When we do colonoscopy, the most common neoplasm is polyps.
Among them, adenomatous polyps are actually the preparatory state for colon cancer, and more than 90% of colorectal cancers evolved from it
.

When we do colonoscopy, the most common neoplasm is polyps.
Among them, adenomatous polyps are actually the preparatory state for colon cancer, and more than 90% of colorectal cancers evolved from it
.

Colorectal cancer

The detection rate of adenomatous polyps after the age of 50 is very high
.

The detection rate of adenomatous polyps after the age of 50 is very high
.

A study showed that: in 7203 cases of colonoscopy, the detection rate of polyps was:

A study showed that: in 7203 cases of colonoscopy, the detection rate of polyps was:

17% before age 50,

35% for 50-59 years old,

56% for 60-69 years old,

>70 years old is 63%
.

17% before age 50,

17% before the age of 50 , 17% before the age of 50,

35% for 50-59 years old,

50-59 years old is 35%, 50-59 years old is 35%,

56% for 60-69 years old,

56% for 60-69 years old, 56% for 60-69 years old,

>70 years old is 63%
.

>70 years old is 63%
.

>70 years old is 63%

The above data does not include colonic polyposis, PJ syndrome, advanced colon cancer , unqualified bowel preparations, and failed examinations

Studies have shown that the malignant transformation rate of adenomas with a diameter of more than 2cm is as high as 50%, and the carcinogenesis rate of multiple familial polyposis can reach 100%, and the age of canceration is relatively young

Therefore, colonoscopy reports, as well as colonoscopy biopsy pathology reports, describe the most about colorectal polyps

Generally speaking, colorectal polyps involve two parts of professional terminology:

One is the report of colonoscopy, and the other is the pathology report after polypectomy or biopsy
.

One is the report of colonoscopy, and the other is the pathology report after polypectomy or biopsy
.

Many patients after removal of polyps took the report was perplexed, want doctors to have time to emulate them, reading about it
.

Many patients after removal of polyps took the report was perplexed, want doctors to have time to emulate them, reading about it
.

Interpretation

This article will explain some common professional terms
.

This article will explain some common professional terms
.

 

Overview of intestinal polyps

Overview of intestinal polyps

The surface of the intestinal mucosa of the human body will also have some limited bulges protruding into the intestinal cavity.
These bulges will be collectively called colorectal polyps before they have a clear nature
.

The surface of the intestinal mucosa of the human body will also have some limited bulges protruding into the intestinal cavity.
These bulges will be collectively called colorectal polyps before they have a clear nature
.

 

Colorectal polyps can be subdivided into adenomatous polyps and non-adenomatous polyps according to pathology;

Colorectal polyps can be subdivided into adenomatous polyps and non-adenomatous polyps according to pathology;

Adenomatous polyps mainly include tubular adenoma, villous adenoma, and tubular-villous adenoma;

Adenomatous polyps mainly include tubular adenoma, villous adenoma, and tubular-villous adenoma;

Non-adenomatous polyps mainly include inflammatory polyps, hyperplastic polyps, and hamartoma polyps
.

Non-adenomatous polyps mainly include inflammatory polyps, hyperplastic polyps, and hamartoma polyps
.

After determining the nature, add the name of the pathological diagnosis according to the location , there will be a more comprehensive professional term, such as: rectal tubular adenoma, sigmoid colon villous tubular adenoma, transverse colon villous adenoma, ascending colon hyperplastic polyp or cecal inflammation Polyps and so on
.

After determining the nature, add the name of the pathological diagnosis according to the location , there will be a more comprehensive professional term, such as: rectal tubular adenoma, sigmoid colon villous tubular adenoma, transverse colon villous adenoma, ascending colon hyperplastic polyp or cecal inflammation Polyps and so on
.

diagnosis

1.

 

1.
Single shot or multiple shots

1.
Single shot or multiple shots

According to the number of polyps: divided into multiple and single
.

Two or more are called polyps

According to the number of polyps: divided into multiple and single
.
Two or more are called polyps
.

Therefore, if your report is about multiple polyps, be sure to look at the number
.
Maybe there are only two
.

