Villous papilloma of the colon and rectum. Part I. A clinical study of 213 patients.

Of the benign colonic epithelial neoplasms the villous papilloma, although rare, is reported to become malignant in 30--50%. This paper reports a retrospective study of 213 patients with a colorectal villous papilloma. The tumours were subdivided histologically according to Wheat and Ackerman (1958) into four different groups. 20% of the tumours contained either focal or invasive carcinoma. The histology of the tumour correlated significantly (p less than 0.01) with the size of the tumour with a more malignant grading of the larger tumours in general. Blood in the stool, diarrhoea, and mucoid discharge from the anus were the most frequent complaints. Malignant change of the tumour was found especially in older patients (eighth decade of life) and among women. Patients with a malignant villous papilloma complained significantly more of pain on defecation than patients with a benign tumour. Over 30% of the malignant tumours were already incurable at the time of discovery because of invasion of surrounding tissues and metastases.