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Serrated polyposis syndrome is considered the most prevalent colonic polyposis syndrome in the world. Its importance has been increasingly discussed due to the significant increase in the risk of developing colorectal cancer in its affected individuals, similarly to other well-known polyposis syndromes, such as familial adenomatous polyposis. Serrated lesions of the colon play a major role in this syndrome represented by hyperplastic polyps, serrated sessile lesions and traditional serrated adenomas. Among these lesions, the sessile serrated lesion stands out, considered the main precursor lesion of the serrated pathway of colon carcinogenesis. Diagnosis of serrated polyposis syndrome is given through colonoscopy examination. Diagnostic criteria are: 1) 5 or more serrated lesions proximal to the rectum, all >4mm in size, with at least two >9mm in size; or 2) 20 serrated lesions of any size located anywhere in the large intestine, with >4 lesions proximal to the rectum. The ideal treatment is removal of all relevant serrated lesions by colonoscopy. In case of failure of endoscopic therapy, surgery is indicated. This manuscript is based on two case reports and a literature review and aims to broaden the discussion about the subject. (AU)

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Objective: To evaluate the prevalence of polyps and their treatments. Materials and Method: This is a retrospective study conducted in our department over 20 years and 3 months between January 2000 and March 2021. All patients with colorectal polyps who underwent endoscopic resection were included. We evaluated the resection techniques and the management of complications. Results: The total number of patients was 273, with a mean age of 57.26 ± 14.058 (18-90) and a M/W sex ratio of 2. The prevalence was 3.35% and the mean number of polyps was 1.33 ± 0.69. The most frequent symptoms were rectal bleeding (23.5%) and constipation (12.1%). The median size was 6 mm (4-12 mm). The left colonic location was the most frequent site (43%). All polyps were classified according to the Paris classification, with a predominance of sessile polyps in 45.75%, followed by pedunculated polyps, representing 42.4%. Endoscopic resection was performed either by biopsy forceps, polypectomy, or mucosectomy in 30.2%, 27.4%, and 25.4% of cases, respectively. Our study noted immediate bleeding in 1.5% of cases, and no perforations or late complications. All complications were treated endoscopically, and no patient required blood transfusion or surgical intervention. Conclusion: Endoscopic resection of rectocolic polyps is the ideal treatment for these lesions. In our department, the prevalence was 3.35%, the most used resection techniques were forceps resection and polypectomy, and the complication rate was 1.5%. (AU)

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Resumen Introducción: los pólipos del colon son los tumores más comunes del tracto gastrointestinal. Se presentan relativamente frecuentes en niños. El método eficaz para su diagnóstico es la colonoscopia que permite su tratamiento mediante la polipectomía. Objetivo: determinar las características clínicas, endoscópicas e histológicas de los pólipos colorrectales, diagnosticados en niños atendidos en el Hospital Pediátrico Provincial "Eliseo Noel Caamaño", de la ciudad de Matanzas. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo en niños diagnosticados con pólipos colorrectales y atendidos en el hospital. En el período comprendido del 2010 al 2018. Se estudiaron 141 pacientes menores de 18 años, con diagnóstico de pólipos por colonoscopia confirmado en el estudio histológico. Se excluyeron los pacientes con diagnósticos diferentes a pólipos y aquellos que no se pudieron estudiar histológicamente. Resultados: se observó mayor frecuencia de pacientes con pólipos en las edades entre 1 y 10 años (37,6 %), del sexo masculino (57,4 %). Los síntomas más frecuentes fueron el sangramiento digestivo bajo, (96,3 %) y prolapso de masa T por el recto, (27 %). Los pólipos estudiados se localizaron con mayor frecuencia en rectosigmoide (73, 4 %), predominando los pólipos únicos (78 %), pediculados (56,2 %), de 1-2 cm de tamaño (53,2 %). Histológicamente predominaron los pólipos juveniles, (62,1 %) seguidos de los inflamatorios (33 %). Conclusiones: los pólipos fueron más frecuentes en las edades de 1 y 10 años y en el sexo masculino. Se demostró la importancia de la colonoscopia en el diagnóstico precoz de estas lesiones (AU).

