BACKGROUND/AIMS: A villous tumor, histologically villous or tubulovillous adenoma, is a clinical challenge because of its higher potential for malignancy and higher recurrence rate. However, information and experience with these tumors in the Korean people is still lacking. For that reason, we designed this study to review and analyze the colonoscopic features, the potential for malignancy, and the treatiment with respect to the confirmation of guidelines for the accurate diagnosis and reasonable management of such tumors in the Korean population. MATERIALS AND METHODS: We performed 753 polypectomies, including 4 transanal excisions and several bowel resections, from January 1996 to May 1997 at Song-Do Colorectal Hospital in Seoul, Among them, 447 cases (59.4%) were adenomas, comprising 405 (53.8%) tubular adenomas, 31 (4.1%) tubulovillous adenomas, and 11 (1.5%) villous adenomas. We analyzed the 42 (5.6%) tubulovillous and villous adenomas.
Adenoma ; Adenoma, Villous* ; Colon* ; Diagnosis ; Rectum* ; Recurrence ; Seoul

BACKGROUND/AIMS: Among colorectal neoplasms, laterally spreading tumors (LSTs) are defined as tumors over 10 mm in diameter that are low in height and grow superficially. We analyzed the clinicopathologic characteristics of LSTs in colorectum. METHODS: Forty six LSTs were analyzed according to their endoscopic and pathologic findings. RESULTS: Incidence of LSTs were 2.0% (46/2,276). Twenty two LSTs (47.8%) were less than 20 mm in diameter, 20 (43.5%) were 20-30 mm, 4 (8.7%) were larger than 30 mm. The most frequent location was rectosigmoid colon (54.3%), followed by ascending colon (21.7%). Morphplogic types were GH types 37.0% (17/46), MN types 30.4% (14/46) and F types 32.6% (15/46). Histologic types were tubular adenomas 65.2% (30/46), tubulovillous adenomas 26.1% (12/46) and villous adenomas 8.7% (4/46). The overall malignancy rate was 19.6% (9/46). Malignancy rates were 4.5% (1/22) in the lesions less than 20 mm, 30.0% (6/20) in 20-30 mm, 50.0% (2/4) in larger than 30 mm. Malignancy rates were 11.8% (2/17) in GH type, 21.4% (3/14) in NM type and 26.7% (4/15) in F type. Carcinoma invaded into the submucosa were present in one lesion of NM types and two of F type. CONCLUSIONS: LSTs larger than 20 mm had high malignant potential, more than 30%. Furthermore, LSTs showed different clinicopathologic characteristics depending on the morphologic classification. NM or F type had higher malignant potential than GH type.
Adenoma ; Adenoma, Villous ; Classification ; Colon ; Colon, Ascending ; Colorectal Neoplasms ; Incidence

Postpolypectomy surveillance has become a major indication for colonoscopy as a result of increased use of screening colonoscopy in Korea. In this report, a careful analytic approach was used to address all available evidences to delineate the predictors for advanced neoplasia at surveillance colonoscopy and we elucidated the high risk findings of the index colonoscopy as follows: 3 or more adenomas, any adenoma larger than 10 mm, any tubulovillous or villous adenoma, any adenoma with high-grade dysplasia, and any serrated polyps larger than 10 mm. Surveillance colonoscopy should be performed five years after the index colonoscopy for those without any high-risk findings and three years after the index colonoscopy for those with one or more high risk findings. However, the surveillance interval can be shortened considering the quality of the index colonoscopy, the completeness of polypectomy, the patient's general condition, and family and medical history.
Adenoma ; Adenoma, Villous ; Colonoscopy ; Colorectal Neoplasms ; Humans ; Korea ; Mass Screening ; Polyps

The villous adenoma of the duodenum is a rare disease and a considerable portion of the cases are known to be associated with malignancy. Although the diagnosis can be made with duodenoscopy, some cases showed false negative rate for malignancy detection with endoscopic biopsy only. So Whipple's operation is preferred than local excision. We experienced a case of tubulovillous adenoma involving ampulla of Vater, which recurred after local excision. So we report a case of tubulovillous adenoma involving ampulla of Vater with relevant literature.
Adenoma* ; Adenoma, Villous ; Ampulla of Vater* ; Biopsy ; Diagnosis ; Duodenoscopy ; Duodenum ; Rare Diseases

