소아 대장용종증 환자의 임상양상 및 내시경적, 조직학적 소견
Clinical, Endoscopic and Pathologic Findings of Colonic Polyposis in Korean Children
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Purpose: Colonic polyposis is less common in children than in adults. The clinical data pertaining to colonic polyposis in children are limited. Children with colonic polyposis have complications associated with numerous polyps, malignant transformation of the polyps, and extraintestinal neoplasms. We studied the clinical spectrum, endoscopic characteristics, and histologic findings of colonic polyposis in Korean children. Methods: We reviewed the clinical data of 37 children with multiple colonic polyps between 1987 and 2009. The mean age at the time of diagnosis of colonic polyposis was 8.0±3.2 years. Results: Peutz-Jeghers syndrome, juvenile polyposis syndrome, familial adenomatous polyposis (FAP), and lymphoid polyposis was diagnosed in 22, 7, 6, and 2 children, respectively. The most common clinical presentation in children with colonic polyposis was hematochezia. A family history of colonic polyposis was noted in 7 children. The colonoscopic findings of colonic polyposis varied with the size and number of polyps. The majority of polyps were multi-lobulatd and pedunculated in children with Peutz-Jeghers syndrome. The polyps in children with juvenile polyposis syndrome were primarily round and pedunculated. For the children with FAP, the colon was carpeted with small, sessile polyps. There were multiple sessile polyps in the patients with lymphoid polyposis. Surgical polypectomy was performed in 14 children (38%). Intestinal segmental resection was performed in 13 children (35%). Four patients with FAP underwent total colectomy. Four children with Peutz-Jeghers syndrome had extraintestinal neoplasms. No malignant transformation of polyp was identified. Conclusion: Children with colonic polyposis should undergo a careful initial evaluation and require periodic re-evaluation. (Korean J Pediatr Gastroenterol Nutr 2010; 13: 154∼163)
Abstract
Purpose: Colonic polyposis is less common in children than in adults. The clinical data pertaining to colonic polyposis in children are limited. Children with colonic polyposis have complications associated with numerous polyps, malignant transformation of the polyps, and extraintestinal neoplasms. We studied the clinical spectrum, endoscopic characteristics, and histologic findings of colonic polyposis in Korean children. Methods: We reviewed the clinical data of 37 children with multiple colonic polyps between 1987 and 2009. The mean age at the time of diagnosis of colonic polyposis was 8.0±3.2 years. Results: Peutz-Jeghers syndrome, juvenile polyposis syndrome, familial adenomatous polyposis (FAP), and lymphoid polyposis was diagnosed in 22, 7, 6, and 2 children, respectively. The most common clinical presentation in children with colonic polyposis was hematochezia. A family history of colonic polyposis was noted in 7 children. The colonoscopic findings of colonic polyposis varied with the size and number of polyps. The majority of polyps were multi-lobulatd and pedunculated in children with Peutz-Jeghers syndrome. The polyps in children with juvenile polyposis syndrome were primarily round and pedunculated. For the children with FAP, the colon was carpeted with small, sessile polyps. There were multiple sessile polyps in the patients with lymphoid polyposis. Surgical polypectomy was performed in 14 children (38%). Intestinal segmental resection was performed in 13 children (35%). Four patients with FAP underwent total colectomy. Four children with Peutz-Jeghers syndrome had extraintestinal neoplasms. No malignant transformation of polyp was identified. Conclusion: Children with colonic polyposis should undergo a careful initial evaluation and require periodic re-evaluation. (Korean J Pediatr Gastroenterol Nutr 2010; 13: 154∼163)
참고문헌 (31)
