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.

Historical Perspective

• Villous adenoma was first discovered by Helwig in 1946.

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.