BACKGROUND: EMR is an alternative to surgical removal of superficial neoplastic lesions of the gastrointestinal tracts. The aim of this study is to assess the diagnostic efficacy of EMR in gastric flat adenoma. METHODS: Ninety five lesions of gastric flat adenoma removed by EMR in 89 patients were enrolled in this study at Kyungpook National University Hospital from January 1999 to June 2002. We have analysed diagnostic efficacy of EMR in gastric flat adenoma. RESULTS: Tubular adenoma were 78 cases (82.1%), tubular adenoma with high grade dysplasia were 16 cases (16.8%) and villous adenoma was 1 case (1.1%). Locations were antrum 57 cases (60.0%), body 22 cases (23.1%), angle 14 cases (14.7%), pylorus 1 case (1.1%) and cardia 1 case (1.1%). Among 95 lesions of gastric flat adenoma, 26 cases (27.4%) revealed upgraded histologic diagnosis between endoscopic biopsy and EMR. Twenty two lesions (37.3%) among 59 lesions that were 1cm size or more were upgraded in the histologic staging to carcinoma or high grade dysplasia, compared with 4 lesions (11.1%) among 36 lesions less than 1cm size (p<0.01). Eight lesions (50.0%) among 16 lesions diagnosed in tubular adenoma with high grade dysplasia were upgraded in the histologic staging to carcinoma, compared with 12 lesions (15.4%) among 78 lesions diagnosed in tubular adenoma (p<0.01). Bleeding was the only complication and occurred in 24 lesions (25.3%). CONCLUSION: EMR resulted in upgrading of the histologic staging to carcinoma or high grade dysplasia in 27.4% of gastric flat adenomas.
Adenoma* ; Adenoma, Villous ; Biopsy ; Cardia ; Diagnosis ; Gastrointestinal Tract ; Gyeongsangbuk-do ; Hemorrhage ; Humans ; Pylorus

The aim of this study was to investigate the association of colorectal polyps with carcinoma of the colon and rectum. METHODS: Between January 1995 and December 1998, 203 consecutive patients with 423 colorectal polyps retrospectively documented at the Department of General Surgery and College of Medicine in Dongguk University. RESULTS: The peak age group of the colorectal polyp was in the fifth decades (33.5%). The proportions of malignant polyps were as follows: for size, 5.2% of polyps less than 1.0 cm and 19.5% of polyps larger than 1 cm (P<0.05); for morphology, 2.6% in polyps of Yamada type I, II and 18.5% in polyps of Yamada type III, IV (P<0.05); for location, 13.4% of the polyps located in rectum and sigmoid colon and 7.6% of the polyps located in descending to ascending colon (P>0.05); for number of polyp, 4.5% in cases of single polyp and 25.0% in cases of multiple polyps (P<0.05); for underlying histology, 9.2% in cases of tubular adenoma and 19.2% in cases of villous adenoma (p<0.05). The presence of distal adenomatous polyp was increased the risk of presence of the proximal adenomas (59.7%), whereas the presence of hyperplastic polyp did not (16.7%). CONCLUSIONS: The malignant potential of colorectal polyps are correlated with size, histologic type, morphologic shape, multiplicity and distal location. The presence of hyperpalstic polyp should not be indication for colonoscopy because they are not associated with proximal adenoma when adjusting for patient characteristics and presence of distal adenoma.
Adenoma ; Adenoma, Villous ; Adenomatous Polyps ; Colon ; Colon, Ascending ; Colon, Sigmoid ; Colonoscopy ; Humans ; Polyps* ; Rectum ; Retrospective Studies

Villous adenomas of the ampulla of Vater are rare premalignant tumors that have been reported to occur in 0.04% to 0.12% of postmortem series. Traditionally surgical treatment has been used but it might result in significant morbidity and mortality. This case is a villous adenoma of ampulla of Vater found incidentally, but successfully removed by endoscopic method. After endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS), we resected the tumor of ampulla of Vater endoscopically using endoscopic mucosal resection (EMR) method. The post-procedure course was uneventful. Here we report an ampullary adenoma resected by endoscopic method in a 42-year-old man with villous adenoma of the ampulla of Vater.
Adenoma* ; Adenoma, Villous ; Adult ; Ampulla of Vater ; Cholangiopancreatography, Endoscopic Retrograde ; Endosonography ; Humans ; Mortality

