Multiple polyposis of the colon, osteomatosis and soft-tissue tumors; report of a familial syndrome

Mesenteric fibromatosis complicating familial adenomatous polyposis: predisposing factors and results of treatment

Between January 1975 and December 1983, 24 of 183 patients (13%) with familial adenomatous polyposis (FAP) seen at the Mayo Clinic had mesenteric fibromatosis (MF). MF was found most often in FAP patients with associated extra-colonic "Gardner" signs (19 patients) and those who had had previous abdominal surgery (20 patients). In 4 patients, MF appeared spontaneously. The male-to-female ratio was 0.4, with a median age of 31 years in women and 37 years in men. Ten of 24 patients (42%) had been asymptomatic prior to diagnosis at time of surgery for FAP. Complications of the disease included intestinal or urinary tract obstruction. Minimal surgical manipulation seemed to be associated with fewer postoperative complications and a lesser risk of regrowth of the tumor. Nonsurgical treatment, including tamoxifen and sulindac in combination, may be beneficial. Surgery should be reserved for relief of obstruction, and bypass is preferred to resection.

Gardner's dento-maxillary stigmas in patients with familial adenomatosis coli

Fifty patients with familial adenomatosis coli (FAC) studied by panoramic tomography (PTG) showed osteomatous jaw changes in 82% as compared with 10% in matched controls. Supernumerary teeth, compound odontomas and/or impacted teeth were seen in 30% of the patients compared with 4% of the controls. A correlation was found between dental abnormalities and the large number of osteomas. The results support the view that both osteomas of the jaws and dental abnormalities are features of FAC. PTG of the jaws may serve as a valuable tool for early detection of FAC by oral surgeons, at least in the case of the most striking changes (about 20%).

Carcinoma arising in an ileostomy stoma: an unusual complication of adenomatous polyposis coli

A patient with adenomatous polyposis coli (APC) without extraintestinal lesions is presented. The clinical course was complicated by rectal adenocarcinoma following subtotal colectomy. A primary adenocarcinoma arising in a villous adenoma within the ileostomy stoma developed seven years later. The varied pathology of gastric and small intestinal involvement in APC/Gardner's syndrome is reviewed. Greater awareness of these lesions has implications for further management.

Adenomas of the small intestine: a clinicopathologic review of 51 cases and a study of their relationship to carcinoma

The authors studied 51 patients who had small bowel tumors that contained adenomatous epithelium. These rare lesions were identified among 392,000 surgical pathology cases seen during a 62-year period. Grossly and histologically, adenomas arising in the mucosa of the small intestine are similar to the adenomas found in the colon. Of the 51 patients, 18 had adenomas, and 33 had tumors that contained both adenoma and carcinoma in the same lesion, including five intramucosal and 28 invasive carcinomas. The location of the tumor usually determined which clinical problems were produced. The data indicate that adenomas originating in the small bowel mucosa probably are premalignant lesions and that many primary adenocarcinomas of the small intestine arise in adenomas. Of the authors' 130 apparently primary small bowel carcinomas (including the papilla of Vater), 33 (25%) histologically demonstrated adenomatous epithelium in the same lesion. Factors associated with an increased chance of finding carcinoma in an adenoma include adenoma type, size of lesion, location, and multicentricity. Carcinomas appear to develop more frequently in papillary (villous) adenomas than in ordinary adenomas. The larger the lesion is, the more likely carcinoma will be identified. Adenomas involving the ampulla contain carcinoma more often than do lesions found elsewhere in the duodenum and small intestine. Three patients had multiple adenomatous polyps of the small bowel; two of these individuals also had duodenal carcinomas. Various problems in pathologic diagnosis and clinical management are discussed.

Osteomatous changes and tooth abnormalities found in the jaw of patients with adenomatosis coli

Oral findings on the panoramic tomograms of fifty-two patients with adenomatosis coli (AC) are presented. Osteomatous lesions, embedded teeth, and supernumerary teeth were found more frequently in AC patients than in a normal population. The osteomatous lesions were found in more than 80 percent of the AC patients, and the average number of such lesions per patient was 4.7. In a normal population, 15 percent had the osteomatous lesions, and the average number per patient was 1.1. The panoramic tomograms of twelve AC patients who had more than six osteomatous lesions showed very characteristic images. The possibility of early detection of AC through oral radiographic findings is suggested.

Adrenal adenomas in a patient with Gardner's syndrome

Gardner's syndrome is an autosomal dominant condition characterized by multiple colorectal polyposis, associated with various soft- and hard-tissue tumors. The occurrence of adrenal adenomas in patients with the syndrome has not been fully appreciated. The following is a report of a member of the original Utah kindred #109, first described in the early 1950's who was found at autopsy to have bilateral adrenal adenomas. A review of the literature resulted in the identification of six cases with adrenal adenomas and one with a primary adrenal carcinoma. The association with the syndrome of these adrenal tumors, as well as other endocrine tumors, especially thyroid tumors, is discussed.

Gardner's syndrome with an unusual fibro-osseous lesion of the mandible

A girl with a family history of Gardner's syndrome presented with an actively growing central lesion of the mandible and localized subcutaneous fibrous hyperplasia which required surgical intervention and bone grafting. The importance of this syndrome is the development of intestinal polyposis which become malignant. The presence of dentofacial stigmata and surface tumors should alert the dentist and physician to the possibility of Gardner's syndrome.

Gardner's syndrome with duodenal adenomas, gastric adenomyoma and thyroid papillary--follicular adenocarcinoma

A case of a woman with Gardner's syndrome, originally manifested by multiple adenomatous polyps of the colon, is presented. She underwent subtotal colectomy at 14 years of age. Over the next 15 years she had a composite odontoma, an impacted supernumerary tooth, two epidermal inclusion cysts, multicentric paillary-follicular adenocarcinoma of the thyroid, two tubulovillous adenomas of the duodenum in which argyrophilic cells were a prominent feature, and an adenomyoma of the gastric antrum. The presence of all of these lesions in one patient expands the spectrum of lesions seen with Gardner's syndrome and supports the concept of a generalized abnormality of growth regulation as the cause of the syndrome.

Polyposis of the stomach and small intestine in association with familia polyposis coli

Three cases of familial polyposis coli with adenomatous polyps of the upper gastro-intestinal tract are reported. This association has not previously been described in Britain, probably because no special attempt has been made to detect polyps in these situations.

A careful study of known cases of polyposis coli is required to establish the frequency and fate of associated gastric or small intestinal polyps, with particular reference to the risk of malignant degeneration and the possibility of prophylactic surgical measures.

Cutaneous manifestations of visceral malignancy

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The occurrence of desmoids in patients with familial polyposis coli

Four cases of desmoid tumour are reported in conjunction with familial polyposis coli, and the salient clinical features of patients with this combination of conditions are examined in the literature and tabulated.

Desmoids occur very rarely in the general population but they are comparatively common in people with familial polyposis, in whom they may be situated in the abdominal wall, within the abdomen, or occasionally in other sites remote from the abdomen. They may antedate the discovery of polyposis by months or years. Any patient who is found to have a desmoid should therefore be examined for polyposis coli.

Intra-abdominal desmoids by virtue of their size and situation are often of serious significance to the patient, and their effects may belie the benign histological picture they present. Renal function may be impaired by pressure on the ureters, whilst surgical removal of the lesion, which is the principal method of treatment of desmoids, may be crippling to the patient or technically impossible. Radiotherapy seems to be of limited value in the management of these tumours.

No mass occurring within the abdomen or in the abdominal wall after surgery for polyposis coli should be regarded as a recurrent adenocarcinoma until proved to be so by adequate biopsy.