대한대장항문학회

Neoplastic polyps of colon are one of the most risky factors for colorectal cancer.<br>Particularly villous adenomas have more malignant potential than other neoplastic polyps.<br>The preoperative detection of malignant change in villous adenoma is very important to<br>determine treatment modality of patients. We conducted that total twenty-four cases of<br>villous adenoma who were diagnosed and treated at our institution between January<br>1990 and December 1995 were reviewed retrospectively. The peak incidence of age was<br>7th decades. And male to female ratio was 2 : 1. Size of the adenoma ranged from 1.2<br>to 10.7 cm with a mean diameter of 3.9 cm. Five cases(20.8%) were between 1 and 2<br>cm, 10(41.7%) between 2 and 4 cm, and 9(31.5%) greater than or equal to 4 cm.<br>Location of the adenoma were 10 cases(41.7%) in upper rectum, 8(33.3%) in<br>rectosigmoid, and 6(25.0%) in lower rectum respectively. Pathologic examination of the<br>resected specimen were diagnosed 9(37.5%) as benign villous adenomas, 10(41.7%) as in<br>situ carcinoma, and 5(20.8%) as invasive carcinoma. The diagnostic accuracy to detect in<br>situ carcinoma or invasive carcinoma was endoscopic examination in 66.7 percent and<br>digital examination in 86.7 percent. The grade of in situ carcinoma had not significantly<br>relationship with the size of the adenoma on our study. However, invasive carcinoma<br>was significantly related to adenoma size(P<0.05) as following results zero percent<br>between 1 and 2 cm, 20 percent between 2 and 4 cm, and 33.3 percent greater than or<br>equal to 4 cm. In conclusion, the larger villous adenoma has higher malignant potential,<br>especially greater than or equal to 4 cm in size. Added, the clinical impression of the<br>malignancy on digital examination can be more accurate than preoperative endoscopic<br>examination on our study.<br>