He Tubular adenoma Is a polyp that is tube-shaped. It is called"tubular adenoma"because of the rounded nature of the neoplastic glands that form it. These have smooth surfaces and are discreet.
Polyps are considered non-cancerous or benign growths and are common lesions in adults, however, if an adenoma or polyp is not removed in some cases and over time can become cancer.
In the case of the colon, tubular adenomas are the most common type of polyps, and most of these polyps are quite small. The larger adenomas rather than tubular, have a hairy growth pattern, are more likely to have cancer.
Small polyps are usually benign. Adenomas can be classified as minute (1 to 5 mm in diameter), small (6 to 9 mm) and large (≥ 10 mm). The advanced ones are ≥ 10 mm, or they are
Risks depend on the person, their habits and their family history. For example, people who smoke have a higher risk of them appearing in the bladder; Those who carry a high-fat diet to develop it in the colon; And women over the age of forty or women who have children are more likely to develop them in the uterus.
Treatment for tubular adenoma depends on its location, size, and whether it is benign or malignant.
Characteristics of the adenoma
Definition
An adenoma is a benign tumor of epithelial tissue with glandular origin, glandular features or both. These can grow from many glandular organs, including the adrenal glands, thyroid, prostate, pituitary gland , among other.
Certain adenomas grow in the non-ganglionic zones from the epithelial tissue. However, they reflect the structure of glandular tissue (as may occur in familial coli polyposis).
Although adenomas are considered benign, over time they can be transformed to become malignant, at which point they are known as adenocarcinomas. However, most adenomas do not transform.
While they are benign, they have the potential to cause serious health complications, because they compress other structures (mass effect) and produce huge amounts of hormones in an unregulated and non-feedback-dependent manner, leading to paraneoplastic syndromes .
Some adenomas are so small that they can not be seen macroscopically, but they can also cause clinical symptoms.
According to the American Cancer Society, definitions of adenoma may also include the term dysplasia. This expression is mostly to specify how much that tissue resembles cancer.
A mild to moderate dysplasia, or low grade dysplasia, means that the tissue is only slightly abnormal. High-grade or severe dysplasia indicates that the tissue looks more like cancer.
On the other hand, serrated sessile adenoma or traditional serrated adenoma or adenoma (adenomatous polyp) are precancerous. While these types of polyps increase the risk of cancer, most people who have them do not develop cancer.
Location
Adenomas can be found at:
Colon : Colonic adenomas are often present in colonoscopy, also known as adenomatous polyps. They are eliminated due to their tendency to become malignant and lead to colon cancer.
Colon polyp
Renal : May be a precursor lesion of renal carcinoma. It is a tumor that is often small and asymptomatic and that is derived from the renal tubules.
Adrenal : Adrenal adenomas are common and are usually discovered incidentally. They are often found in the abdomen. Approximately one in ten thousand is malignant, so a biopsy is rarely required, especially if the lesion is homogeneous and less than three centimeters. Monitoring images every three to six months can confirm growth stability.
Thyroid Approximately one in 10 people have solitary thyroid nodules. Research is necessary because a small percentage of these are malignant. The biopsy generally confirms that growth is an adenoma, but sometimes, excision is required in a surgery, especially when the cells found on the biopsy are follicular.
Parathyroid : An adenoma of a parathyroid gland can secrete an inappropriately high amount of parathyroid hormone and, therefore, cause what is known as Hyperparathyroidism primary.
Pituitary : Many of these adenomas remain undiagnosed. Pituitary adenomas are seen in 10% of neurological patients. Their treatment is usually surgical, and patients usually respond well.
The most common subtype, Prolactinoma , Is seen most often in women, and is frequently diagnosed during pregnancy, as the hormone progesterone increases its growth. Medical therapy with cabergoline or bromocriptine generally suppresses prolactinomas.
Liver : Hepatic adenomas are a benign and rare liver tumor, which can occur with Hepatomegaly Or other symptoms.
Chest : Breast adenomas are called Fibroadenomas . They are often very small and difficult to detect, because there are usually no symptoms. Treatments may include needle biopsy and / or removal.
Sebaceous : A sebaceous adenoma is a cutaneous condition characterized by a slow-growing tumor. It often presents as a pink or yellow colored papule or nodule.
Bronchial : Bronchial adenomas are adenomas in the bronchi. They can cause carcinoid syndrome, a type of paraneoplastic syndrome.
Appendix : Adenomas may also appear in the appendix, although this condition is extremely rare. The most common version is called cystadenoma.
They are usually discovered in the course of a tissue examination after an appendectomy. If the appendix has ruptured and there is a tumor present, this presents challenges, especially if malignant cells have formed and therefore have spread to the abdomen.
Salivary glands : These tumors are almost never dangerous. Most tumors of the salivary glands are benign, so they are not cancer and will not spread to other parts of the body.
There are many types of benign salivary gland tumors with names such as adenomas, oncocytomas, Warthin tumors, and benign mixed tumors (also known as pleomorphic adenomas). Benign tumors are almost always cured by surgery.
Very rarely, they can become cancer if they are not treated for a long time or if they are not completely eliminated and grow back. It is not clear exactly how benign tumors develop into cancers. There are many types of cancers of the salivary glands.
Normal salivary glands are made up of several different types of cells, and tumors can begin in any of these types. The type of cancer of the salivary glands, are named according to which of these cell types are most similar when viewed under a microscope.
