Hyperplastic polyps with a diameter less than 5 mm often occur in a pile and are ubiquitous in the entire colorectum (Fig. 22.1). They definitely have no malignant potency [4].

The main symptom of hyperplastic polyps is prolapse.

A colonoscopy is necessary to confirm a diagnosis of polyps. Multiple hyperplastic polyps should be excised and sent for histological examination to confirm their benign nature.

Colonoscopic snaring is the therapy of choice; further treatment is not recommended [9].

Hamartomas are benign lesions consisting of both epithelial and mesenchymal components. They are classified as a benign mesenchymal lesion; the epithelial components seem to be reactive [10].

Hamartomas are usually asymptomatic. Obstruction and/or bleeding rarely occur.

A colonoscopy is necessary to confirm the diagnosis of hamartoma. The lesion should be excised and sent for histological examination to confirm its benign nature.

Colonoscopic snaring is the therapy of choice; further treatment is not recommended.

Polyps are usually asymptomatic. Obstruction and/or bleeding rarely occur.

A colonoscopy is necessary to confirm the diagnosis of polyps. Multiple polyps should be excised and sent for histological examination. A histological distinction between a juvenile polyp and an adenomatous polyp is essential. The complete colon has to be examined endoscopically to exclude juvenile polyposis syndrome.

Colonoscopic snaring is the therapy of choice; further treatment is not recommended.

In contrast to single juvenile polyps, so-called juvenile polyposis syndrome, referring to the presence of more than five juvenile polyps, is associated with malignancy. The risk of patients with juvenile polyposis developing cancer of the colon before 60 years of age ranges from 20 up to 60 % [12–14].

Colorectal polyps predominantly cause diffuse symptoms such as bleeding, acute abdominal pain, and diarrhea. Probably as a result of genetic dysfunction, the following concomitant extracolonic manifestations may be found:

Colonoscopic excisions should be considered if only a few polyps are found. Surgical approaches depend on the site of lesion, especially if the rectum is involved:

Peutz-Jeghers syndrome is a rare, hereditary autosomal-dominant disorder with a mutation on chromosome 19. The typical age at presentation is 10–30 years. There is a signature presentation with hamartomatous polyposis of the gastrointestinal tract and melanotic pigmented spots. Melanotic pigmented spots appear in early childhood at the age of 2 years and increase in size and colour until puberty; after that they slowly fade. The location of these spots varies Notiz:

Typical symptoms are intestinal obstruction and bleeding [18].

Case history (family history, gastrointestinal symptoms) is key. Pigmentation is a signature feature and can be found during a clinical exam. In addition, contrast enema can show multiple polyps, and gastroscopy and colonoscopy allow histological probes.

There is no causal therapy. Endoscopic snaring is recommended since the frequency of tumors decreases with age. Surgical approaches are recommended in obstruction or intussusception that cannot be solved colonoscopically, but resections should be done restrictively [19].

Polyps may have an inflammatory origin as a result of long-lasting ulcerative colitis or Crohn’s disease of the colon. Histologically they are pseudo-polyps showing inflamed mucosa surrounded by ulcerative tissue, with no tendency for malignant transformation. Malignancy can, however, be a result of chronic ulcerative colitis or Crohn’s disease.

Typical symptoms are intestinal obstruction and bleeding.

Polyps should be excised and send for histological examination to distinguish a diagnosis.

Inhibition of the underlying inflammation is a basic treatment. In addition, colonoscopic snaring is recommended.

Lymphoid polyps are benign lesions and are located where piles of lymphoid follicles are present. They must be differentiated from malignant lymphomas. Histologically, lymphoid polyps comprise lymphoid tissue [4, 20].

Polyps are usually asymptomatic. Obstruction and/or bleeding rarely occur.

Polyps should be excised colonoscopically and send for histological examination to distinguish a diagnosis.

Colonoscopic snaring is recommended.

The incidence of adenomatous polyps (adenomas) depends on age, sex, and geography. The incidence in Western countries is 7–12 %. Risk factors may be a diet low in fiber and high in fat, a positive family history of colorectal and/or gynecological cancer, atherosclerosis, nulliparity (in women), and age. Maximum incidence occurs at an age of 60–70 years.