SlideShare a Scribd company logo
1 of 34
Neoplastic Colonic Polyps Dr. Saud Al-Subaie Department of Surgery  Amiri Hospital Monday 17/04/2006
Introduction   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Polyp- Cancer Sequence
[object Object],[object Object],[object Object],[object Object],[object Object],Classification of polyps ,[object Object],[object Object],[object Object],[object Object],Neoplastic Non- Neoplastic
Epidemiology  10.5% (100 %) Weighted chance 40 % 10 % Villous adenoma 22% 15 % Tubulovillous 5% 75% Tubular adenoma % Malignant Prevalence TYPE
Size and % of Ca                                         54% 10% 10% Villous 45% 9% 4% Tubulo-villous 34% 10% 1 % Tubular  > 2cm 1-2 cm < 1cm
Endoscopic appearance
                                       
Etiology  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Etiology of Ca
Etiology (FAP)
Clinical Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management
Endoscopic Management ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Adenoma  With  Ca Adenoma  With  Ca
What is next  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Malignant Polyp   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Haggitt Highest  Invasion of  submucosa, not the muscularis propria, sessile polyp 4 Moderate Invasion of the (MM)& polyp stalk 3 Low  Invasion of the (MM) & polyp neck  2  None  Invasion of the (MM) & polyp head  1 None  No invasion of the muscularis mucosa (MM), carcinoma in situ 0  Risk of LN mets  Histologic description level
Histologic assessment  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Histological assessment  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cesare Hassan et al ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dis Colon Rectum  2005
Cesare Hassan et al ,[object Object],[object Object],[object Object],[object Object],Dis Colon Rectum  2005
Cesare Hassan et al ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dis Colon Rectum  2005
Cesare Hassan et al ,[object Object],[object Object],Dis Colon Rectum  2005
Sitz et al ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dis Colon Rectum  2004
Sitz et al ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dis Colon Rectum  2004
Sitz et al ,[object Object],[object Object],[object Object],Dis Colon Rectum  2004
Volk / Fazio ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Gastroenterology 1995
Operative Management ,[object Object],[object Object],[object Object],Malignant rectal polyps Anatomic resection with removal of adjacent LN Malignant / incompletely excised / Suspicious polyp - Colotomy+ Polypectomy - Segmental Resection Benign polyp(>3cm can’t be managed endoscopically) Surgical options Type of polyp
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
“ Colon cancer can only be found if looked for.   And it  can only be cured if found early.”
THANK YOU

More Related Content

What's hot

Stomas- Dr.Enja Amarnath Reddy
Stomas- Dr.Enja Amarnath ReddyStomas- Dr.Enja Amarnath Reddy
Stomas- Dr.Enja Amarnath Reddyapollobgslibrary
 
Breast carcinoma march 15. 2015
Breast carcinoma march 15. 2015Breast carcinoma march 15. 2015
Breast carcinoma march 15. 2015eliasmawla
 
Gastro intestinal fistula
Gastro intestinal fistulaGastro intestinal fistula
Gastro intestinal fistulaMario Ruano
 
Diagnosis And Management Of Pancreatic Cystic Lesion
Diagnosis And Management Of Pancreatic Cystic LesionDiagnosis And Management Of Pancreatic Cystic Lesion
Diagnosis And Management Of Pancreatic Cystic LesionMyounghwan Kim
 
lower gastrointestinal bleeding ppt
 lower gastrointestinal bleeding ppt lower gastrointestinal bleeding ppt
lower gastrointestinal bleeding pptAdedotun Adesiyakan
 
Determining a vascular cause for leg pain and referrals
Determining a vascular cause for leg pain and referralsDetermining a vascular cause for leg pain and referrals
Determining a vascular cause for leg pain and referralsSpecialistVeinHealth
 
Oncology and surgical practice
Oncology and surgical practiceOncology and surgical practice
Oncology and surgical practiceThaere Aljanabi
 
Acute abdomen a practical approach
Acute abdomen   a practical approachAcute abdomen   a practical approach
Acute abdomen a practical approachDR Laith
 
Principles of bowel anastomosis
Principles of bowel  anastomosisPrinciples of bowel  anastomosis
Principles of bowel anastomosisBashir BnYunus
 
Pancreatic Carcinoma
Pancreatic CarcinomaPancreatic Carcinoma
Pancreatic CarcinomaJibran Mohsin
 
Colorectal Polyps & Carcinomas Diagnosis & characterization
Colorectal Polyps & Carcinomas Diagnosis & characterizationColorectal Polyps & Carcinomas Diagnosis & characterization
Colorectal Polyps & Carcinomas Diagnosis & characterizationHossam Ghoneim
 

What's hot (20)

Stomas- Dr.Enja Amarnath Reddy
Stomas- Dr.Enja Amarnath ReddyStomas- Dr.Enja Amarnath Reddy
Stomas- Dr.Enja Amarnath Reddy
 
Breast carcinoma march 15. 2015
Breast carcinoma march 15. 2015Breast carcinoma march 15. 2015
Breast carcinoma march 15. 2015
 
