Orii S, Nakamura S, Sugai T. et al . Hyperplastic (metaplastic) polyposis of the colorectum associated with adenomas and an adenocarcinoma.  J Clin Gastroenterol. 1997;  25 369-372
  CrossrefPubMedGoogle Scholar
• 23 Keljo D J, Weinberg A G, Winick N, Tomlinson G. Rectal cancer in an 11-year-old girl with hyperplastic polyposis.  J Pediatr Gastroenterol Nutr. 1999;  28 327-332
  CrossrefPubMedGoogle Scholar
• 24 Place R J, Simmang C L. Hyperplastic-adenomatous polyposis syndrome [review].  J Am Coll Surg. 1999;  188 503-507
  CrossrefPubMedGoogle Scholar
• 25 Jass J R, Iino H, Ruszkiewicz A. et al . Neoplastic progression occurs through mutator pathways in hyperplastic polyposis of the colorectum.  Gut. 2000;  47 43-49
  CrossrefPubMedGoogle Scholar
• 26 Hawkins N J, Gorman P, Tomlinson I P. et al . Colorectal carcinomas arising in the hyperplastic polyposis syndrome progress through the chromosomal instability pathway.  Am J Pathol. 2000;  157 385-392
  CrossrefPubMedGoogle Scholar
• 27 Leggett B A, Devereaux B, Biden K. et al . Hyperplastic polyposis: association with colorectal cancer.  Am J Surg Pathol. 2001;  25 177-184
  CrossrefPubMedGoogle Scholar
• 28 Koide N, Saito Y, Fujii T. et al . A case of hyperplastic polyposis of the colon with adenocarcinomas in hyperplastic polyps after long-term follow-up.  Endoscopy. 2002;  34 499-502
  Article in Thieme ConnectPubMedGoogle Scholar
• 29 Ferrandez A, Samowitz W, DiSario J A, Burt R W. Phenotypic characteristics and risk of cancer development in hyperplastic polyposis: case series and literature review.  Am J Gastroenterol. 2004;  99 2012-2018
  CrossrefPubMedGoogle Scholar
• 30 Lage P, Cravo M, Sousa R. et al . Management of Portuguese patients with hyperplastic polyposis and screening of at-risk first-degree relatives: a contribution for future guidelines based on a clinical study.  Am J Gastroenterol. 2004;  99 1779-1784
  CrossrefPubMedGoogle Scholar
• 31 Hyman N H, Anderson P, Blasyk H. Hyperplastic polyposis and the risk of colorectal cancer.  Dis Colon Rectum. 2004;  47 2101-2104
  CrossrefPubMedGoogle Scholar
• 32 Jass J, Burt R. Hyperplastic polyposys. In: Hamilton SR, Aaltonen LA, (eds) WHO international classification of tumours. 3rd edn. Pathology and genetics of tumours of the digestive system. Berlin; Springer-Verlag 2000: 135-136
  Google Scholar
• 33 Rubio C A. Colorectal adenomas: time for reappraisal.  Pathol Res Pract. 2002;  198 615-620
  CrossrefPubMedGoogle Scholar
• 34 Atkin W, Saunders B. Surveillance guidelines after removal of colorectal adenomatous polyps.  Gut. 2002;  51 (Suppl 5) v6-v9
  CrossrefPubMedGoogle Scholar
• 35 Rubio C, Nesi G, Messerini L, Zampi G C. Serrated and microtubular colorectal adenomas in Italian patients. A 5-years survey.  Anticancer Research. 2005;  25 1353-1359
  PubMedGoogle Scholar

C. A. Rubio, MD, PhD

Gastrointestinal and Liver Pathology Research Laboratory · Department of Pathology · Karolinska Institute and University Hospital

17176 Stockholm · Sweden

Fax: +46-8-51774524·

Email: Carlos.Rubio@onkpat.ki.se