- 김성준, "소아기의 대장 용종 : 두 병원에서 조사한 34례", Korean Journal of Pediatrics, 47(7), pp.756~761 (2004), 대한소아과학회
- Gelb AM, "Rectal and colonic polyps occurring in young people", N Y State J Med, 62, pp.513~518 (1962)
- Mestre JR, "The changing pattern of juvenile polyps", Am J Gastroenterol, 81, pp.312~314 (1986)
- Poddar U, "Colonic polyps: experience of 236 Indian children", Am J Gastroenterol, 93, pp.619~622 (1998)
- Durno CA, "Colonic polyps in children and adolescents", Can J Gastroenterol, 21, pp.233~239 (2007)
- Latt TT, "Rectal bleeding and polyps", Arch Dis Child, 69, pp.144~147 (1993)
- Longo WE, "Malignant potential of juvenile polyposis coli. Report of a case and review of the literature", Dis Colon Rectum, 33, pp.980~984 (1990)
- 고평곤, "Peutz-Jeghers 증후군 환자에서 발생한 췌장 두부의 관내 유두상 점액성 악성 종양 1예", 대한소화기학회지, 55(1), pp.73~77 (2010), 대한소화기학회
- Kim JO, "A case of nonfamilial generalized gastrointestinal juvenile polyposis with pancytopenia", Korean J Pediatr, 39, pp.423~429 (1996)
- 곽정원, "소아 Peutz-Jeghers 증후군 환자에서 전장 내시경술에 의한 용종 절제술 1례", 대한소아소화기영양학회지, 8(1), pp.76~80 (2005), 대한소아소화기영양학회
- Jean-Francois M, "Intestinal polyps and polyposis. In: Walker WA, Walker SJ, editors. Pediatric gastrointestinal disease", pp.637~652 (2008), BC Decker Inc
- Elitsur Y, "Clinical and endoscopic data in juvenile polyposis syndrome in preadolescent children: a multicenter experience from the United States", J Clin Gastroenterol, 43, pp.734~736 (2009)
- 강보영, "단백 소실 장증으로 발현한 연소성 용종증 1례", 대한소아소화기영양학회지, 6(2), pp.208~214 (2003), 대한소아소화기영양학회
- Chang MS, "Intestinal polyposis: a clinicopathologic analysis of 28 resected cases with special reference to surgical intervention", Korean J Gastroenterol, 23, pp.62~74 (1990)
- Farmer RG, "The spectrum of the Peutz-Jeghers syndrome. Report of 3 cases", Am J Dig Dis, 8, pp.953~961 (1963)
- Calva D, "Hamartomatous polyposis syndromes", Surg Clin North Am, 88, pp.779~817 (2008)
- Jass JR, "Colorectal polyposes: from phenotype to diagnosis", Pathol Res Pract, 204, pp.431~447 (2008)
- Kojima M, "Localized lymphoid hyperplasia of the rectum resembling polypoid mucosa-associated lymphoid tissue lymphoma: a report of three cases", Pathol Res Pract, 201, pp.757~761 (2005)
- Seo JK, "Therapeutic colonoscopy in children: endoscopic snare polypectomy and juvenile polyps", Seoul J Med, 34, pp.285~294 (1993)
- Howe JR, "Direct genetic testing for SMAD4 mutations in patients at risk for juvenile polyposis", Surgery, 126, pp.162~170 (1999)
- Schmid C, "Primary B-cell mucosa-associated lymphoid tissue lymphoma presenting as a solitary colorectal polyp", Histopathology, 243, pp.357~362 (1994)
- Byrne WJ, "Lymphoid polyps (focal lymphoid hyperplasia) of the colon in children", Pediatrics, 69, pp.598~600 (1982)
- Scully RE, "Sex cord tumor with annular tubules a distinctive ovarian tumor of the Peutz-Jeghers syndrome", Cancer, 25, pp.1107~1121 (1970)
- Van Lier MG, "High cancer risk in Peutz-Jeghers syndrome: a systematic review and surveillance recommendations", Am J Gastroenterol, 105, pp.1258~1264 (2010)
- Barnard J, "Screening and surveillance recommendations for pediatric gastrointestinal polyposis syndromes", J Pediatr Gastroenterol Nutr, 48, pp.S75~78 (2009)
- Attard TM, "Diagnosis and management of gastrointestinal polyps: pediatric considerations", Gastroenterol Nurs, 29, pp.16~22 (2006)
- Park JG, "Hereditary colorectal cancer", Korean J Gastroenterol, 45, pp.78~87 (2005)
- Vasen HF, "Guidelines for the clinical management of familial adenomatous polyposis (FAP)", Gut, 57, pp.704~713 (2008)
- Merg A, "Genetic conditions associated with intestinal juvenile polyps", Am J Med Genet C Semin Med Genet, 129C, pp.44~55 (2004)
- Volikos E, "LKB1 exonic and whole gene deletions are a common cause of Peutz- Jeghers syndrome", J Med Genet, 43, pp.e18~ (2006)
- Yang HR, "Germline mutation analysis of STK11 gene using direct sequencing and multiplex ligation-dependent probe amplification assay in Korean children with Peutz-Jeghers syndrome", Dig Dis Sci, ~ (2010)