Gastro intestinal fistula
Gastro intestinal fistulaGastro intestinal fistula
Gastro intestinal fistula
 
Diagnosis And Management Of Pancreatic Cystic Lesion
Diagnosis And Management Of Pancreatic Cystic LesionDiagnosis And Management Of Pancreatic Cystic Lesion
Diagnosis And Management Of Pancreatic Cystic Lesion
 
Polyposis & Cancer Colon
Polyposis & Cancer ColonPolyposis & Cancer Colon
Polyposis & Cancer Colon
 
Angiodysplasia[1]
Angiodysplasia[1]Angiodysplasia[1]
Angiodysplasia[1]
 
lower gastrointestinal bleeding ppt
 lower gastrointestinal bleeding ppt lower gastrointestinal bleeding ppt
lower gastrointestinal bleeding ppt
 
Determining a vascular cause for leg pain and referrals
Determining a vascular cause for leg pain and referralsDetermining a vascular cause for leg pain and referrals
Determining a vascular cause for leg pain and referrals
 
Oncology and surgical practice
Oncology and surgical practiceOncology and surgical practice
Oncology and surgical practice
 
Acute abdomen a practical approach
Acute abdomen   a practical approachAcute abdomen   a practical approach
Acute abdomen a practical approach
 
Vulva
VulvaVulva
Vulva
 
Stoma
StomaStoma
Stoma
 
Gastric carcinoma
Gastric carcinomaGastric carcinoma
Gastric carcinoma
 
Principles of bowel anastomosis
Principles of bowel  anastomosisPrinciples of bowel  anastomosis
Principles of bowel anastomosis
 
Ca. Rectum.pptx
Ca. Rectum.pptxCa. Rectum.pptx
Ca. Rectum.pptx
 
Pancreatic Carcinoma
Pancreatic CarcinomaPancreatic Carcinoma
Pancreatic Carcinoma
 
Benign breast disease
Benign breast diseaseBenign breast disease
Benign breast disease
 
Primary GIT Lymphoma
Primary GIT LymphomaPrimary GIT Lymphoma
Primary GIT Lymphoma
 
Lynch syndrome
Lynch syndromeLynch syndrome
Lynch syndrome
 
Colorectal Polyps & Carcinomas Diagnosis & characterization
Colorectal Polyps & Carcinomas Diagnosis & characterizationColorectal Polyps & Carcinomas Diagnosis & characterization
Colorectal Polyps & Carcinomas Diagnosis & characterization
 

Similar to Neoplastic Colonic Polyp

Ca Vulva: Recapitulating the facts
Ca Vulva: Recapitulating the factsCa Vulva: Recapitulating the facts
Ca Vulva: Recapitulating the factsDr. Sunaina Wadhwa
 
Medical Students 2011 - G. Pentheroudakis - UROGENITAL CANCER SESSION - Germ ...
Medical Students 2011 - G. Pentheroudakis - UROGENITAL CANCER SESSION - Germ ...Medical Students 2011 - G. Pentheroudakis - UROGENITAL CANCER SESSION - Germ ...
Medical Students 2011 - G. Pentheroudakis - UROGENITAL CANCER SESSION - Germ ...European School of Oncology
 
Management of Oral Cavity Cancers
Management of Oral Cavity CancersManagement of Oral Cavity Cancers
Management of Oral Cavity CancersKUNALGUPTA294
 
Mgmt vulva and vagina cancers
Mgmt vulva and vagina cancersMgmt vulva and vagina cancers
Mgmt vulva and vagina cancersAshutosh Mukherji
 
Management of Non Muscle Invasive Bladder Cancer
Management of Non Muscle Invasive Bladder CancerManagement of Non Muscle Invasive Bladder Cancer
Management of Non Muscle Invasive Bladder CancerDr.Bhavin Vadodariya
 
Seminar on gi malig.pptx
Seminar on gi malig.pptxSeminar on gi malig.pptx
Seminar on gi malig.pptxabhi23459
 
Renal Cancers Rationale
Renal Cancers RationaleRenal Cancers Rationale
Renal Cancers Rationalefondas vakalis
 
Renal Cancers Rationale
Renal Cancers RationaleRenal Cancers Rationale
Renal Cancers Rationalefondas vakalis
 
Carcinoma Colon And Management
Carcinoma Colon And ManagementCarcinoma Colon And Management
Carcinoma Colon And ManagementPGIMER, AIIMS
 
ETIOPATHOGENESIS AND STAGING OF CA PENIS (1).pptx
ETIOPATHOGENESIS AND STAGING OF CA PENIS (1).pptxETIOPATHOGENESIS AND STAGING OF CA PENIS (1).pptx
ETIOPATHOGENESIS AND STAGING OF CA PENIS (1).pptxDebashis Routray
 
ARROCase_SalivaryGlandTumors (2).pdf
ARROCase_SalivaryGlandTumors (2).pdfARROCase_SalivaryGlandTumors (2).pdf
ARROCase_SalivaryGlandTumors (2).pdfwaleedalqaini
 
