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* colon polyps- villous and adenomas - confusion??
 #401107  
  aditi12345 - 04/13/09 03:16
 
  these are three uw questions..i posted i answers too..plz anyone can clarify? thanks!!!

q1--> A healthy 62-year-old Caucasian man comes to see you for follow-up. He recently had a screening sigmoidoscopy. The report from the gastroenterologist says that he had two sessile polyps in the sigmoid colon, which were removed and sent for histology. The polyps were 1.5 cm and 2 cm in size. The result of the biopsy comes back as villous adenoma with low-grade dysplasia. The stalk of the polyp and the resected margins are free of dysplastic changes. The patient has never had any symptoms in the past. There is no history of colon polyps or cancer in his immediate family. Which of the following is the most appropriate next step in the management of this patient?

A) Do nothing at this point.

B) Schedule him for a double contrast barium enema.

C) Schedule him for a colonoscopy now.

D) Schedule a colonoscopy in 1 year.

E) Schedule a colonoscopy in 3 – 5 years.

The correct answer is: C



q2 --> The following vignette applies to the next 2 items

A 69-year-old African-American man comes to see you in the office. He recently had a screening colonoscopy, and was found to have a 1.8 cm pedunculated colon polyp on the right side, which was completely excised. The biopsy showed a high-grade dysplastic villous adenoma without any involvement of the stalk and its margins. There was no vascular or lymphatic involvement, either. There is no family history of colon polyps or colorectal cancer. He is otherwise in good health, and has no other medical problems.

(1)

Which of the following is the most appropriate next step in the management of this patient?

A) Do nothing at this point.

B) Repeat colonoscopy in 4 weeks.

C) Arrange for elective right hemicolectomy.

D) Repeat colonoscopy in 1 year.

E) Schedule for total colectomy.

The correct answer is: A


(2)
Which of the following is the most appropriate next step in the surveillance of this patient after an initial colonoscopic polypectomy?

A) Annual colonoscopy

B) Colonoscopy in 20 years

C) Colonoscopy in 3 years

D) Colonoscopy in 5 years

E) Colonoscopy in 10 years

The correct answer is: C
 
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* Re:colon polyps- villous and adenomas - confusion?
#1720557
  aditi12345 - 04/13/09 03:18
 
  AHHH...This 4th ques as well plz???

Thanks a million!!!

q -- > A 71-year-old Caucasian man comes to see you in the office for a follow-up visit. He recently had his second screening colonoscopy. His first colonoscopy was at age 50. The most recent colonoscopy revealed a 1 cm pedunculated polyp in the sigmoid colon. The polyp and its stalk were completely resected and sent for histopathology, which revealed an adenomatous polyp with an area of well-differentiated adenocarcinoma invading the muscularis mucosa in the head of the polyp. The stalk and the polyp margins were completely free of cancerous tissue. There was no lymphatic or vascular involvement seen in the tissue sample. The patient is otherwise in good health. Which of the following is the most appropriate next step in the management of this patient?

A) Repeat the colonoscopy in one year.

B) Refer the patient for an elective sigmoid resection.

C) Repeat the colonoscopy in three years.

D) Schedule the patient for an elective right hemicolectomy.

E) Refer the patient to a colorectal surgeon for further evaluation.
The correct answer is: C
 
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* Re:colon polyps- villous and adenomas - confusion?
#1720563
  aditi12345 - 04/13/09 03:38
 
  anyone?? plz!

i realy suck at the concepts for adenomas, tubular and vilous etc etc...so any feedback will be very appreciated..thanks!!!!
 
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* Re:colon polyps- villous and adenomas - confusion?
#1720787
  aditi12345 - 04/13/09 10:26
 
  bump  
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* Re:colon polyps- villous and adenomas - confusion?
#1720842
  crazycool6 - 04/13/09 11:18
 
  Based on the guidelines issued by the American College of Gastroenterology for postpolyectomy surveillance high risk patients should have a repeat surveillance colonoscopy in 3 yrs.

High risk patients include-
large polyps (more than 2 cm)
Multiple adenomatous polyps (more than 2 polyps)
Villous adenomas (worst type: sessile polyp)
High grade dysplasia or
non-invasive cancer at initial colonoscopy

Hope this helps !
 
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* Re:colon polyps- villous and adenomas - confusion?
#1720862
  crazycool6 - 04/13/09 11:34
 
  Also check this link for the paper:

http://www.ncbi.nlm.nih.gov/pubmed/18322143?dopt=Abstract
 
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* Re:colon polyps- villous and adenomas - confusion?
#1720975
  dochijazi - 04/13/09 13:04
 
  Q1 should be 1, is the same as Q2  
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* Re:colon polyps- villous and adenomas - confusion?
#1721447
  aditi12345 - 04/13/09 20:10
 
  i did not understand ur msg dochijazi

and thanks crazycool6..but still...i m still confused over the 4 ques above? :(

any help plz!
 
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* Re:colon polyps- villous and adenomas - confusion?
#1721508
  aditi12345 - 04/13/09 20:30
 
  FYI- i just found this link, and it made all 4 questions clear! :)

http://www.medicinenet.com/colon_polyps/article.htm
 
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