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PubMed2003

Benign gastric polyps: morphological and functional origin.

The most common types of benign gastric polyps are fundic gland polyps, hyperplastic polyps, and adenomas. The aim of this study was to determine on which morphological and functional background benign gastric polyps develop. The study includes 85 consecutive patients with gastric polyps and sex- and age-matched controls without polyps selected at random from a general population sample. The type of polyp was hyperplastic in 52 (61%), fundic gland in 18 (21%), adenoma in 10 (12%), carcinoid in 2 (2%), hamartoma in 2 (2%), and inflammatory fibroid in 1 (1%) of the cases. Routine biopsies from the gastric corpus and antrum were examined for presence of gastritis and H. pylori. Blood samples were analyzed for H. pylori antibodies, H+,K+-ATPase antibodies, gastrin, and pepsinogen I. Patients with hyperplastic polyps had increased P-gastrin concentrations and S-H+,K+-ATPase antibody titers and decreased S-pepsinogen I concentrations with a high prevalence of atrophic corpus gastritis or pangastritis. A similar pattern was observed among patients with adenomas, whereas patients with fundic gland polyps had normal serology and a lower prevalence of gastritis and H. pylori infection than controls. In conclusion, hyperplastic polyps and adenomas are generally associated with atrophic gastritis. Patients with fundic gland polyps seem to have a sounder mucosa than controls. Whereas the risk of malignant gastric neoplasia is increased in patients with hyperplastic polyps or adenomas, this does not seem to be the case in patients with fundic gland polyps.

Adenomatous Polyps↗
PubMed1983

Surgical pathology of endoscopically removed malignant polyps of the colon and rectum.

Fifty-six endoscopically removed malignant polyps of the colon and rectum were studied to assess criteria for adequacy of therapeutic polypectomy. Features examined were: 1) tumor grade; 2) lymphatic invasion; 3) tumor extent (head, stalk, margin); 4) sessile versus pedunculated; 5) size; and 6) type of background adenoma. Thirty-four patients underwent colon resection while the remaining 22 malignant polyps were followed for a mean of 4.5 years. Five (8.9%) malignant polyps metastasized to lymph nodes while three cases showed metachronous liver metastases. Pathologically, malignant polyps were grouped into 28 long stalk (LS), 21 short stalk (SS), and seven sessile types, with a lymph node metastatic rate of 0%, 19%, and 14%, respectively. Only one of six malignant polyps with lymphatic invasion had any lymph node metastases (16.5), while 66% of grade III cancers had lymph node metastases. In those 24 cases with tumor at or near the resection margin (17 SS and seven sessile cases), the incidence of lymph node metastases or local recurrence was 25%. The incidence of lymph node metastases or local recurrence was 0% among the 28 LS polyps and the four SS polyps with tumor limited to the head. Two of seven polypoid carcinomas (28.5%) metastasized; however, both had positive resection margins. There was no difference in size between metastasizing and nonmetastasizing malignant polyps. Of the 36 cases where histological criteria indicated polypectomy inadequate, the incidence of lymph node metastases or local recurrence was 17%. There were no metastases or recurrences where polypectomy was considered histologically adequate. LS polyps may be treated by polypectomy alone, except in those cases with grade III cancer, lymphatic invasion, or tumor at the resection margin. SS polyps with cancer limited to the head may be treated similarly to LS polyps, while all other SS polyps and sessile polyps should undergo resection postpolypectomy.

Adult↗
PubMed1993

Hyperplastic polyps.

A colonoscopy and colonoscopic polypectomy service was established at Wellington Hospital, New Zealand in April 1975. Between April 1975 and March 1990 1157 polyps were either removed or biopsied and examined histologically. Twenty-five polyps were lost. Patient-age seemed to increase through the spectrum hyperplastic, tubular, tubulovillous, villous, and polypoid carcinoma. Sessile < 6 mm in diameter hyperplastic polyps were more numerous than small adenomatous polyps. Pedunculated tumours were most commonly adenomata in all sizes, whereas sessile tumours in the rectum and sigmoid colon were usually hyperplastic. As polyp size increased the numbers of hyperplastic polyps decreased relative to the numbers of adenomatous polyps. The majority of hyperplastic polyps were found in the distal colo-rectum. Site distribution for hyperplastic polyps corresponded to the site distribution for colorectal carcinomata. One of five patients with hyperplastic index polyps was found to have an adenomatous polyp at follow-up. Strong evidence for a sequential relationship between hyperplastic and adenomatous polyps was not found in this study. It is unlikely that an aggressive attitude to the investigation and removal of hyperplastic polyps will have a significant effect on the later development of colorectal cancer.

Adenomatous Polyps↗
PubMed2001

Gender differences in colorectal polyps and tumors.

