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Fig. 6.35 Proliferating cells demonstrated by immunohistochemistry for MIB1. A Hyperplastic polyp with proliferative cells restricted to the basal parts of the crypts. B Tubular adenoma with proliferating adenomatous epithelium also at the luminal surface.

Fig. 6.35 Proliferating cells demonstrated by immunohistochemistry for MIB1. A Hyperplastic polyp with proliferative cells restricted to the basal parts of the crypts. B Tubular adenoma with proliferating adenomatous epithelium also at the luminal surface.

Fig. 6.36 Hyperplastic polyps. Typical sessile Fig. 6.37 Hyperplastic polyp with deep proliferative, appearance. non-serrated zone protruding into submucosa.
Fig. 6.38 Hyperplastic polyp. A Pedunculated. B Short deep proliferative zone and superficial serrated mature zone.
Fig. 6.39 Inverted hyperplastic polyp. Endophytic growth of hyperplastic glands projects into submu-cosa. Proliferative zone at the periphery, maturation at the center.

(familial clustering) has been observed only in Japan, a country at high incidence for that type of tumour. Cancers of the liver and of the upper gastrointestinal tract are exceedingly rare (less than 0.5% of all Li-Fraumeni neoplasms). In these neoplasms, sporadic cases often carry somatic TP53 mutations. The low frequency of these tumours in families with germline TP53 mutations suggests that the pre-existence of a TP53 mutation is not sufficient to increase the likelihood of cancer development.

BRCA 1 and BRCA 2

In a retrospective analysis of 33 large, high-risk breast and breast/ovarian cancer families linked to the BRCA1 locus, a significantly elevated risk of colon cancer was found, with an estimated relative risk

Fig. 6.40 Juvenile polyp. A Smooth eroded surface with numerous mucous retention cysts, typical of sporadic juvenile polyps. B Expanded inflamed stroma with distorted glands showing reactive atypia.

of 4.11 (95% CI 2.36 - 7.15) {518}. This corresponds to a risk of colon cancer by age 70 of about 6%. In this study, there did not seem to be any increased relative risk at younger ages, although power to detect either sex or age effects was somewhat low in this set of data. In a similar study of BRCA2 carriers {69}, no increased risk of colorectal cancer was observed. However, there was a significantly elevated risk for both stomach and gallbladder tumours among known or likely mutation carriers with estimated relative risks associated with BRCA2 of 2.6 (95% CI 1.46 - 4.61) and 5.0 (1.50 -16.5), respectively.

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