Advanced Colorectal Adenomas in Patients Under 45 Years of Age Are Mostly Sporadic

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dc.contributor.author Azar, Riad R.
dc.contributor.author Kushnir, Vladimir M.
dc.contributor.author Nalbantoglu, ILKe
dc.contributor.author Watson, Rao
dc.contributor.author Goodwin, Johnathan
dc.contributor.author Safar, Elyas
dc.contributor.author Chokshi, Reena V.
dc.contributor.author Davidson, Nicholas O.
dc.date.accessioned 2016-10-07T12:10:07Z
dc.date.available 2016-10-07T12:10:07Z
dc.date.copyright 2014 en_US
dc.date.issued 2016-10-07
dc.identifier.issn 0163-2116 en_US
dc.identifier.uri http://hdl.handle.net/10725/4533
dc.description.abstract Background The presence of advanced adenomas in younger individuals is a criterion for Lynch syndrome (LS). However, the utility of screening advanced adenomas for loss of mismatch repair (MMR) protein expression to identify suspected LS remains unclear. Aims Determine the prevalence of MMR defects to understand whether these patients harbor a defined genetic risk for CRC. Methods The study cohort included adult patients ≤45 years of age with advanced adenomas (villous histology, ≥1 cm in diameter, ≥3 polyps of any size) endoscopically removed between 2001 and 2011. Clinical records were reviewed along with detailed pathological review and immunohistochemical MMR analysis. Results A total of 76 (40.1 % male, age 40.6 ± 5.4 years) patients met inclusion and exclusion criteria. Indications for colonoscopy were gastrointestinal (GI) bleeding 39 (51.3 %), CRC in a first-degree relative 17 (22.4 %) and somatic GI symptoms 20 (26.3 %). Index colonoscopy revealed a median of 1 adenoma (range 1–4), mean diameter of 12.9 ± 7.1 mm, 40 (52.6 %) with villous histology. The mean follow-up duration was 3.3 ± 2 years. Recurrent adenomas developed in 24 (31.6 %), of which 8 (10.5 %) were advanced adenomas; none of these patients developed CRC. One of 66 (1.5 %) adenomas available for immunohistochemical (IHC) testing revealed loss of MLH1 and PMS2. Conclusions IHC screening of advanced adenomas from patients younger than 45 years of age identified potential LS in one of 64 patients. The low yield of IHC screening in this population suggests that universal IHC screening of advanced adenomas from patients younger than 45 years of age for MMR defects is not an efficient strategy for identifying LS subjects. en_US
dc.language.iso en en_US
dc.title Advanced Colorectal Adenomas in Patients Under 45 Years of Age Are Mostly Sporadic en_US
dc.type Article en_US
dc.description.version Published en_US
dc.author.school SOM en_US
dc.author.idnumber 200902767 en_US
dc.author.department N/A en_US
dc.description.embargo N/A en_US
dc.relation.journal Digestive Diseases and Sciences en_US
dc.journal.volume 59 en_US
dc.journal.issue 11 en_US
dc.article.pages 2757-2764 en_US
dc.keywords Colonoscopy en_US
dc.keywords Colonic polyps en_US
dc.keywords Colorectal Neoplasms en_US
dc.keywords Hereditary Nonpolyposis en_US
dc.keywords Microsatellite en_US
dc.keywords Instability en_US
dc.keywords Immunohistochemistry en_US
dc.identifier.doi http://dx.doi.org/10.1007/s10620-014-3245-9 en_US
dc.identifier.ctation Kushnir, V. M., Nalbantoglu, I., Watson, R., Goodwin, J., Safar, E., Chokshi, R. V., ... & Davidson, N. O. (2014). Advanced colorectal adenomas in patients under 45 years of age are mostly sporadic. Digestive diseases and sciences, 59(11), 2757-2764. en_US
dc.author.email riad.azar@lau.edu.lb en_US
dc.identifier.tou http://libraries.lau.edu.lb/research/laur/terms-of-use/articles.php en_US
dc.identifier.url http://link.springer.com/article/10.1007/s10620-014-3245-9 en_US

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