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June 28, 1976

Adenomatous Polyps of the Colon: A Rational Approach

Author Affiliations

From the Department of Radiology, Mt Sinai School of Medicine (Drs Marshak and Maklansky), and the Department of Medicine, New York University School of Medicine (Dr Lindner), New York.

JAMA. 1976;235(26):2856-2858. doi:10.1001/jama.1976.03260520050028

THE MANAGEMENT of adenomatous polyps of the colon is a controversial subject. We have taken an approach that utilizes the points of agreement among clinicians, radiologists, and pathologists to offer a rational basis for the diagnosis and treatment of these lesions.

Pathologists agree that an adenomatous polyp on a long stalk is at most a lesion of low-grade clinical malignancy. Even if the head of the polyp histologically harbors carcinoma cells, these cells rarely traverse the pedicle into adjacent lymph nodes. Grinnell and Lane,1 in a series of 2,000 patients, did not find a single patient who had a polyp on a long stalk with a head measuring less than 1.5 cm in whom metastasis had occurred. Enterline2 recently restated this view, noting that he had never seen metastasis when a carcinoma is confined to the head of a polyp on a stalk. Ackerman and Spratt,3 Castleman