OBJECTIVES: To use a national endoscopy database (CORI) to determine 1) whether gender differences are noted in the prevalence and location of polyps and tumors; 2) whether women have a higher rate of right-sided polyps or tumors; and 3) whether age influences these results. METHODS: CORI database from April 1, 1997 to February 19, 1999, captured in a computer-generated report, was analyzed. Polyps for this study were defined as sessile or pedunculated and as >9 mm. Tumors were defined as lesions characteristic of adenocarcinoma (mass, apple-core). Pure right-sided colon (PRS) was defined as cecum, ascending, hepatic flexure; right-sided as PRS plus the transverse colon; and left-sided as the splenic flexure, descending, sigmoid and rectum. RESULTS: Men have a greater risk of polyps [odds ratio (OR), 1.5] and tumors (OR, 1.4) than women. The risk of finding polyps and tumors at colonoscopy increases with age, with the highest risk noted in those >69 yr of age relative to patients <50 yr of age (polyps, OR = 2.7; tumors, OR = 4.0). Right-side polyps and pure right-sided polyps as defined by the study design were noted to be more frequent than left-sided polyps in patients >60 yr of age. Women have a greater risk of developing pure right-sided polyps (OR, 1.2), tumors (OR, 1.6) and right-sided tumors (OR, 1.5) than men. CONCLUSIONS: Men have a higher prevalence of colon polyps and tumors than women. A progressive risk of polyp or tumor formation is noted with aging. Women had a greater number of pure right-sided polyps and tumor development. Colonoscopy is needed to correctly diagnose an increasing prevalence of right-sided pathology in the elderly.

Adenocarcinoma↗
PubMed2006

Occult colorectal polyps on CT colonography: implications for surveillance.

OBJECTIVE: Our purpose was to determine the prevalence of polyps that are invisible on CT colonography (CTC) in a population previously screened for colorectal neoplasms. Differences in the prevalence of occult polyps in various populations might help explain the discordant reported sensitivities for polyp detection in published reports of CTC. SUBJECTS AND METHODS: Seventy-five consecutive patients who had been previously screened for polyps underwent same-day colonoscopy and CTC. Many of the patients had personal histories of previous polypectomies and were undergoing surveillance colonoscopy. The scans were interpreted prospectively by an experienced radiologist. Polyps missed prospectively on CTC were analyzed retrospectively by three experienced radiologists and categorized as perception errors (visible in retrospect), technical errors (e.g., obscured by feces or fluid), or occult (invisible). RESULTS: Thirty polyps 5 mm or larger were found at colonoscopy, 18 of which were missed prospectively on CTC. Of the 18 missed polyps, 12 could not be identified in retrospect, even though they were located in clean, dry, well-distended colonic segments. These were classified as occult. Ten of the 12 occult polyps showed flat morphology on review of colonoscopy video recordings. Of the remaining six missed polyps, two were classified as perception errors, two as technical errors, and two as a combination of technical and perception error. CONCLUSION: In this population, colonographically occult polyps were common and accounted for more detection failures than perception errors and technical errors combined. The high prevalence of occult polyps may be explained by the fact that previous screening may have led to removal of easy-to-see polyps, creating a study population with a higher percentage of hard-to-see polyps.

Aged↗
PubMed1988

Small polyps found during fiberoptic sigmoidoscopy in asymptomatic patients.

STUDY OBJECTIVE: To determine the prevalence of small polyps in the rectosigmoid in an asymptomatic group and the likelihood of finding synchronous neoplastic polyps proximally at colonoscopy. DESIGN: Asymptomatic patients with polyps 9 mm or less found at screening fiberoptic sigmoidoscopy were referred for colonoscopy, at which time all polyps were removed. SETTING: Screening fiberoptic sigmoidoscopy unit. PATIENTS: Referral from Executive Health Wellness Clinic and large multispeciality clinic. RESULTS: From 3923 sigmoidoscopic examinations, 258 asymptomatic subjects (7%) were identified who had polyps 9 mm or smaller. One hundred and eighty-nine patients (73%) had colonoscopy. In 179 patients, the target lesion noted at sigmoidoscopy was identified at colonoscopy. Based on histology of the target lesion, patients were divided into three groups: Group 1 (72 patients) had only hyperplastic polyps; Group 2 (69 patients) had at least one neoplastic polyp; and Group 3 (31 patients) had polyps with normal histology. Seven patients were not classified. Neoplastic polyps were found proximally in 21 patients in Group 1 (29%; 95% CI, 19 to 39), 23 patients in Group 2 (33%; 95% CI, 22 to 44), and 4 patients in Group 3 (13%; 95% CI, 4 to 30). There was no difference in mean age between groups. The results were similar when only polyps 5 mm or smaller were analyzed. CONCLUSION: Because small polyps of any histologic type in the rectosigmoid indicate a high risk for having neoplastic polyps proximally, the guidelines of both the American College of Physicians and the American Society of Gastrointestinal Endoscopy may need to be revised. Colonoscopy seems justified in any patient in whom a small polyp is discovered at sigmoidoscopy.

Adult↗
PubMedDate not supplied

Gastric polyps.

