From Big Medical Encyclopedia

FLEECY TUMOUR (papillary adenoma, polypiform adenoma, adenopapilloma, fleecy polyp) — a benign ferruterous tumor, coming from a cover epithelium of a mucous membrane of a straight line (is more rare — other departments thick) guts; nek-ry types are inclined to a malignancy.

Fig. 1. A microscopic structure of a fleecy tumor with the initial phenomena of proliferation of glands (it is specified by shooters; X 200).
Fig. 2. The expressed proliferation and an atipizm of a ferruterous epithelium in a malignizirovanny ferruterous tumor (it is specified by shooters; x 400).
Fig. 1. A fleecy tumor of a large intestine with a characteristic melkodolchaty and papillary surface.
Fig. 2. A fleecy tumor of a large intestine on the wide basis.

Century of the lake of a soft consistence, pinkish-red color; a surface of its spongy look at the expense of speakers over the level of a mucous membrane of the numerous long or short easily bending thin fibers, coming from the general wide basis of irregular shape (tsvetn. fig. 1 and 2). Microscopically these tumors are presented by the branching fringed fibers in the form of the thin connective tissue outgrowths dressed by a single-row cylindrical epithelium with the light cytoplasm which is painted with mucicarmine, and intensively painted oval kernel. The stroma of a fleecy tumor consists of fine connective tissue fibers, among to-rykh pass thin-walled circulatory and limf, vessels. Border between a normal mucous membrane and fleecy growths very accurate; if there is no malignancy of a tumor, growing of cells of an epithelium into the subject fabrics and penetration through stratum musculare tunicae mucosae is not noted. Histologically distinguish several types of V. of the lake: 1) the tumors created against the background of a focal hyperplasia of the fleecy adenomatous polyps which are long left without essential changes; 2) proliferating V. of the lake (fig. 1), in to-rykh an epithelium shows the expressed signs of the strengthened proliferation, cells are located closely, without clear boundary, with the extended intensively painted kernels in several rows; 3) malignizirovanny V. the lakes differing in big polymorphism of glands covered by a multirow epithelium with kernels, places rich with chromatin with sites of an invasion of an atypical polymorphic epithelium (fig. 2) in adjacent fabrics; sometimes the picture of cancer which developed from V. of the lake is found.

Fig. 3. A fleecy tumor of a rectum with the limited ulceration in the center indicating a malignancy.
Fig. 4. Multiple fleecy tumors of a large intestine. In the middle of the ascending colon — cancer regeneration of a tumor.
Fig. 5. A fleecy tumor of a rectum with transition to cancer (in the center of drug).

V.'s growth by the lake goes preferential to a gleam of a gut and to the parties on a mucous membrane. However over time at a malignancy also submersible growth is found; process of a malignancy of V. of the lake (tsvetn, the tab., Art. 353, fig. 3 — 5) can sometimes proceed within several years; approximately from three fleecy tumors two turn into cancer over time.

Century of the lake occurs at men and women of middle and advanced age. As a rule, the tumor is localized in direct and sigmoid guts (tsvetn. fig. 1), can reach the big sizes (8 — 10 cm in dia.), occupying a considerable part of an intestinal wall, up to all circle.

Origin Century of the lake still remains obscure. Possibly, process of excess proliferation of a muciparous epithelium of a mucous membrane of a gut is the cornerstone of their emergence. However the reason of the beginning of proliferative changes in any site of a mucous membrane is not established yet. Nek-ry scientists suggest about a virus origin of V. of the lake

of V. of the lake long can remain imperceptible for patients, proceeding for a long time asymptomatically. Then there is the most frequent symptom — allocations from a rectum of the characteristic viscous slime similar to ovalbumin. Considerable accumulations of such slime in a gut quite often force the patient to empty several times intestines only one slime. Frequent mucifyings are followed sometimes by maceration of skin of ano-perineal area and an itch. Occasionally, in addition to mucous allocations, appear bloody as a result of damage or a separation of fibers and disturbance of an integrity of their vessels. However bloody allocations have no systematic character and only long repeated blood losses can lead to anemia. Sometimes the disease is followed by locks, feeling of weight and feeling of a foreign matter in a rectum, but pains do not happen. False ponosa at first are accepted to manifestation of a proctocolitis though at a proctocolitis of allocation usually serous and mucous, sometimes with impurity of pus. Besides, proctocolites are followed by pains, do not last long and interrupted by light intervals. At an arrangement of a tumor to an anus it during defecation can close drop out (it is set by fingers). Occasionally it is possible to find the come-off particles of a tumor in excrements, microscopic examination to-rykh gives essential help in diagnosis. At V. of the lake of a rectum the simple manual research allows to make the diagnosis. At the same time soft, pliable, friable tissue is defined and the feeling of immersion in zhelepodobny pasty weight is created. At more highly located new growths it is necessary rektoromanoskopiya (see), in time cover a tumor or its parts can be easily taken for gistol. researches. Essential help is given by X-ray inspection with a contrast agent (see. Irrigoskopiya ).

Treatment low located and small V. of the lake Endo consists in the rectal way in their removal, it is the best of all an electroknife, a loop or in the way of electrothermic coagulation. At larger polyps it is necessary to resort to a rektotomiya from sacrococcygeal access or to a colotomy, and it is frequent to a resection of the struck department in the abdominal or abdomino-proctal way especially as there is not always a confidence in lack of a malignancy in one of sites of polypostural growths. Outcomes in general favorable, however there is recuring of process. See also Intestines (tumors), Rectum (tumors).

Bibliography: The guide to pathoanatomical diagnosis of tumors of the person, under the editorship of N. A. Krayevsky and A. V. Smolyan-nikova, M., 1971; Holdin S.A. Malignant new growths of a rectum, L., 1955, bibliogr.; Bacon H. E. and. E isenberg S. W. Papillary adenoma or villous tumor of the rectum and colon, Ann. Surg., v. 174, p. 1002, 1971.

S. A. Holdin.