ABSTRACT Introduction: colon polyps are the most common tumors of the gastrointestinal tract. They are found relatively frequently in children. The efficacious method for their treatment is the colonoscopy, allowing their treatment through polypectomy. Objective: to determine the histological, endoscopic and clinical characteristics of colorectal polyps diagnosed in children who attended the Pediatric Provincial Hospital "Eliseo Noel Caamaño", of Matanzas. Materials and methods: a retrospective, descriptive study was carried out in children diagnosed with colorectal polyps in the hospital in the period from 2010 to 2018. 141 patients under 18 years-old were studied, all with diagnosis of polyps by colonoscopy confirmed in the histological study. The patients with different diagnosis but polyps were excluded, and also those who could not be histologically studied. Results: the highest frequency of patients with polyps was found in ages between 1 and 10 years (37,6 %), and the male sex (57.4 %). The most frequent symptoms were low digestive bleeding (96.3 %) and Mass T prolapse through the rectum (27 %). The studied polyps were more frequently located in the rectosigmoid (73.4 %). The single polyps predominated (78 %)m and the pedunculated ones (56.2 %) of 1-2 cm size (53.2 %). Histologically predominated young polyps (62.1 %), followed by the inflammatory ones (33 %). Conclusions: polyps were more frequent at the ages from 1 to 10 years and in the male sex. The authors showed the importance of colonoscopy in the precocious diagnosis of these lesions (AU).

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ABSTRACT Background: In the therapeutic decision about the malignant colon polyp, several factors predicting residual disease after the endoscopic resection guide the decision of surveillance or surgical intervention. This is a challenging decision, because even in the presence of high-risk predictors currently used, only 15-30% of the patients will have residual disease in the surgical specimen. Objective: To evaluate patients with a diagnosis of malignant colon polyp at the Hospital Center of São João, who were indicated for surgical treatment, studying the predictors of residual disease in the surgical specimen. Methods: A retrospective study was carried out, based on the patients with malignant colon polyp diagnosed and treated at the Hospital Center of São João in the city of Porto, Portugal, between 2009 and 2016. The endoscopic, anatomopathological, surgical and follow-up data were reviewed. Results: Of the total number of patients in the study (n = 96), 59 (61.5%) were indicated for surgery after a multidisciplinary discussion. Of this group, 21 patients (35.6%) had residual disease in the surgical specimen, with presence of lymph node invasion in 8 patients (13.6%). The presence of malignancy in the surgical resection specimen was statistically significantly associated with: size of the resected polyp (p = 0.023); sessile polyp (p = 0.007); piecemeal resection (p = 0.002). Conclusions: The persistence of malignancy in the surgical specimen was associated with larger sessile polyps and piecemeal removal. A significant number of patients did not show malignancy in the surgical resection specimen, with more markers being required to better stratify patients.

RESUMO Contexto: Na decisão terapêutica do pólipo maligno do cólon diversos fatores preditores de doença residual após a recessão endoscópica norteiam a decisão de vigilância ou intervenção cirúrgica. Esta é uma decisão desafiadora, uma vez que mesmo na presença dos preditores de alto risco usados atualmente, apenas 15% a 30% dos doentes terão doença residual na peça cirúrgica. Objetivo: Avaliar os doentes com diagnóstico de pólipo maligno do cólon no Centro Hospitalar de São João que foram orientados para tratamento cirúrgico, estudando os preditores de doença residual na peça cirúrgica. Métodos: Foi realizado um estudo retrospetivo, tendo por base os doentes com pólipo maligno do cólon diagnosticado e tratado no Centro Hospitalar de São João no Porto, Portugal, entre 2009 e 2016. Os dados endoscópicos, anatomopatológicos, cirúrgicos e o seguimento foram revistos. Resultados: Do total de doentes em estudo (n = 96); 59 (61,5%) tiveram indicação para cirurgia após discussão multidisciplinar. Deste grupo, 21 doentes (35,6%) apresentavam doença residual na peça cirúrgica, com presença de invasão ganglionar em 8 doentes (13,6%). A presença de malignidade na peça de ressecção cirúrgica associava-se de forma estatisticamente significativa a: tamanho do pólipo ressecado (p = 0,023); pólipo séssil (p = 0,007); ressecção em piecemeal (p = 0,002). Conclusões: A persistência de malignidade na peça cirúrgica associou-se a pólipos sésseis, de maiores dimensões e à remoção em piecemeal. Um número importante de doentes não apresentava malignidade na peça de ressecção cirúrgica, sendo necessários mais marcadores para melhor estratificar os doentes.

