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Colorectal neoplasia in juvenile polyposis or juvenile polyps
F M Giardiello1, S R Hamilton, S E Kern
1Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21205.
Insights
Juvenile polyps, especially when multiple or with a family history, are linked to colorectal neoplasia. Early surveillance is recommended for patients with juvenile polyposis to detect cancers.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Pediatric Oncology
Background:
- Juvenile polyps are typically solitary colorectal lesions, but can be multiple in juvenile polyposis.
- The link between juvenile polyps and colorectal neoplasia remains a subject of debate.
- Juvenile polyposis is a rare condition characterized by the development of numerous juvenile polyps.
Purpose of the Study:
- To investigate the association between juvenile polyps and the development of colorectal neoplasia.
- To identify risk factors for colorectal neoplasia in patients with juvenile polyps.
- To determine the appropriate surveillance strategies for individuals with juvenile polyps.
Main Methods:
- Retrospective analysis of 57 patients with one or more juvenile polyps.
- Review of three pediatric cases with juvenile polyposis and concurrent colorectal neoplasia.
- Evaluation of patient history for family history of juvenile polyps and colorectal neoplasia.
Main Results:
- 18% of patients with juvenile polyps (10 out of 57) exhibited colorectal neoplasia.
- Neoplasia included adenocarcinoma, tubular adenoma, and adenomatous epithelium within juvenile polyps.
- Colorectal neoplasia was more prevalent in patients with juvenile polyposis (≥3 polyps) and a family history, occurring at a mean age of 37 years.
Conclusions:
- Patients with juvenile polyps, particularly those with juvenile polyposis or a family history, have an increased risk of colorectal neoplasia.
- Early-onset colorectal neoplasia can occur in individuals with juvenile polyps.
- Surveillance for colorectal neoplasia is warranted in patients with multiple juvenile polyps or a family history of the condition.
Abstract:
Juvenile (retention) polyps are usually solitary lesions in the colorectum but may be multiple in juvenile polyposis. The association between juvenile polyps and colorectal neoplasia is controversial. We present three patients with juvenile polyposis who had colorectal adenomas or adenomatous epithelium in juvenile polyps at ages 3, 4, and 7 years. In a retrospective study of 57 additional patients with one or more juvenile polyps, 10 patients (18%) had colorectal neoplasia including three with adenocarcinoma, two with tubular adenoma, and six with adenomatous epithelium in a juvenile polyp (one had both adenomatous epithelium and an adenocarcinoma). Nine of these 10 patients had juvenile polyposis defined by the presence of at least three juvenile polyps; and eight of the nine had a family history of juvenile polyps. Colorectal neoplasia occurred at young age (mean (SEM) 37 (5) years). Our findings suggest that patients with juvenile polyps who have three or more juvenile polyps or a family history of juvenile polyps should undergo surveillance for colorectal neoplasia.