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Answers on p 541.
A 56 year old woman with no previous history of gastrointestinal disease presented with a short history of abdominal pain, altered bowel habit, weight loss, and anaemia. There was no mucus or blood in the stool. Colonoscopy revealed a constricting carcinoma at the hepatic flexure of the transverse colon and numerous sessile and pedunculated polyps both proximal and distal to the tumour. Subtotal colectomy with ileosigmoid anastomosis was performed. The resection specimen showed a Dukes' B adenocarcinoma with vascular invasion and contained 53 polyps, two of which measured 30 mm in diameter and many measured around 15 mm; two further polyps were sampled from the residual colon. Histologically these all proved to be hyperplastic polyps with two polyps showing foci of low grade dysplasia. The patient is still being followed up and 10 further small polyps (largest 8 mm) were found at colonoscopy six months postoperatively. She is a member of a large family and so far two first degree relatives have undergone colonoscopy. A 25 year old daughter had two hyperplastic polyps of the right colon; a second 28 year old daughter had no polyps.
A 33 year old man presented with a perianal abscess. Examination under anaesthesia performed at the time of drainage demonstrated irregularity and thickening of the rectum, clinically suspected to be a carcinoma. Biopsy specimens, however, showed a large hyperplastic polyp with epithelioid granulomata within the lamina propria suggestive of Crohn's disease. In total, 29 polyps were found at subsequent colonoscopy with the largest measuring 25 mm in diameter. Twenty four polyps were sampled and all showed hyperplastic morphology but three polyps also showed foci of mild dysplasia. There was no evidence of invasive tumour. He was treated with mesalazine for his suspected Crohn's disease and is currently well, although with several residual left sided polyps. He is being regularly followed up with colonoscopy.
(1) What are the differential diagnoses? (2) What is the diagnosis for these patients? (3) How would you manage patients with this diagnosis?
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