Therefore, if your report is about multiple polyps, be sure to look at the number
.
Maybe there are only two
.

2.
According to pedicle or without pedicle: Divided into pedicle type, Yati type (wide base type), flat polyps
.

2.
According to pedicle or without pedicle: Divided into pedicle type, Yati type (wide base type), flat polyps
.

The root means root
.
Think of the stems of mushrooms, hawthorns, and cherries
.
Generally speaking, pedicled polyps are much easier to remove
.

The root means root
.
Think of the stems of mushrooms, hawthorns, and cherries
.
Generally speaking, pedicled polyps are much easier to remove
.

3.
Endoscopic typing of polyps

3.
Endoscopic typing of polyps

(1) Japanese Yamada classification

(1) Japanese Yamada classification

Yamada Type I: The polyp has a flat base and a wide base, slightly raised on the surface of the intestinal wall
.
Simply put, this type of polyp is flat and has no pedicle
.

Yamada Type I: The polyp has a flat base and a wide base, slightly raised on the surface of the intestinal wall
.
Simply put, this type of polyp is flat and has no pedicle
.

Yamada Type II: The base of the polyp is prominent, and the polyp is hemispherical
.
Although the mucosal surface is prominent, the pedicle has not yet formed
.

Yamada Type II: The base of the polyp is prominent, and the polyp is hemispherical
.
Although the mucosal surface is prominent, the pedicle has not yet formed
.

Yamada Type III: The base of the polyp is prominent, forming an acute angle with the surrounding intestinal mucosa, and the polyp is spherical in shape
.
This is a thick pedicle polyp
.

Yamada Type III: The base of the polyp is prominent, forming an acute angle with the surrounding intestinal mucosa, and the polyp is spherical in shape
.
This is a thick pedicle polyp
.

Yamada Type IV: Polyps are spherical in shape, connected to the intestinal wall by short and long pedicles
.
A true pedunculated polyp
.

Yamada Type IV: Polyps are spherical in shape, connected to the intestinal wall by short and long pedicles
.
A true pedunculated polyp
.

(2) PS classification

(2) PS classification

This classification is in English, P (pedunculated) refers to peduncles, S (sessile) refers to flat, and PS refers to Yati
.
So if Ip refers to type I pedicled, and so on, Is refers to flat, Ips refers to Yati
.
Generally, professionals will divide it in more detail.
For non-professionals, it is enough to know whether a polyp has a pedicle or not
.

This classification is in English, P (pedunculated) refers to peduncles, S (sessile) refers to flat, and PS refers to Yati
.
So if Ip refers to type I pedicled, and so on, Is refers to flat, Ips refers to Yati
.
Generally, professionals will divide it in more detail.
For non-professionals, it is enough to know whether a polyp has a pedicle or not
.

2.
Pathology report

2.
Pathology report

 

1.
Adenomatous polyps

1.
Adenomatous polyps

It is a benign tumor composed of dysplastic glandular epithelium
.
The pathological types of adenomatous polyps are mostly classified according to the composition of the villi.
Those with a villus content of <25% are tubular adenomas, 25%-75% are villous tubular adenomas, and >75% are villous adenomas
.

It is a benign tumor composed of dysplastic glandular epithelium
.
The pathological types of adenomatous polyps are mostly classified according to the composition of the villi.
Those with a villus content of <25% are tubular adenomas, 25%-75% are villous tubular adenomas, and >75% are villous adenomas
.

(1) Tubular adenoma

(1) Tubular adenoma

It is the most common type of colorectal adenomatous polyps, mainly distributed in the rectum and sigmoid colon
.
Tubular adenomas under colonoscopy are mostly round or elliptical, with smooth surface, partly lobed, polyps of varying sizes, and most of them are pedicled
.

It is the most common type of colorectal adenomatous polyps, mainly distributed in the rectum and sigmoid colon
.
Tubular adenomas under colonoscopy are mostly round or elliptical, with smooth surface, partly lobed, polyps of varying sizes, and most of them are pedicled
.

