GASTROENTEROLOGY 1990;98:1117-1122
ALIMENTARY TRACT
Colorectal Adenomas in the Lynch Syndromes Results of a Colonoscopy Screening Program STEPHEN J. LANSPA, HENRY T. LYNCH, THOMAS C. SMYRK, PATRICIA STRAYHORN, PATRICE WATSON, JANE F. LYNCH, JOSEPH X. JENKINS, and HENRY D. APPELMAN Department of Medicine-Gastroenterology, Department of Preventive Medicine, and Department of Pathology, Creighton University School of Medicine, and the Hereditary Cancer Consultation Center, Omaha, Nebraska; and Department of Pathology, University of Michigan School of Medicine, Ann Arbor, Michigan.
Forty-four asymptomatic putative Lynch syndrome patients participated in a colonoscopy screening program. There were 18 men and 26 women; mean age was 44 yr. Thirty percent of Lynch syndrome patients had at least one adenoma; 200/0 had multiple adenomas. In 180/0 of the patients, adenomas were discovered proximal to the splenic flexure. In a reference group of 88 age- and sex-matched patients, 11 % had adenomas, 40/0 had multiple adenomas, and 1 % had right-sided adenomas. Twenty-one Lynch syndrome patients had follow-up colonoscopies. Of 7 patients with adenomas on initial examinations, 6 had adenomas at follow-up. Of 14 patients with negative initial examination results, 3 had adenomas at follow-up. The prevalence of adenomas in the Lynch syndromes is greater than in an unselected reference group. The adenomas are more proximally located, corresponding to the site of cancer distribution in the Lynch syndromes. A high rate of synchronous and metachronous lesions is found. Our findings support the hypothesis that adenomatous changes are the premalignant lesion in the Lynch syndromes. We also found evidence of heterogeneity among Lynch syndrome families in adenoma incidence.
I
ncreasing interest has been given to the role of genetics in the etiology of colorectal cancer. The best-known hereditary syndromes predisposing to colorectal cancer are those associated with multiple polyps of the colorectum, referred to as familial adenomatous polyposis. These disorders account for
ALIMENTARY TRACT
Colorectal Adenomas in the Lynch Syndromes Results of a Colonoscopy Screening Program STEPHEN J. LANSPA, HENRY T. LYNCH, THOMAS C. SMYRK, PATRICIA STRAYHORN, PATRICE WATSON, JANE F. LYNCH, JOSEPH X. JENKINS, and HENRY D. APPELMAN Department of Medicine-Gastroenterology, Department of Preventive Medicine, and Department of Pathology, Creighton University School of Medicine, and the Hereditary Cancer Consultation Center, Omaha, Nebraska; and Department of Pathology, University of Michigan School of Medicine, Ann Arbor, Michigan.
Forty-four asymptomatic putative Lynch syndrome patients participated in a colonoscopy screening program. There were 18 men and 26 women; mean age was 44 yr. Thirty percent of Lynch syndrome patients had at least one adenoma; 200/0 had multiple adenomas. In 180/0 of the patients, adenomas were discovered proximal to the splenic flexure. In a reference group of 88 age- and sex-matched patients, 11 % had adenomas, 40/0 had multiple adenomas, and 1 % had right-sided adenomas. Twenty-one Lynch syndrome patients had follow-up colonoscopies. Of 7 patients with adenomas on initial examinations, 6 had adenomas at follow-up. Of 14 patients with negative initial examination results, 3 had adenomas at follow-up. The prevalence of adenomas in the Lynch syndromes is greater than in an unselected reference group. The adenomas are more proximally located, corresponding to the site of cancer distribution in the Lynch syndromes. A high rate of synchronous and metachronous lesions is found. Our findings support the hypothesis that adenomatous changes are the premalignant lesion in the Lynch syndromes. We also found evidence of heterogeneity among Lynch syndrome families in adenoma incidence.
I
ncreasing interest has been given to the role of genetics in the etiology of colorectal cancer. The best-known hereditary syndromes predisposing to colorectal cancer are those associated with multiple polyps of the colorectum, referred to as familial adenomatous polyposis. These disorders account for
