In which condition are colon polyps most likely to become malignant?

Gardner's syndrome is the condition most likely associated with a higher risk of malignant transformation of colon polyps. This genetic disorder is characterized by the presence of multiple adenomatous polyps in the colon, which have a significant risk of progressing to colorectal cancer if not monitored and managed appropriately. In individuals with Gardner's syndrome, the polyps tend to develop at an earlier age and can number in the hundreds. The genetic mutations that underlie this syndrome lead to both the proliferation of polyps and the development of extra-colonic manifestations, such as osteomas and soft tissue tumors, highlighting the systemic implications of this syndrome.

In contrast, the other conditions listed do not have such a strong association with the development of malignant colon polyps. Frey's syndrome is a disorder related to gustatory sweating, primarily affecting the facial region, and does not involve colon pathology. An adenomatoid odontogenic tumor is an odontogenic neoplasm primarily affecting the jaw and has no bearing on colon cancer risk. An odontogenic keratocyst is a jaw cyst with a potential for recurrence but also does not relate to colorectal cancer. Thus, Gardner's syndrome stands out as the condition in which colon polyps are most likely to become malignant.