Tubular adenomas generally grow slowly, differentiate well, and rarely become cancerous
.

Tubular adenomas generally grow slowly, differentiate well, and rarely become cancerous
.

If the polyp is a tubular adenoma, it can be a little relieved.
Tubular adenoma is the best type of neoplastic polyps.

If the polyp is a tubular adenoma, it can be a little relieved.
Tubular adenoma is the best type of neoplastic polyps.

It should be noted that although it is less cancerous, it does not mean that it will not become cancerous!

It should be noted that although it is less cancerous, it does not mean that it will not become cancerous!

(2) Villiform adenoma

(2) Villiform adenoma

It is not common in colorectal adenomatous polyps, accounting for 5%-10% of all colorectal adenomas, most of which are broad-based
.

It is not common in colorectal adenomatous polyps, accounting for 5%-10% of all colorectal adenomas, most of which are broad-based
.

Under colonoscopy, the villous adenoma has a pom-shaped surface and is often covered with mucus, sometimes with erosions
.

Under colonoscopy, the villous adenoma has a pom-shaped surface and is often covered with mucus, sometimes with erosions
.

The rate of dysplasia and carcinogenesis of villous adenomatous polyps is relatively high.
It has been reported in the literature that the rate of malignant transformation with a diameter greater than 2 cm is 50%
.

The rate of dysplasia and carcinogenesis of villous adenomatous polyps is relatively high.
It has been reported in the literature that the rate of malignant transformation with a diameter greater than 2 cm is 50%
.

If the polyp is villous, you must be highly vigilant and follow up closely
.

If the polyp is villous, you must be highly vigilant and follow up closely
.

(3) Tubular villous adenoma

(3) Tubular villous adenoma

As the name implies, this is a mixed type of tubular adenoma and villous adenoma, with different sizes.
Tubular villous adenomas can present different degrees of dysplasia, and their cancer risk is between tubular adenomas and villous adenomas.
Its cancer rate is related to its villi content
.

As the name implies, this is a mixed type of tubular adenoma and villous adenoma, with different sizes.
Tubular villous adenomas can present different degrees of dysplasia, and their cancer risk is between tubular adenomas and villous adenomas.
Its cancer rate is related to its villi content
.

For mixed adenomas, you must look at the villi content and the degree of dysplasia described.
If they are both high, follow up closely
.

For mixed adenomas, you must look at the villi content and the degree of dysplasia described.
If they are both high, follow up closely
.

2.
Hyperplastic polyps

2.
Hyperplastic polyps

Proliferative polyps are mostly sessile, a few have pedicles, with a small diameter, generally less than 5 mm, and usually occur in the proximal part of the large intestine
.
In the past, many doctors thought that the possibility of sporadic hyperplastic polyps becoming cancerous is very small
.
The current view is that some hyperplastic polyps can appear dysplasia, which has the potential to develop into atypical structures and cellular characteristics
.
Although the 2010 WHO digestive tumor classification system stated that the distal colon hyperplastic polyps less than 5mm in diameter can not be removed, but there is no clear grasp of hyperplastic polyps, do not be taken lightly, the need to follow-up review
.

Proliferative polyps are mostly sessile, a few have pedicles, with a small diameter, generally less than 5 mm, and usually occur in the proximal part of the large intestine
.
In the past, many doctors thought that the possibility of sporadic hyperplastic polyps becoming cancerous is very small
.
The current view is that some hyperplastic polyps can appear dysplasia, which has the potential to develop into atypical structures and cellular characteristics
.
Although the 2010 WHO digestive tumor classification system stated that the distal colon hyperplastic polyps less than 5mm in diameter can not be removed, but there is no clear grasp of hyperplastic polyps, do not be taken lightly, the need to follow-up review
.
Digestion

3.
Serrated adenoma

3.
Serrated adenoma

For this type of adenoma, not every endoscopist and pathologist are good at diagnosing
.
This kind of adenoma is characterized by a jagged appearance, and has both the structural characteristics of hyperplastic polyps and the cytological characteristics of adenomas
.