Testicular cancer
Testicular cancerTesticular cancer
Testicular cancerKiron G
 
Role of chemotherapy Carcinoma colon
Role of chemotherapy Carcinoma  colon Role of chemotherapy Carcinoma  colon
Role of chemotherapy Carcinoma colon Anil Gupta
 
Testicular tumors-Cassification, Biomarkers and Staging by Dr Rajesh
Testicular tumors-Cassification, Biomarkers and Staging by Dr RajeshTesticular tumors-Cassification, Biomarkers and Staging by Dr Rajesh
Testicular tumors-Cassification, Biomarkers and Staging by Dr RajeshRajesh Sinwer
 

Similar to Neoplastic Colonic Polyp (20)

Ca Vulva: Recapitulating the facts
Ca Vulva: Recapitulating the factsCa Vulva: Recapitulating the facts
Ca Vulva: Recapitulating the facts
 
Medical Students 2011 - G. Pentheroudakis - UROGENITAL CANCER SESSION - Germ ...
Medical Students 2011 - G. Pentheroudakis - UROGENITAL CANCER SESSION - Germ ...Medical Students 2011 - G. Pentheroudakis - UROGENITAL CANCER SESSION - Germ ...
Medical Students 2011 - G. Pentheroudakis - UROGENITAL CANCER SESSION - Germ ...
 
Cervical Cancer
Cervical CancerCervical Cancer
Cervical Cancer
 
Cancer of the Vulva
Cancer of the VulvaCancer of the Vulva
Cancer of the Vulva
 
Management of Oral Cavity Cancers
Management of Oral Cavity CancersManagement of Oral Cavity Cancers
Management of Oral Cavity Cancers
 
Ca vulva
Ca vulvaCa vulva
Ca vulva
 
Mgmt vulva and vagina cancers
Mgmt vulva and vagina cancersMgmt vulva and vagina cancers
Mgmt vulva and vagina cancers
 
Colorectal polyp
Colorectal  polypColorectal  polyp
Colorectal polyp
 
Management of Non Muscle Invasive Bladder Cancer
Management of Non Muscle Invasive Bladder CancerManagement of Non Muscle Invasive Bladder Cancer
Management of Non Muscle Invasive Bladder Cancer
 
Seminar on gi malig.pptx
Seminar on gi malig.pptxSeminar on gi malig.pptx
Seminar on gi malig.pptx
 
Renal Cancers Rationale
Renal Cancers RationaleRenal Cancers Rationale
Renal Cancers Rationale
 
Renal Cancers Rationale
Renal Cancers RationaleRenal Cancers Rationale
Renal Cancers Rationale
 
Carcinoma Colon And Management
Carcinoma Colon And ManagementCarcinoma Colon And Management
Carcinoma Colon And Management
 
ETIOPATHOGENESIS AND STAGING OF CA PENIS (1).pptx
ETIOPATHOGENESIS AND STAGING OF CA PENIS (1).pptxETIOPATHOGENESIS AND STAGING OF CA PENIS (1).pptx
ETIOPATHOGENESIS AND STAGING OF CA PENIS (1).pptx
 
Carcinoma rectum (Rectal Cancer)
Carcinoma rectum (Rectal Cancer)Carcinoma rectum (Rectal Cancer)
Carcinoma rectum (Rectal Cancer)
 
ARROCase_SalivaryGlandTumors (2).pdf
ARROCase_SalivaryGlandTumors (2).pdfARROCase_SalivaryGlandTumors (2).pdf
ARROCase_SalivaryGlandTumors (2).pdf
 
Cancer cervix 2020
Cancer cervix 2020Cancer cervix 2020
Cancer cervix 2020
 
Testicular cancer
Testicular cancerTesticular cancer
Testicular cancer
 
Role of chemotherapy Carcinoma colon
Role of chemotherapy Carcinoma  colon Role of chemotherapy Carcinoma  colon
Role of chemotherapy Carcinoma colon
 
Testicular tumors-Cassification, Biomarkers and Staging by Dr Rajesh
Testicular tumors-Cassification, Biomarkers and Staging by Dr RajeshTesticular tumors-Cassification, Biomarkers and Staging by Dr Rajesh
Testicular tumors-Cassification, Biomarkers and Staging by Dr Rajesh
 

Recently uploaded

Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...chandars293
 
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...Dipal Arora
 
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...narwatsonia7
 
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...Genuine Call Girls
 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...parulsinha
 
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Call Girls in Nagpur High Profile
 
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...narwatsonia7
 
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...astropune
 
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...Dipal Arora
 
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋TANUJA PANDEY
 
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Gwalior Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Gwalior Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore EscortsCall Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escortsvidya singh
 
Call Girls Tirupati Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Tirupati Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Lucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel roomLucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel roomdiscovermytutordmt
 

Recently uploaded (20)

Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
 
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
 
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
 
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
 
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
 
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
 
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
 
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
 
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
 
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
 
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
 
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
 
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Gwalior Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Gwalior Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore EscortsCall Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
 
Call Girls Tirupati Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Tirupati Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 9907093804 Top Class Call Girl Service Available
 
Lucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel roomLucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel room
 

Neoplastic Colonic Polyp