BACKGROUND/AIMS: Endoscopic en-bloc resection of the large colorectal lesions is technically difficult. The aim of this study is to evaluate the usefulness of combined endoscopic submucosal dissection (ESD) and snare resection for treating colorectal lesions. METHODS: We enrolled 23 patients (M:F=14:9, age range: 46~76 years) with 25 colo rectal tumors that were around or above 20 mm in diameter. A combined treatment of ESD and snare resection was performed. RESULTS: The mean size of the 25 lesions was 22.6+/-8.2 mm (range: 15.0~44.0 mm). Ten lesions were laterally spreading tumors and 15 lesions were found in the rectum. On the histopathologic examination, 16 lesions were adenocarcinoma, 2 lesions were villous adenoma, 1 lesion was a villotubular adenoma, 5 lesions were tubular adenoma and 1 lesion was a hyperplastic polyp. The mean resection time was 27+/-22 min (range: 10~91 min). En bloc resection was possible for 19 lesions (76%). Of these, 18 specimens showed clear resection margins and 1 showed a positive deep resection margin. Of the 6 piecemeal resection cases, 2 showed positive lateral resection margins. Therefore, an 88% tumor free resection rate was obtained. CONCLUSIONS: Combined ESD and snare resection may be an effective and safe modality for the resection of large colorectal lesions.
Adenocarcinoma ; Adenoma ; Adenoma, Villous ; Colorectal Neoplasms ; Humans ; Polyps ; Rectal Neoplasms ; Rectum ; SNARE Proteins*

BACKGROUND/AIMS: Adenomatous polyps of the colon are believed to be precursor of colon cancer. Total polyp resection is indicated when they are identified. However, resection of the polyp is not always attainable at the initial colonoscopy. The aim of this study was to assess the validity of cold biopsy findings as representative of the whole polypectomy specimen, with regard to the histopathological features. METHODS: We analyzed 221 patients with colon polyps that were biopsied at their initial colonoscopy and had their adenomas subsequently removed by polypectomy within 2 weeks from the initial procedure. We analyzed the histopathological discrepancies between the cold biopsy and the polypectomy specimens. RESULTS: We analyzed 302 cases from 221 patients. There was 71.2% agreement between the forceps biopsy and the polypectomy. When colon polyps were diagnosed as carcinoma and villous adenomas, the diagnosis was the same in the polypectomy. Discrepancy between in forceps biopsy with polypectomy was found in the tubular adenomas obtained by forceps biopsy. Fifty tubular adenoma samples obtained by forceps biopsy had a deferent diagnosis than did the polypectomy. Fourteen of 50 tubular adenomas were underestimated by the forceps biopsy samples and seven of the 50 tubular adenomas were finally diagnosed as carcinoma from the polypectomy specimens. Seven villous adenomas were diagnosed as carcinoma and had severe dysplasia (n=4) or 1>=(n=1) size. CONCLUSIONS: Accurate tissue sampling of colorectal adenomas is crucial for their management. However, forceps biopsy does not accurately reflect the histology of colon polyps. Total resection of colon polyps is needed for an accurate diagnosis.
Adenoma ; Adenoma, Villous ; Adenomatous Polyps ; Biopsy ; Cold Temperature ; Colon ; Colonic Neoplasms ; Colonoscopy ; Humans ; Polyps ; Surgical Instruments

Villous adenomas of the common bile duct are rare and accordingly it is difficult to render a firm preoperative diagnosis. They are the unusual cause of bile duct obstruction and can mimic malignant extrahepatic biliary tumors or stones. Until recently, only a few cases had been reported in the medical literature. Although some authors advocate open surgical excision, especially with recurrence or carcinomatous change, an endoscopic resection of a distal common bile duct adenoma is a viable alternative for those patients considered poor surgical risks. We present two cases of villous adenoma of the common bile duct diagnosed by an endoscopic biopsy and endoscopically resected, with review of the relevant literature on the subject.
Adenoma ; Adenoma, Villous* ; Biopsy ; Cholestasis ; Common Bile Duct* ; Diagnosis* ; Humans ; Recurrence