For this type of adenoma, not every endoscopist and pathologist are good at diagnosing
.
This kind of adenoma is characterized by a jagged appearance, and has both the structural characteristics of hyperplastic polyps and the cytological characteristics of adenomas
.

There are two main types: broad-based type (SSA/P) is more likely to occur in the proximal colon, which causes fewer symptoms, is larger than hyperplastic polyps, usually 5-10mm, and is flat or slightly raised polyps without a pedicle.
；

There are two main types: broad-based type (SSA/P) is more likely to occur in the proximal colon, which causes fewer symptoms, is larger than hyperplastic polyps, usually 5-10mm, and is flat or slightly raised polyps without a pedicle.
；

Traditional adenomas (TSA) are common in the distal colon.
Exogenous polyps are similar to tubular adenomas on the naked eye
.

Traditional adenomas (TSA) are common in the distal colon.
Exogenous polyps are similar to tubular adenomas on the naked eye
.

At present, serrated adenoma is a hot spot of concern, because researchers believe that the serrated pathway is the third way of colorectal cancer
.

At present, serrated adenoma is a hot spot of concern, because researchers believe that the serrated pathway is the third way of colorectal cancer
.

Once a serrated adenoma is diagnosed, attention should be paid
.

Once a serrated adenoma is diagnosed, attention should be paid
.

4.
Inflammatory polyps

4.
Inflammatory polyps

It is the inflammatory response hyperplasia caused by chronic inflammation of the intestinal mucosa.
The inflammatory stimulus leads to epithelial regeneration and repair, and the proliferation of fibrous tissue leads to the formation of polyps
.
Such polyps are usually small, with a diameter of less than 1cm
.
Whether inflammatory polyps become cancerous is currently controversial, but it is generally believed that inflammatory polyps can evolve into colorectal cancer after adenomatous changes occur
.

It is the inflammatory response hyperplasia caused by chronic inflammation of the intestinal mucosa.
The inflammatory stimulus leads to epithelial regeneration and repair, and the proliferation of fibrous tissue leads to the formation of polyps
.
Such polyps are usually small, with a diameter of less than 1cm
.
Whether inflammatory polyps become cancerous is currently controversial, but it is generally believed that inflammatory polyps can evolve into colorectal cancer after adenomatous changes occur
.

I think that if it is clear that it is an inflammatory polyp, the primary disease should be treated
.

I think that if it is clear that it is an inflammatory polyp, the primary disease should be treated
.

 

5.
Dysplasia (dysplasia)

5.
Dysplasia (dysplasia)

The so-called dysplasia or dysplasia is a very professional pathological term.
In layman's terms, the cell proliferation has not followed the benign direction, but has gone astray
.

The so-called dysplasia or dysplasia is a very professional pathological term.
In layman's terms, the cell proliferation has not followed the benign direction, but has gone astray
.

The degree of dysplasia of adenoma is divided into three degrees:

The degree of dysplasia of adenoma is divided into three degrees:

Mild dysplasia means that dysplasia cells are limited to the bottom of the epithelial layer, not exceeding 1/3 of the epithelial layer;

Mild dysplasia means that dysplasia cells are limited to the bottom of the epithelial layer, not exceeding 1/3 of the epithelial layer;

Moderate, that is, dysplastic cells account for 1/3～2/3 of the whole epithelial layer;

Moderate, that is, dysplastic cells account for 1/3～2/3 of the whole epithelial layer;

Severe dysplasia means that dysplasia cells account for more than 2/3 of the entire epithelial layer
.

Severe dysplasia means that dysplasia cells account for more than 2/3 of the entire epithelial layer
.

In layman's terms, the heavier the dysplasia, the closer to the cancer
.

In layman's terms, the heavier the dysplasia, the closer to the cancer
.

6.
Tumor (dysplasia, dysplasia)

6.
Tumor (dysplasia, dysplasia)

In the 2000 edition of the WHO classification of tumors, it is proposed that gastrointestinal tumors uniformly use "intraepithelial neoplasia" to replace the original term "dysplasia (dysplasia)"
.

In the 2000 edition of the WHO classification of tumors, it is proposed that gastrointestinal tumors uniformly use "intraepithelial neoplasia" to replace the original term "dysplasia (dysplasia)"
.

