Villous adenoma

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Synonyms and keywords: Adenomatous polyps; VA; TVA

Overview

Villous adenoma (also known as adenomatous polyp) is a type of polyp that grows in the colon and other places in the gastrointestinal tract. Villous adenomas may have a malignant (cancerous) transformation.[1]

Historical Perspective

  • Villous adenoma was first discovered by Helwig in 1946.[2]

Classification

  • Villous adenoma may be classified according to the World Health Organization into 3 groups:
  • Tubular,
  • Tubulovillous
  • Villous (most common)

Pathophysiology

  • The pathogenesis of villous adenoma is characterized by:
  • Villous adenoma arises from epithelial tissue with glandular characteristics
  • Villous adenoma are considered pre-malignant lesions
  • The APC mutation has been associated with the development of villous adenoma, involving the [molecular pathway] pathway.
  • On gross pathology, characteristic findings of villous adenoma, include:
  • Polypoid or sessile mass
  • Cauliflower-like in appearance
  • On microscopic histopathological analysis, characteristic findings of villous adenoma, include:
  • Nuclear changes at the surface of the mucosa
  • Cigar-shaped (elongated) nucleus (usu. length:width > 3:1) with nuclear hyperchromasia
  • Large round nuclei
  • Nuclear crowding
  • Positive Ki-67

Causes

  • The most important cause of villous adenoma is familial adenomatous polyposis.

Differentiating Villous Adenoma from Other Diseases

  • Villous adenoma must be differentiated from other diseases that cause abnormal growth of tissue projecting from a mucous membrane such as:
  • Cowden syndrome
  • Peutz-Jeghers Polyp
  • Inflammatory fibroid polyp

Epidemiology and Demographics

  • The prevalence of villous adenoma is approximately [number or range] per 100,000 individuals worldwide.

Age

  • Patients of all age groups may develop villous adenoma.

Gender

  • Males are more commonly affected with villous adenoma than females.

Race

  • Villous adenoma usually affects individuals of the Caucasian race.

Risk Factors

  • Common risk factors in the development of villous adenoma are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

  • The majority of patients with villous adenoma remain asymptomatic for [duration/years].
  • Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
  • If left untreated, [#%] of patients with villous adenoma may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
  • Common complications of villous adenoma include [complication 1], [complication 2], and [complication 3].
  • Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with villous adenoma is approximately [#%].

Diagnosis

Symptoms

  • Villous adenoma is usually asymptomatic.
  • Symptoms of villous adenoma may include the following:
  • [symptom 1]
  • [symptom 2]
  • [symptom 3]
  • [symptom 4]
  • [symptom 5]
  • [symptom 6]

Physical Examination

  • Patients with villous adenoma usually are well-appearing.
  • Physical examination may be remarkable for:
  • [finding 1]
  • [finding 2]
  • [finding 3]
  • [finding 4]
  • [finding 5]
  • [finding 6]

Laboratory Findings

  • There are no specific laboratory findings associated with villous adenoma.

Imaging and Diagnostic Findings

  • Colonoscopy is the imaging modality of choice for villous adenoma.
  • On colonoscopy, characteristic findings of villous adenoma, include:

Other Diagnostic Studies

  • Villous adenoma may also be diagnosed using colonoscopy.
  • Findings on colonoscopy, include:

Treatment

Medical Therapy

  • There is no treatment for villous adenoma; the mainstay of therapy is supportive care.

Surgery

  • Surgery is the mainstay of therapy for villous adenoma.
  • [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of villous adenoma.
  • [Surgical procedure] can only be performed for patients with [disease stage] villous adenoma.

Prevention

  • Effective measures for the primary prevention of villous adenoma include periodical screening on patients with family history of familial adenomatous polyposis
  • Once diagnosed and successfully treated, patients with villous adenoma are followed-up every 12 or 24 months.

References

  1. Villous adenoma
  2. Helwig E.B. Adenoma of the large bowel in children. . American Journal of Diseases in Children. 1946;72:289–95