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El síndrome de Cowden es una enfermedad hereditaria, de transmisión autosómica dominante, caracterizada por la presencia de múltiples hamartomas y nódulos en la piel y la mucosa oral, junto con anomalías en mamas, tiroides y pólipos en el tracto gastrointestinal, con un riesgo incrementado de tumores malignos. Se reporta un caso de una paciente con diagnóstico de bocio tóxico nodular, y que presentaba -por los antecedentes y estudios realizados- manifestaciones compatibles con el síndrome de Cowden. El síndrome de Cowden es el síndrome hamartomatoso tumoral del phosphatase and tensinhomolog mejor descrito hasta el momento. Los pacientes con él tienen lesiones mucocutáneas características y un elevado riesgo de cáncer de mama, tiroides, endometrio, colorrectal y renal, así como varias manifestaciones benignas como macrocefalia y gangliocitomadisplásico del cerebelo. Es importante el diagnóstico precoz de este síndrome y el seguimiento a largo plazo, dado el alto riesgo de desarrollar tumores malignos(AU)

Cowden syndrome is a hereditary disease, of autosomal dominant transmission, and characterized by the presence of multiple hamartomas and nodules in the skin and oral mucosa, and also with abnormalities in the breast, thyroid, and polyps in the gastrointestinal tract with an increased risk of malignant tumors. It is reported a case of a patient with a diagnosis of toxic nodular goiter, and who presented -due to the antecedents and studies carried out- manifestations compatible with the Cowden syndrome. Cowden syndrome is the hamartomatous tumor syndrome of phosphatase and tensin homolog which is better described so far. Patients having it present characteristic mucocutaneous lesions and a high risk of breast, thyroid, endometrial, colorectal and renal cancers, as well as several benign manifestations such as macrocephaly and gangliocytoma of the cerebellum. Early diagnosis of this syndrome and long-term follow-up are important given the high risk of developing malignant tumors(AU)

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Pólipos colorretais são pequenas protrusões da mucosa colônica e do reto, sendo a sua grande maioria de potencial maligno baixo (como os adenomas tubulares com displasia de baixo grau) ou nulo (como os pólipos hiperplásicos). Os pólipos que contêm potencial maligno ­ os adenomas ­ são a parte inicial da cascata de carcinogênese de 95% das neoplasias malignas colorretais e podem ser diagnosticados e removidos através da colonoscopia. Esta guia apresenta informação que orienta a conduta para casos de pólipos colorretais no contexto da Atenção Primária à Saúde, incluindo: classificação dos pólipos colorretais, avaliação dos pólipos colorretais, seguimento das lesões pré-malignas, manejo dos pólipos colorretais, colonoscopia - procedimento e cuidados, rastreamento e vigilância de câncer colorretal, encaminhamento para serviço especializado.

