An adenoma is a benign tumor of epithelial tissue with glandular origin, glandular characteristics, or both. Adenomas can grow from many glandular organs, including the adrenal glands, pituitary gland, thyroid, prostate, and others. Some adenomas grow from epithelial tissue in non-glandular areas but express glandular tissue structure (as can happen in familial polyposis coli). Although adenomas are benign, they should be treated as pre-cancerous. Over time adenomas may transform to become malignant, at which point they are called adenocarcinomas. Most adenomas do not transform. However, even though benign, they have the potential to cause serious health complications by compressing other structures (mass effect) and by producing large amounts of hormones in an unregulated, non-feedback-dependent manner (causing paraneoplastic syndromes). Some adenomas are too small to be seen macroscopically but can still cause clinical symptoms.
Histopathology
Adenoma is a benign tumor of glandular
tissue, such as the mucosa of stomach, small intestine, and colon, in which
tumor cells form glands or gland like structures. In hollow organs (digestive
tract), the adenoma grows into the lumen – adenomatous polyp or polypoid
adenoma. Depending on the type of the insertion base, adenoma may be
pedunculated (lobular head with a long slender stalk) or sessile (broad base).
The adenomatous proliferation is
characterized by different degrees of cell dysplasia (atypia or loss of normal
differentiation of epithelium) irregular cells with hyperchromatic nuclei,
stratified or pseudostratified nuclei, nucleolus, decreased mucosecretion, and
mitosis. The architecture may be tubular, villous, or tubulo-villous. Basement
membrane and muscularis mucosae are intact.
Locations
There are colon, renal, adrenal,
thyroid, pituitary, parathyroid, liver, breast, appendix, bronchial, sebaceous,
salivary gland, and prostate adenomas,
Treatment
A physician's response to detecting an
adenoma in a patient will vary according to the type and location of the
adenoma among other factors. Different adenomas will grow at different rates,
but typically physicians can anticipate the rates of growth because some types
of common adenomas progress similarly in most patients. Two common responses
are removing the adenoma with surgery and then monitoring the patient according
to established guidelines.
One common example of treatment is the
response recommended by specialty professional organizations upon removing
adenomatous polyps from a patient. In the common case of removing one or two of
these polyps from the colon from a patient with no particular risk factors for
cancer, thereafter the best practice is to resume surveillance colonoscopy
after 5–10 years rather than repeating it more frequently than the standard
recommendation.
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