First observation of microadenomas in the ileal mucosa of patients with familial adenomatous polyposis and colectomies

Giorgio Bertoni, Romano Sassatelli, Evandro Nigrisoli, Paolo Tansini, Luca Roncucci, Maurizio Ponz de Leon, Giuliano Bedogni

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Abstract

Background & Aims: Little data are available on the type and prevalence of mucosal changes involved in the development of ileal adenomas in patients with familial adenomatous polyposis who have undergone colectomy. However, colonic metaplasia of the ileal epithelium is thought to be an important step in the development of such adenomas. Methods: Retrograde endoscopy and biopsy of the distal ileum were performed in 17 affected patients who underwent total colectomy or proctocolectomy 3-184.1 months (mean, 80.3 ± 13.9 months) before the study. Results: Macroscopic ileal polyps were identified in 14 (82.4%) patients. All polyps were sessile and 1-5 mm in size. Histological analysis showed adenomas in 9 (52.9%) patients and lymphoid hyperplasia or inflammation in the others. In 1 patient, an area of colonic-type metaplasia of the ileal mucosa was found close to an adenoma. However, in 5 (29.4%) patients, random biopsy specimens of the normal-appearing mucosa showed foci of abnormal crypts in the absence of metaplasia, with histological appearence similar to the findings described in dysplastic aberrant crypt foci of the colon. Such lesions, previously observed only in colorectal mucosa and referred to as microadenomas or oligocryptal adenomas, are considered putative preneoplastic abnormalities. Conclusions: Although the hypothesized sequence normal ileal mucosa leading to colonic-type metaplasia leading to adenoma cannot be excluded, our findings support the sequence normal ileal mucosa leading to microadenoma leading to gross adenoma and possibly cancer as the main histogenetic pathway, as already suggested for the large bowel.

Original languageEnglish
Pages (from-to)374-380
Number of pages7
JournalGastroenterology
Volume109
Issue number2
DOIs
Publication statusPublished - 1995

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Adenomatous Polyposis Coli
Colectomy
Adenoma
Mucous Membrane
Observation
Metaplasia
Polyps
Aberrant Crypt Foci
Biopsy
Ileum
Endoscopy
Hyperplasia
Colon
Epithelium
Inflammation

ASJC Scopus subject areas

  • Gastroenterology

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First observation of microadenomas in the ileal mucosa of patients with familial adenomatous polyposis and colectomies. / Bertoni, Giorgio; Sassatelli, Romano; Nigrisoli, Evandro; Tansini, Paolo; Roncucci, Luca; de Leon, Maurizio Ponz; Bedogni, Giuliano.

In: Gastroenterology, Vol. 109, No. 2, 1995, p. 374-380.

Research output: Contribution to journalArticle

Bertoni, Giorgio ; Sassatelli, Romano ; Nigrisoli, Evandro ; Tansini, Paolo ; Roncucci, Luca ; de Leon, Maurizio Ponz ; Bedogni, Giuliano. / First observation of microadenomas in the ileal mucosa of patients with familial adenomatous polyposis and colectomies. In: Gastroenterology. 1995 ; Vol. 109, No. 2. pp. 374-380.
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AU - Tansini, Paolo

AU - Roncucci, Luca

AU - de Leon, Maurizio Ponz

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