Histopathological Characteristics of Colon Polyps – A Population-based Study in Tirana, Albania

Background: In Western countries the most common polyps are adenomatous.1 There are no studies from Albania regarding of polyps in colorectal area.

Objectives: Our aim was to evaluate the predominant colorectal polyps in our two centers of Albania.

Material and Methods: We retrospectively analyzed the pathology reports of colonoscopies during a six-year study (2008-2013).

Results: During these years, patients with colorectal polyps were referred to these two centers. The most common types of polyps were adenomatous 300 (72.99%), followed by hyperplastic 69 (16.78%), inflammatory25 (6.08%) and juvenile 17 (4.13%).

Discussion: Adenomatous polyps are the most frequently found polyps in our study. There are no studies from Albania regarding the distribution of different types of colorectal polyps. Therefore in this study we tried to evaluate the frequency of colorectal polyps concerning their type, age and gender.

Colorectal polyp; Albania; Hyperplastic; Gastrointestinal; Adenomatous; Lesion; Colonoscopy

The word polyp [1] in the gastrointestinal tract is used to describe any circumscribed lesion that projects above the surface of surrounding mucosa and used alone conveys nothing about the nature of such a lesion. It is only by microscopic examination that their true nature is determined. [2]. Colorectal polyps are very common. The most common polyps of the colorectal are the epithelial polyps which consist of adenomatous and hyperplastic polyps. The other less common polyps are nonepithelial polyps consist of inflammatory and juvenile polyps [3]. Colon polyps are important lesions and a concern because of the potential for colorectal cancer, one of the most common causes of cancer-related deaths in Albania.

Our aim was to evaluate the distribution of different types of colorectal polyps from January 2008 to December 2013 in the Department of Pathology of the University Hospital Center "Mother Teresa"and the Endoscopic Private Clinic “La Vita”.

This descriptive study was based on the review of 411 polypoid lesions of colon received fromJanuary 2008 to December 2013.

We examined all cases diagnosed as “polypoid lesions ” for patients admitted to one of two Endoscopy Centers in Tirana , Albania. Two doctors performed colonoscopy examinations. The patients underwent polypectomy procedures when polyps were revealed or cold forceps biopsy when malignancy was suspected. Two centers performed procedures with Narrow band

Imaging NBI, EVIS EXERA II CV-180 Olympus™, high definition endoscopes and they did not use chromo-endoscopy during the identification procedure. An opened biopsy forceps, measured 7 mm and opened polypectomy snare with known diameter were used for measuring the polyps before piecemeal resection. The polyps resected en block were measured with ruler. Cold forceps and cold snare have been the polypectomy methods of choice for smaller polyps, and hot snare has been the method of choice for larger polyps. Cold forceps polypectomy was used for small polyps 1 to 3 mm. Cold snare polypectomy was the method for removal of polyps 4-10 mm. Snare supplemented with electrocautery was used for polyps greater size then 10 mm in diameter. Endocopic Mucosal Resection (EMR) was been performed on sessile polyps 2 cm in size or larger, using submucosal injection of saline creating a cushion for the polyp and then hot snaring the polyp either en bloc or piecemeal. The most common way to retrieve a polyp which was snared was suctioning the polyp through the scope into a poliptrap. Sometimes polyp tissue can also be grabbed with forceps or with a snare while the entire colonoscope is withdrawn. In case of the polypoid lesion suspected for malignancy, 7-10 specimens was taken in each lesion. Clinical data, including age, sex, endoscopic findings and clinical diagnosis were recorded. The sections were stained with HE. The slides were examined by light microscope using 4 X, 10 X and 40 X dry objectives. All the cases were examined from two pathologists.

There were observed 411 polyps of large intestine, in 267 males and 144 females. The most common types of polyps were adenomatous 300 (72.99%), followed by hyperplastic 69 (16.78%), inflammatory 25 (6.08%) and juvenile 17 (4.13%).

Tubular adenomatous polyps were 225, the commonest polyps,in the current study. The age of patients ranged from 18 to 84 years with maximum number 24 in the fourth decade. In our study 159 from adenomatous polyps were tubular low grade dysplasia and 66 were tubular high grade dysplasia . The size of the polyps range from 0-4.5 cm. There were two brothers with adenomatous polyps and two female (aunt-niece) with adenomatous polyps and juvenile polyps. There were 295 (71.8%) polyps on the left side (rectum, sigmoid colon and descendent colon/from anus to lineal flexure) and 116 (28.2%) on the right side (colon ascendent and colon transvers).

Epithelial colorectal tumors are common pathologic entities. Their histology report should be comprehensive of a series of pathological parameters essential for the correct clinical management of the patients [4]. All adenomas have variable degrees of dysplasia ranging from low- grade to high-grade. Classically, it is believed that the malignant potential of adenomas

correlates with type of polyp, size and degree of dysplasia. Higher grades of dysplasia, increasing percentage of villous tissue within the polyp and polyps greater than 1 cm in diameter are associated with increased risk of malignancy [5]. Accurately identifying the colorectal polyps will promote better patient care [6]. The prevalence of colorectal adenomatous polyps varies widely from country to country [7]. It is very important to know the distribution of colorectal polys in other countries, because it may affect the efficacy of screening modalities and also the prevalence of adenomas that are roughly equivalent to the risk of colorectal malignancies [8,9]. There are no studies from Albania and regarding the distribution of different types of colorectal polyps. Therefore in this study we tried to evaluate the frequency colorectal polyps concerning their type, age and gender. In this study the majority of polyps were adenomatous. Overall, in most of the studies from Western countries, adenomatous polyps were more common than hyperplastic polyps, these reports are comparable to our findings. In this study the majority of polyps were adenomatous located in the rectosigmoid area (Tables 1-4).

Table 3 [10] shows the comparison between our findings and other studies from Western countries and countries such as India [11], Thailand [12] and Hong Kong. Overall, in most of the studies from Western counteris, adenomatous polyps were more common than hyperplastic polyps, these reports are comparable to our findings.

The results from Iran are very similar to those from Western countries such as Norway [13,14], and Canada [15] and different from reports of countries such as Denmark in which the number of hyperplastic polyps were more common than adenomatous polyps [9]. There are also uncommon reports from countries such as Thailand in which the most common type of polyps was juvenile type colorectal polyps [12].

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