|| This report is concerned with clinical study on 90 patients with polypoid lesions (107 lesions) which we have encountered in Misasa Hospital, Okayama University in the past 4 years. Following results were obtained : (1) Polypoid lesions were detected in 90 (22.4%) and advanced adenocarcinoma (mostly resectable) in 22 (5.5%) of 402 patients who were examined by sigmoidoscopy and barium enema ; (2) Histological examination of the polypoid lesions showed adenoma in 77.2%, hyperplastic polyp in 8.7%, inflammatory polyp in 7.6%, neurinoma in 0.3% and early cancer (adenocarcinoma) in 5.4% ; (3) It was impossible to differentiate benign and malignant polypoid lesions on the basis of endoscopic and X-ray findings alone ; (4) Forty-two percent of the polypoid lesions was
detected in the sigmoid colon, 30% in the rectum, 16.8% in the descending colon, 9.3% in the ascending colon, 0.9% in the caecum ; (4) Patients younger than 50 years of age showed only one polypoid lesion in the right hemicolon, whereas elder patients showed as many as 17 polypoid lesions ; (5) Among the 90 patients with polypoid lesions, 40 presented with abdominal pain, 20 with no symptoms
(annual health check-up), 17 with irregular bowel habits, and 10 with melena ; (6) Among the 90 patients, occult blood in stool was positive in 75.8% with a lower positive
rate in the lesions of the sigmoid and rectum ; (7) Among 5 asymptomatic patients with lesions and with a negative hemoccult test, 3 patients with a polypoid lesion were examined because of the patients' request, 1 patient with a polypoid lesion because of a positive family history, and the remaining 1 patient in a search for the primary lesion of the metastatic liver cancer ; (8) Among
patients with a positive hemoccult test, the detection rate of polypoid lesions was 41.9% with use of an immunological method, whereas it was 19.7% with use of a chemical method. In conclusion, (1) detection of colonic
polypoid lesions can lead to the detection of early cancer, although only histological examination can confirm the accurate diagnosis ; (2) a hemoccult test in stool with an immunological method is an effective method for screening asymptomatic colonic polypoid lesions, although it must be admitted that negative results may occasionally occur ; (3) macroscopic observation of the stool mass is important before sampling, because lesions of the sigmoid colon or the rectum may show scanty blood only on the limited area of the surface of the stool ; (4) patients elder than 50 years of age should be examined more carefully for the whole colon preferably with an endoscope, because they show a high incidence of small polypoid lesions in the right hemicolon.