This classification integrates all the original dysplasia into intraepithelial neoplasia, that is, low-grade intraepithelial neoplasia replaces the original mild and moderate dysplasia, and high-grade intraepithelial neoplasia replaces severe dysplasia, and the original severe Dysplasia, carcinoma in situ, etc.
are completely equivalent to high-grade intraepithelial neoplasia
.

This classification integrates all the original dysplasia into intraepithelial neoplasia, that is, low-grade intraepithelial neoplasia replaces the original mild and moderate dysplasia, and high-grade intraepithelial neoplasia replaces severe dysplasia, and the original severe Dysplasia, carcinoma in situ, etc.
are completely equivalent to high-grade intraepithelial neoplasia
.

Therefore, it is recommended that for endoscopic biopsy pathology suggesting colorectal adenoma with intraepithelial neoplasia, whether it is low-grade or high-grade, it should be completely removed under endoscopy
.

Therefore, it is recommended that for endoscopic biopsy pathology suggesting colorectal adenoma with intraepithelial neoplasia, whether it is low-grade or high-grade, it should be completely removed under endoscopy
.

3.
Clinical significance

3.
Clinical significance

The purpose of understanding these professional words is to standardize treatment and regular review
.

The purpose of understanding these professional words is to standardize treatment and regular review
.

Colorectal adenomas can be distributed in various parts of the intestine, among which the left colon and rectum are more common
.
The purpose of polyp detection is to prevent cancer
.

Colorectal adenomas can be distributed in various parts of the intestine, among which the left colon and rectum are more common
.
The purpose of polyp detection is to prevent cancer
.

Modern science is very advanced, but the mechanism of colorectal cancer is still not fully understood.
Researchers believe that 70%-95% of colorectal cancer are derived from adenomatous polyps
.

Modern science is very advanced, but the mechanism of colorectal cancer is still not fully understood.
Researchers believe that 70%-95% of colorectal cancer are derived from adenomatous polyps
.

The development of colorectal cancer simply boils down to:

The development of colorectal cancer simply boils down to:

The process of normal mucosa-epithelial cell hyperplasia-tubular adenoma-villous adenoma-early cancer-invasive cancer, this evolution process takes about 5-15 years
.

The process of normal mucosa-epithelial cell hyperplasia-tubular adenoma-villous adenoma-early cancer-invasive cancer, this evolution process takes about 5-15 years
.

 

The size, pathological type, and degree of dysplasia of adenomas are closely related to the malignant transformation of colorectal adenomas, and the degree of dysplasia is more closely related to malignant transformation
.

The size, pathological type, and degree of dysplasia of adenomas are closely related to the malignant transformation of colorectal adenomas, and the degree of dysplasia is more closely related to malignant transformation
.

After understanding these professional words, focus on checking whether you are a high-risk adenoma according to your own endoscopy and pathology report.
If you are in line with high-risk, you should review the colonoscopy within 3-6 months after polypectomy
.

After understanding these professional words, focus on checking whether you are a high-risk adenoma according to your own endoscopy and pathology report.
If you are in line with high-risk, you should review the colonoscopy within 3-6 months after polypectomy
.

What is a high-risk adenoma?

What is a high-risk adenoma?

If the number of polyps is ≥3, the diameter is greater than 1cm, the pathology shows villous adenoma or mixed adenoma (containing more villous structural components), severe dysplasia (dysplasia), this type has a high tendency of malignant transformation , Called high-risk adenoma (American Cancer Society)
.

If the number of polyps is ≥3, the diameter is greater than 1cm, the pathology shows villous adenoma or mixed adenoma (containing more villous structural components), severe dysplasia (dysplasia), this type has a high tendency of malignant transformation , Called high-risk adenoma (American Cancer Society)
.

On the basis of the above definition, I suggest that serrated adenomas should also be included in high-risk adenomas to attract everyone's attention
.

On the basis of the above definition, I suggest that serrated adenomas should also be included in high-risk adenomas to attract everyone's attention
.
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