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Dermatopathology: Practical & Conceptual July - September 2007
7. General Pathology: What is the true nature of colonic adenoma?—Part I: Confusion and controversy—a historical literature review
Masoud Asgari, M.D.
Sheng Chen, M.D., Ph.D.
Earliest descriptions of colonic polyps
Benign, premalignant, or malignant?
Unsatisfactory classification of colonic polyps
"The area of outright carcinoma (adenocarcinoma, Grade 2), is microscopic in dimensions. Had not the section luckily gone through this tiny carcinoma, the character of the growth surely would have been misjudged. In fact, this particular polyp, like many others in the series, was sectioned as a routine and pronounced benign. How many of these tumors are mislabeled, no one can know. Certainly, it is out of the question, in every day laboratory practice, to submit all of them to serial sectioning."
Fitzgibbon G, 1931[
"In the study of the histogenesis of these 24 carcinomata is the inescapable conclusion that carcinoma of the colon develops from an earlier stage as a polyp or through an intermediate stage as a polyp and not otherwise."
Fitzgibbon G, 1931 [
"The writer adds his opinion to that of others that the greatest majority, if not all, polypoid lesion of the colon and rectum, whether sessile or pedunculated, single or multiple, however small, will show definite changes from normal, whether they be anaplastic, hyperplastic, or in the so-called precancerous stage and, if allowed to remain in situ, will become frankly malignant."
Martin WJ, 1939 [
"We are hopelessly confused by their (pathologists) terms of metaplastic, hyperplastic, pseudoadenomatous, papillomatous, benign, precancerous, and carcinomatous polyps."
Ortmayer M, 1947 [
"The establishment of the transition from simple adenoma to carcinoma is relatively difficult . . . It is well known that some carcinomas of the large intestine simulate the cell arrangement of an adenoma so closely that the diagnosis of a malignant tumor depends entirely on the invasion of the wall of the intestine."
Helwig BB, 1947 [
"The actual transition from polypoid lesion to frank carcinoma has not been seen by the eye of man . . . The length of time necessary for the growth of polyps and the development of carcinoma vary with individuals but there can be no doubt that this phenomenon occurs.
" Bargen J, 1951 [
"In our opinion polyps (adenomas) of the large intestine, if given sufficient time, develop into carcinomas. Whether all carcinomas of the colon have their origin in polyps are a debatable point, and the mechanism by which a polyp becomes transformed into cells which assume independent growth is unknown. Likewise, the time factor needed for what one may consider a benign polyp to assume malignant characteristics is variable and difficult to determine."
Jackman RJ, 1951 [
"The words 'premalignant' or 'precancerous' have been avoided because they are essentially prognostic or statistical terms which indicate only a greater probability of the development of cancer. About the only precancerous aspect of the colon is the colon itself."
Turell R, 1964 [
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