Grade 1 cancers (also called low-grade or well-differentiated) look much like normal cells in the salivary glands. They tend to grow slowly and have a good result (prognosis). Grade 2 cancers (also called intermediate grade or moderately differentiated) have an appearance and perspective that is between grade 1 and grade 3 cancers.
Finally, grade 3 (also called high grade or poorly differentiated) cancers look very different from normal cells and often grow and / or spread rapidly. The outlook for these cancers is usually not as good as for lower grade cancers.
Polyps
Polyps are abnormal tissue growths that often look like small flat lumps or tiny mushroom-like stems. Most polyps are small and less than half an inch wide.
Polyps are commonly found in the colon, sinus, stomach, urinary bladder, uterus, nose, and ear. They may also be present in other parts of the body where there are mucous membranes such as the vocal folds, small intestine and cervix.
Some polyps are tumors (neoplasms) and others non-neoplastic (eg, hyperplastic or dysplastic). Neoplastic tumors are generally benign, although some may be premalignant and / or coincidental with a malignant neoplasm.
In the case of the colon, a polyp is a projection (growth) of tissue that goes from the lining of the colon to the lumen (hollow center) of the colon. Polyps are benign (non-cancerous), but cancer can begin in some types of polyps. Different types of polyps look different under a microscope.
Tubular adenomas are the most common adenomatous polyps. They can occur all over the colon and are the least likely colon polyps to develop in colon cancer.
Under the microscope different types of polyps are seen. Most polyps (approximately 90%) are small, usually less than 1 cm in diameter, and have a small potential for malignancy. The remaining 10% of the adenomas are greater than 1 cm and approach the 10% chance of containing invasive cancer.
symptom
In the case of tubular colon adenoma (the most common), there may be no symptoms. However, some patients have reported certain usual symptoms that, if they appear, it is advisable to attend a medical appointment. These are:
- Pain, nausea or vomiting . A large colon polyp may partially clog the bowel, leading to colicky abdominal pain, nausea and vomiting.
- Changes in bowel habits . Having constipation or diarrhea for more than a week may indicate the presence of a large colon polyp, although a number of other conditions can also cause changes in bowel habits.
- Change in stool color . The blood may appear as red streaks in the stool or make the stool tilt to black. However, a change in color can also be caused by foods, medications and supplements.
- Rectal bleeding . This can be a sign of polyps in the colon, cancer or other conditions such as hemorrhoids.
- iron deficiency anemia . Bleeding from polyps can occur over time, with no blood visible in the stool. Chronic bleeding takes away from the body the iron needed to produce hemoglobin , A substance that allows red blood cells to carry oxygen to the body. The result is anemia Iron deficiency , Which can make the patient feel tired and out of breath.
In other cases, depending on where you are, the following symptoms may or may not appear:
- Auditory: loss of hearing, presence of blood in the ear.
- Nasal: similar to the common cold, headache, loss of smell, pain in the nose.
- Gastric: nausea, pain, vomiting.
- Cervical: Heavier bleeding during menstruation or sex, unusual flow.
- Endometrial: irregular menstrual bleeding, vaginal bleeding, infertility.
- Vocal strings: voice hoarse and choppy for several weeks.
- Bladder: blood in the urine, frequent urination, pain when urinating.
Treatment
The treatment will depend on a number of factors, such as whether the adenoma is benign or cancerous, whether it is one or multiple, where they are located, and what their size is.
According to the American Cancer Society, in the case of the colon, most often adenomas are treated by removing them during a colonoscopy.
If an adenoma is too large to be removed during a colonoscopy, surgery may be necessary. Usually, an additional colonoscopy is programmed to monitor an individual for increased adenoma growth.
On the other hand, for some types and locations of tubular adenoma, certain hormones, and / or steroids may be indicated.
Difference between tubular, tubulovellosal and villous adenomas
Adenomas have several different growth patterns that can be seen by the pathologist under the microscope. There are two main growth patterns: tubular and villous. Because many adenomas have a mixture of both growth patterns, some polyps may be called tubulovelosal adenomas.
Most adenomas are small (less than ½ inch) and have a tubular growth pattern. Larger adenomas may have a pattern of villus growth.
In the larger adenomas are found more frequently the cancers. Adenomas with a pattern of villus growth are also more likely to have cancer. As long as the polyp has been completely removed and does not show cancer, the patient does not need to worry about the type of growth pattern seen in his polyp.
These growth patterns are primarily used to try to determine how often you will need a colonoscopy to make sure you do not develop colon cancer in the future.
Prevention
- Perform regular check-ups at the doctor, especially if there is a family history.
- Eat fruits and vegetables daily.
- Reduce fat intake.
- Limit consumption of tobacco and alcohol.
- Maintain a healthy body weight.
- Exercise regularly.
- Consult with your doctor about calcium and aspirin consumption, since in some cases they are beneficial.
- Consider having genetic counseling if you have a family history.
References
- Teri Longacre, MD (2014). Adenomas and hyperplastic polyps. ADASP. Retrieved from adasp.org.
- Spencer S. (2014). Tubular Adenoma. The University of Utah. Retrieved from library.med.utah.edu.
- Gloria Rosen (2016). Understanding Your Pathology Report: Colon Polyps. American Cancer Society.
- Deyhle P (1980). "Results of endoscopic polypectomy in the gastrointestinal tract". Endoscopy (Suppl): 35-46.
- Ann Pietrangelo (2016). What Are the Symptoms, Types, and Treatments for Polyps?. Healthline. Retrieved from healthline.com.