Ileostomy polyps, adenomas, and adenocarcinomas.

Abstract

Ileostomy polyps are uncommon and poorly described. The aim of this study was to undertake a retrospective clinicopathological review of ileostomy polyps. Seven patients with 60 polyps arising on ileostomies performed for ulcerative colitis were studied. The histopathological evaluation of archival ileostomy biopsy specimens, polypectomy or excision specimens, and clinical review of patient records was undertaken. Fifty of 60 polyps were inflammatory cap polyps and six further polyps were composed of granulation tissue only. They occurred anywhere on the stoma at any time after ileostomy construction and were strongly associated with overt stomal prolapse. Four neoplastic polyps were identified in two patients 27-36 years after ileostomy construction; all occurred at the mucocutaneous junction. One patient presented with a 2 cm polypoid invasive adenocarcinoma while in the second a 1-7 cm polypoid mucinous adenocarcinoma and a 0.7 cm ileal tubular adenoma with high grade dysplasia occurred at the site of excision of a cap polyp showing focal low grade adenomatous dysplasia six years previously. Neoplastic and non-neoplastic polyps could not be differentiated clinically. It was found that most ileostomy polyps are inflammatory cap polyps associated with stomal prolapse. Less common are polypoid adenomas or adenocarcinomas arising at the mucocutaneous anastomosis >20 years after ileostomy construction. To prevent ileostomy carcinoma it is recommended that a biopsy of all polyps at the mucocutaneous anastomosis and of any nonprolapse associated polyps elsewhere on the stoma occurring >15 years after ileostomy construction is done. (Gut 1995; 37: 840-844)

Mucosal Dysplasia in Ileal Pelvic Pouches After Restorative Proctocolectomy

“…More than 20 cases of adenocarcinomas occurring within the ileostomy in patients with UC and patients with FAP have been reported. [39][40][41][42][43][44][45][46][47][48][49][50] The risk of cancer forming within a Kock pouch or ileal J-pouch based on the current literature seems to be no greater than the risk in a Brooke ileostomy.…”

In which patients do I perform IRA, and why?

“…Ileostomy neoplasia occurs in a small number of patients with FAP [23], although ignorance of the denominator makes its actual incidence hard to determine. The time to ileostomy neoplasia is quite long however, and inspection of the stoma at intervals is relatively easy to do.…”

“…This is most noticeable at either end of the polyposis spectrum. Attenuated FAP is associated with mutations in exons 3 and 4 (as well as 3¢ mutations in exon 15) [23], and profuse polyposis with the 'hot spot' mutation at codon 1309 [20]. In these circumstances the genotype suggests the surgical option: IRA for exon 3 and 4 mutations, and IPAA for 1309.…”

Successful Local Excision of Ileostomy Adenocarcinoma After Colectomy for Familial Adenomatous Polyposis: Report of a Case

“…The interval between the formation of the ileostomy and the presentation of an adenocarcinoma was about 26 years on average, ranging from 3 years to a maximum of 48 years. Five patients died; one of unresectable local recurrence, 4 one of bleeding after resection, 5 and three of widespread metastases after surgery. 2,6,7 Two patients had early-stage carcinoma developing in association with underlying disease.…”