On Adenomas and Hyperplastic Polyposis

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On Adenomas and Hyperplastic Polyposis
        
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?????????? ?? ????? ?????? ????? ??????? ???
?????? ?????? - ??? ??, ???? ?????????
?????????? ???? ?????? ????????????, ??????
????? ?Juvenile ????? ?????????, ???? ??????
????? ?????? ??????????? ??? ?? ?????? ???
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3 ???????? ??????? ??????? ????? ?5-6 ??. -
????? ???????? ???? ??? ????????? ????? ?????
???? ??????? ????????? LGD, ????
???????????, ?????? Juvenile -- ????????? ??????
?????????, ??????? ???? ????? ?-15 ?? ????
???????????.
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????????? ?? ????? ??? ?????? ?????(
Sweet K et al, JAMA 12.2005 294
(19)2465-73Ferrandez A et al, Am J Gastro
10.2004 99 (10) 2012-8
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????? ?????? ?"? ?WHO- ?-2000 (Jass and Burt)
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Ferrandez A et al, Am J Gastro 10.2004 99 (10)
2012-8
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60 ????? ?? ????????? ??????????
??????? ????? ????, ????? ??????? ?-1980
?"?Williams ??? ????? ??? ???????? ?????
(????? ???? 3-13 ???? ?? ????? ???????)
????? ???? ????? ????? ?????, ??????? ????? - ???
????? ??????? (Serrated ?? ??????) ?????
?????? ???? ? 0-60 ?????? ?????
Sweet K et al, JAMA 12.2005 294
(19)2465-73Ferrandez A et al, Am J Gastro
10.2004 99 (10) 2012-8
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60 ????? ?? ????????? ??????????
?? ?? ??????? ?????? ????????? ????? ???????
???? ??? ?????? -Hereditary Mixed Polyposis
syndrome ??? ???? ????? ?? ???????
???????????, Juvenile ????????, ???? ??
??????? ??????? ?? ?????? AD (15q13-q14)
??????????? ??????? ??? ??? ?? ???????
??????????? ???????? ???? ???????? ????? ??????
??? ???? ?? ????? ?????????? ???? ?????
Sweet K et al, JAMA 12.2005 294
(19)2465-73Ferrandez A et al, Am J Gastro
10.2004 99 (10) 2012-8
12
??????? ????? ?????????? ??????????
??' ?????
??????
????
????
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Williams GT, Histopathol 1980
0 (???? Y 3-13)
23
81
Sweet K, JAMA 2005
36 (4 ?-11)
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Rubio CA, Endoscopy 2006
70
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Hyman NH, Dis Col Rec 2004
54
14
79
Lage P, Am J Gastro 2004
43
15
73
Ferrandez A, Am J Gastro 2004
7 (???? 0.3-13, AV3Y)
12
92
Leggett BA, Am J Surg Pathol 2001
58
Place RJ, J Am Coll Surg 1999
6

50
7

Rozen P, Am J Gastro 2003(1 pedigree, mixed
polyposis)
0 (CRC in family members)
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??????? ????? ?????????? ??????????

• ????? ??????? ????? ?????-??? (overestimation) ??
  ?????? ?????????
• 1. ???? ??????, ?????? ????? ????? ????? ??????
  ??????????? ?????? ?????? ?? ??????? ??????
  ?? ????? ??? ?????? ???????.
• 2. ??? ???? ????? ???? ????? ????? ?? ?????
  ???????? ?????????? ????? ???? ??????
  ????????????? (???? ??? ????? ??????) ????
  ?????? ?????.
• .3 ????? ??????? ???? ??????? ????? ????? ???
  ?????.

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???? ????? ?????????? ?????? 1-3 ???? ??"?
???? 20
??? ??????? ????? ?????? ?????? ????? ??????
???? ?? ??? ????? ??????? ?????. ?????
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???? ???? ??? ??? ?????? ??????? ?????
??????? ?????? ?? ?????? ????? ??? ?? ????
?????-?????? ????? ???? ???? ???? ??????.
Lage P et al, Am J Gastro 9.2004 99 (9) 1779-84
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?????? (?????)
1. ?????! 2. ??? - ????? ??? ?? ????, ?????
????? ?? ???? ????
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Familial Syndromes with Juvenile Polyps
????????? ?????? (Juvenile Polyposis)

• Juvenile Polyposis (JPS)
• Peutz-Jeghers (PJ)
• Hereditary mixed polyposis

• Basal cell nevous
• Gorlin
• Osler-Weber- Rendu

• Bannayan- Riley- Ruvalcaba(BRR)
• Cowden

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??????? ??????? ??? ??????? ???? Juvenile

• Bannayan- Riley- Ruvalcaba (BRRs) Juvenile
  polyposis, macrocephaly, cognitive motor
  dysfunction, subcutaneous and visceral
  lipomatosis, hemangiomas, genital
  pigmentation.
• Cowden Juvenile polyposis, multiple other
  hamartomas, macrocephaly, cancers of breast,
  thyroid, uterus skin, papillomas,
  trichilemmomas.
• Basal cell nevous Juvenile polyposis, multiple
  basal cell carcinomas
• Gorlin Juvenile polyposis, multiple basal cell
  carcinomas, intracranial calcifications,
  skeletal, odontogenic cranio-facial
  abnormalities
• Osler-Weber-Rendu

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????????? ?????? (Juvenile Polyposis) ???????
Autosomal dominant
SMAD4/ DPC4 (18q21.1) (small mothers against
decapentaplegic /deleted in pancreatic
carcinoma) - tumor suppressor gene - acts in
TGF-? signal transduction
PTEN (10q22-23) (phosphatase tensin
homologue) - specific phosphatase, acts as
tumor suppressor
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• ????????? ??????- ????? ?????? (????? ???
  ???????????? ?????)
• ????? 5-10 ??????? ???? ??????- Juvenile ???? ???
• ????? ??????? ???? ?? ????? ?? ????? ??????
• ?????? ?? ???? ?????? ?? ????????? ?????? ??
  ???? ?? ??????? ???? ??

( Vasen HFA, J Clin Oncol, 11/2000)
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???????/??????? ?????????? ?????? (Juvenile
Polyposis)
???????
?? ????? ??????
????
??? ??

• ????? ???? ????? ????? ????? ???????? ??????
  ?????? 55-27 (???? ?? 38-13 ????' ?????
  ?????? 21-14)

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• ????????? ?????? - ????? ??????
• ???? ???? ??????, ????? ??????? (??????)
• ????? ????? ??????????? ?? ??' ????? ??????
  ??????? ????? ??? ?2-3 ???? (???? ?????-25 ??
  ????? ???? ?? ?? ?????????)

• ????????? ?????? - ?????
• ??????????? ?? ????? ??????? ?????
• ????? ??? ?? - ????????/??????? ?????????? ?????
  ?????? ?????? ?????????? ?? ?????????? ????