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Antecedentes: La mayoría de los pólipos colorrectales son pequeños, no neoplásicos, asintomáticos y hallados durante la pesquisa o en forma incidental. Algunos de mayor tamaño pueden causar sangrado u obstrucción, aunque su verdadera importancia radica en que los adenomatosos preceden en más del 90 por ciento, al cáncer colorrectal (CCR), siguiendo en la mayoría de los casos una secuencia adenoma-carcinoma de lenta progresión que involucra múltiples alteraciones en genes supresores y oncogenes. En los últimos años una creciente evidencia demuestra otra vía de carcinogénesis a partir de los pólipos aserrados. Estos son precursores de cánceres colorrectales con inestabilidad microsatélite alta y extensa metilación del ADN, alteraciones genéticas diferentes a las de la vía tradicional que presenta inestabilidad cromosómica. El prolongado lapso de la clásica secuencia adenoma-carcinoma permite la realización de pruebas para la pesquisa de los pólipos adenomatosos y, ante su hallazgo el tratamiento endoscópico, como una forma efectiva de prevenir el CCR. Alrededor del 5 por ciento de los pólipos extirpados endoscópicamente presentan un adenocarcinoma invasor de la submucosa. La pesquisa ha llevado a encontrar más frecuentemente estos pólipos malignos que son por definición carcinomas tempranos T1. La polipectomía endoscópica se considera segura si es completa y el pólipo no tiene factores histológicos de riesgo para presentar metástasis linfáticas y recurrencia local. Sin embargo, hay cierta controversia en la literatura sobre cuáles son estos factores que permiten definir a los pólipos de alto riesgo para un resultado desfavorable con la polipectomía sola y que requieren una resección quirúrgica oncológica. Varios adelantos tecnológicos, algunos surgidos muy recientemente, pueden ayudar en la decisión terapéutica diferenciando las lesiones benignas de las malignas...

Background: Most colorectal polyps are small, non neoplastic, asymptomatic, and are found during screening or incidentally. Some larger polyps may cause bleeding or obstruction, however, their real importance is based on the fact that colorectal cancer (CRC) is preceded in more than 90 per cent by adenomatous polyps, in most cases through a slow progression of the adenoma-carcinoma sequence, involving multiple alterations in suppressor genes and oncogenes. In latest years, accumulative evidence shows that there is another pathway to carcinogenesis, arising in serrated polyps. These polyps are the precursors of CRCs with high microsatellite instability, and extensive DNA metylation, genetic alterations different from those seen in the traditional pathway, which presents chromosomal instability. The long period of time of the classical adenoma-carcinoma sequence allows performance of screcning tests for adenomatous polyps, and their endoscopic treatment when found, as an elective way to CRC prevention. Nearly 5 per cent of polyps removed endoscopically have an adenocarcinoma invading into the submucosa. The screening has lead to find these malignant polyps, early carcinomas T1 by definition, more frequently. Endoscopic polypectomy is considered safe if complete, and the polyp lack histological risk factors for lymphatic metastases and local recurrence. However, there is some controversy in the literature regarding which are these factors that define the high risk polyps for an unfavorable outcome with polypectomy only, and require an oncologic resection. Several technological advances, some very recently aroused, can assist in the therapeutic decision, by differentiating benign from malignant lesions. Others, like transanal endoscopic microsurgery, or laparoscopic technique, have contributed with the advantages of minimally invasive surgery...

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El cáncer colo-rectal (CCR) es la segunda causa de muerte por cáncer en los países occidentales. En el año 2004 se diagnosticaron aproximadamente 160.000 casos nuevos en EEUU, reportándose alrededor de 60.000 muertes por esta causa. En nuestro país se ha reportado un aumento dramático en la incidencia de este tipo de tumores, sin embargo, una de las principales características de éstos, es su buen pronóstico, logrando cifras de sobre vida a 5 años de hasta un 80%. Para alcanzar estos resultados es fundamental el diagnóstico precoz. En este sentido es muy importante tener una actitud agresiva frente a la pesquisa e identificación de pacientes con riesgo de desarrollar un CCR. Se ha considerado que los pólipos de colon son un factor de riesgo importante para desarrollar un CCR. De ahí deriva la importancia de su conocimiento, detección y extracción. El presente artículo tiene como objetivo presentar una actualización de los distintos tipos de pólipos excluyendo a la poliposis adenomatosa familiar, entidad que creemos merecería un artículo propio y por lo tanto escapa de los objetivos de la presente revisión.

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