Polypen im Kolorektum

Zusammenfassung Nichtneoplastische und nichthamartomatöse kolorektale Polypen bzw. tumorähnliche Läsionen stellen eine sehr heterogen zusammengesetzte Gruppe von Veränderungen dar. Bei den polypoiden Veränderungen sind sicher die verschiedenen Manifestationsformen des Mukosaprolapssyndroms und die inflammatorischen Polypen, die ganz überwiegend im Rahmen chronisch-entzündlicher Darmerkrankungen auftreten, als wichtigste Vertreter zu nennen. Sie stellen uns in ihrer Abgrenzung gegenüber neoplastischen Veränderungen wie Adenomen, hyperplastischen/serratierten Polypen/Adenomen und invasiven Karzinomen immer wieder vor differenzialdiagnostische Schwierigkeiten. Die wesentlich selteneren tumorähnlichen Läsionen wie Schleimhautheterotopien, Endometriosis externa, Amyloidtumoren und die sog. Pseudolipomatose sind häufig histologisch gut diagnostizierbar und sollten in die differenzialdiagnostischen Überlegungen mit einbezogen werden. Die Ätiologie, das endoskopische und histologische Erscheinungsbild dieser Entitäten und ihre wichtigsten Differenzialdiagnosen werden im Folgenden besprochen. Abstract Non-neoplastic and non-hamartomatous colorectal polyps or tumor-like lesions comprise a very heterogeneous group of changes in the colorectal mucosa or the colon wall. Mucosal prolapse-associated lesions and inflammatory polyps, which are predominantly associated with chronic inflammatory bowel disease, are the most prominent examples for polypoid lesions difficult to distinguish from neoplastic lesions such as adenomas, hyperplastic/serrated polyps/adenomas and invasive carcinomas. The considerably less frequent tumor-like lesions like heterotopias, endometriosis, amyloid tumors and pseudolipomatous changes are histologically often well defined and should be considered in the differential diagnosis of colorectal lesions. 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