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Les polypes recto-coliques

Contribution of the anatomo-pathological analysis to the detection of intestinal tumours

Colorectal polyps

Apport de l’examen anatomo-pathologique au dépistage des tumeurs de l’intestin

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Résumé

Les polypes épithéliaux du côlon peuvent être classés en trois groupes distincts. Au premier groupe des lésions hamartomateuses appartiennent les polypes juvéniles et les polypes de la Maladie de Peutz-Jeghers. On peut ranger dans un second groupe de «polypes épithéliaux» de néoformation: les polypes adénomateux, villeux et carcinomateux. Le troisième groupe enfin comprend les polypes hyperplasiques.

Le polype hyperplasique occupe une place à part; il s’agit en effet d’une lésion de petite taille dont le décours est toujours bénin. Bien que l’on rencontre des polypes carcinomateux d’emblée, il est difficile d’apprécier l’incidence de ces «micro-cancers» dans la carcinogenèse colique. Il est par contre certain que les polypes adénomateux comme les polypes villeux peuvent constituer le point de départ de cancers. Le risque de transformation maligne est cependant très différent pour ces deux types de lésions: faible pour le polype adénomateux (en dehors de la polypose familiale), il est élevé dans le cas du polype villeux.

Dans le cadre d’un dépistage des lésions cancéreuses il importe donc de traiter aussi précocément que possible les polypes adénomateux et surtout villeux. Une collaboration étroite entre le pathologiste et le clinicien est importante pour permettre une orientation correcte des polypes et apprécier ainsi l’extension des zones de transformation maligne.

Summary

Three distinct groups of lesions can be differenciated among the epithelial colorectal polyps:

  1. a)

    The hamartomatous polyps i.e. juvenile and Peutz-Jeghers polyps;

  2. b)

    The hyperplastic polyps;

  3. c)

    The neoplastic polyps to which belong the adenomatous polyps, the villous adenomas and the carcinomatous polyps.

The small sized hyperplastic polyp has always a benign outcome. Although the carcinomatous polyps or «de novo» polypoid carcinomas are not rare, it seems very difficult to appreciate their incidence in colon carcinogenesis. On the contrary, it is well known that the adenomatous and villous polyps have a malignant potential. The risk of malignant transformation is however different for these two types of lesions: weak for the adenomatous polyps, it is significant in the villous adenomas.

With respect to early detection of bowel cancer, adenomatous and villous polyps should be handled whenever possible by total resection. A close cooperation between the endoscopist and the pathologist is necessary to permit a correct orientation of the resected polyps for the pathological examination, in order to appreciate with great accuracy the extension of possible foci of malignant transformation.

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Correspondence to J. Haot.

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Haot, J., Rahier, J. & Maskens, A. Les polypes recto-coliques. Acta Endosc 9, 161 (1979). https://doi.org/10.1007/BF02973633

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Mots-clés

  • Cancer
  • polypes
  • tumeurs
  • côlon rectum

Key-words

  • Colorectal cancer
  • polyps
  • tumours