Background: Routine screening colonoscopy is on the rise and pathologists have to deal with the ever larger numbers of excised colonic polyps. It is very important to optimize the patients’ individual treatment and further surveillance. Pathologists play a critical role in management, as most of the clinical decisions concerning colonic polyp management are based on pathologic findings. One of the most important clinical issues in colonic adenomas is the diagnosis of malignancy and reporting its different aspects by the pathologist. The histologic type and the extent of carcinoma within a malignant polyp have considerable impact on the decisions of gastroenterologists and surgeons for further management. Therefore, the most recent literature regarding the diagnosis and reporting of the different features of malignant polyps was reviewed. Data Acquisition: There is growing literature regarding the different pathologic features and reporting of malignant colonic polyps, and in this review, published articles that are listed on Google Scholar and Pub Med are discussed. Conclusion: Diagnosis of malignant colon polyp requires the presence of tumor cells that are penetrating beyond the muscular mucosa into submucosa (pT1). As well as establishing a diagnosis of malignant polyp, it is very important to report the size of the invasive component, the presence or absence of lymphovascular invasion, the degree of tumor differentiation and the distance of the carcinoma from the line of resection. Other important features that may be reported include: the presence or absence of tumor budding, the depth of tumor cell penetration into the submucosa, and results of immunohistochemistry for mismatch repair proteins and BRAF.

Aim: The aim of this study was to report the anatomical location and histologic type of Colorectal polyps in a large series of Iranian patients that attended for colonoscopy.Background: polyps that develop through the adenoma-carcinoma pathway are considered neoplastic and may eventually progress to invasive carcinomas. In addition polyps can develop with no neoplastic potential. These neoplastic and non-neoplastic polyps can be identified and removed at colonoscopy.Patients and methods: In this retrospective study, the medical records of patients who had attended for colonoscopy were reviewed. Patient demographics and colonoscopy findings were reviewed. The anatomical location, macroscopic appearance and histological assessment of any polyps were recorded.Results: 716 patients’ records were reviewed. 437 patients (61 %) were male and 279(39%) were females. The mean patient age was 55.3 yr (18-89 yr). A total of 936 polyps were identified. 779 (83.3%) were neoplastic and 157(16.7%) polyps were non-neoplastic.727 of the polyps were adenomatous. Of the 727 adenomatous polyps: 198(27.2%) were in sigmoid, 156(21.24%) were in caecum and ascending colon, 153(21%) were in descending colon, 131(18%) were in transverse colon and 89(12.3%) were in rectum. 39.5% of adenomas were proximal to the splenic flexure. Carcinoma was observed in 52 cases. 18 carcinomas (34.5%) were left sided and 34 (65.5% of carcinomas) were right sided. Of the 716 patients, 179 patients (25%) had synchronous lesion(s).Conclusion: A significant number of adenomas and carcinomas lie proximal to the splenic flexure and occur in the absence of distal lesions. These lesions would be missed if the distal colon was examined and the entire colon examined only if a distal lesion was identified.

OBJECTIVES: To investigate fasting glucose, glucose tolerance, insulin resistance and insulin–like growth factor 1 in patients with or without Colorectal polyps.MATERIALS AND METHODS: In this cross-sectional study, we evaluated fasting glucose, insulin, insulin–like growth factor 1 (IGF-1), lipid profile and glucose tolerance test in 103 patients undergoing colonoscopy (52 normal and 53 with Adenomatous polyps). We also estimated homeostasis model assessment insulin resistance index (HOMA-IR) in two groups. Statistical analyses were performed using the Student T-test and Chi-square test. For all tests a P value£0.05 was considered to be statistically significant.RESULTS: The mean of waist circumference (P<0.01), waist to hip ratio (P<0.01), fasting serum glucose (P<0.05), total cholesterol (P<0.05), and LDL (P<0.05) were significantly higher in patients with adenomatous polyps. The mean of HDL was significantly lower in patients with adenomatous polyps (P<0.01). There was no relation between fasting serum insulin, IGF-1 and glucose tolerance test with adenomatous polyps. Hence HOMA-IR was higher in patients with adenomatous polyps (2.9±2.6 vs. 2.82±2.1), this difference was not significant statistically.CONCLUSION: Fasting hyperglycemia could be a risk factor to adenomatous polyps’ development. Although this study did not show any relation between insulin resistance index and adenomatous polyps, further studies are needed for more evaluation.