Endoscopy allows a better diagnosis and treatment of gastric polyps. Current methodology includes a detailed examination of the stomach after good insufflation, necessary to diagnose small fundic polyps, biopsies of the polyp as well as of the surrounding mucosa (antrum and fundus). Endoscopy allows a preliminary diagnosis based on the number, location and size of the polyps. Resection is not performed at initial endoscopy as it is not necessary for all polyps and may be risky if vascular lesions are confused with polyps. Glandulocystic fundic polyps are the most frequent (50%), are always associated with a normal gastric mucosa and sometimes with omeprazole. Resection and follow-up are not indicated. Hyperplastic polyps represent 25% of gastric polyps, are located everywhere, with a mean size of 1 cm, and sometimes erosions or superficial necrosis. Gastritis is present, Helicobacter pylori is frequent and eradication may cause regression or disappearance of polyps. The small risk of cancer and the risk of bleeding increase with size. Polypectomy and follow-up are thus indicated in most cases. Adenomatous polyps, although similar in appearance to hyperplastic polyps concerning macroscopy and gastritis have a higher risk of cancer in the polyp or in the stomach. Polypectomy and follow-up are thus mandatory.

Adenomatous Polyps↗
PubMed2005

[Clinical, enteroscopic, and pathological characteristics of 796 cases of colorectal polyps].

OBJECTIVE: To study the age, clinical, enteroscopic and pathological characteristics of colorectal polyps and factors affected polyp-carcinoma. METHODS: We analyzed the clinical, enteroscopic and pathological characteristics of 7276 cases of colorectal polyps. RESULTS: The incidence of colorectal polyps was 10.94%, including 521 men and 275 women. The rate of colorectal polyp was 82.29% in 30-69 year olds. The adenomatous, inflammatory, hyperplastic and juvenile polyps were 43.84%, 42.09%, 11.06% and 1.51%, respectively. Polypoid lesions were located at cecum 3.29%, ascending 11.88%, transverse 4.89%, descending 11.58%, sigmoid 26.05%, and rectum 42.32%. Thirty-five cases (4.4%) were found to have polpous canceration. The canceration rates in villous, mixed and tubular adenomas were 29.73%, 11.11%, and 4.86%. The rate of canceration seemed to depend on its dimensions, being 1.3%, 7.4%, and 25.6% for the 0.6 - 1.0 cm, 1.1 - 1.9 cm, and > or = 2.0 cm in size, respectively. Conclusion The ages between 30-69 tend to suffer from colorectal polyps. The incidence in the male is higher than that in the female. Colorectal polyps are more likely to locate in left colon. The common pathological types were adenomatous and inflammatory polyps. There is a high canceration of polyps in the left colon, villous adenomas and > or = 2.0 cm polyps. The broader the pedicles and the larger the diameters of polyps are, the higher the canceration rate. All of the colon polyps should be excised and undergo the pathological examination. Enteroscopic polypectomy helps prevent colorectal polpous canceration.

Adenoma↗
PubMed1991

[Anatomopathological aspects of colorectal polyps in Cameroon].

In order to present the main types of colo-rectal polyps in Cameroon, we reviewed all those cases received and examined in our Pathology laboratories during a six and a half year period (1st January 1984-30th June 1990). The polyps were sent by gastro-enterologists after resection during total colonoscopy, with information about age and sex of patients, signs and symptoms and sites and number of polyps. One hundred and two colorectal polyps were taken from 88 patients with a maximum of two polyps per patient. Out of these 102 polyps, we noted: 55 juvenile polyps (54%), 23 hyperplastic polyps (22.5%), 13 adenomatous polyps (12.5%), 10 inflammatory polyps (10%) and one polyp of the Peutz-Jeghers type. One case of hyperplastic polyposis and one of familial polyposis with adenomas on histological examination were registered. On the whole, juvenile polyps predominated and adenomas which can become carcinomas were less frequent than what is seen in Western developed countries. This may be due to the fact that the polyps we examined were only taken only from patients seen in outpatient department for gastrointestinal complaints.

Adolescent↗
PubMed1986

Colorectal polyps: an endoscopic experience.

Between April 1975 and December 1985, 870 colonoscopies were performed and 803 colorectal polyps were managed endoscopically. Thirty-nine per cent of the polyps were metaplastic polyps. The majority (59%) of polyps less than 5 mm in diameter were metaplastic polyps. Of the adenomatous polyps 63% were tubular, 32% were tubulovillous and 5% were villous histologically. Sixty-two per cent of all polyps were found in either the sigmoid colon or rectum. There was a higher proportion of tubulovillous adenomata (32%) than reported previously. Twenty-two patients had polypoid carcinomata and eight were removed endoscopically; four were subsequently referred for surgical excision because of 'incomplete' removal but no residual tumour was found. Fifty-three per cent of patients examined had more than one polyp. Fourteen of 19 patients who presented with a single polyp were found to have further polyps when examined subsequently and 29 of 39 patients with multiple index polyps had more polyps at follow-up. Perforation occurred in three patients, and two patients required blood transfusion following endoscopic polypectomy. It is suggested that total colonoscopy should be undertaken in all patients with polypoid disease because of the distribution of polyps found. It is further suggested that the findings of this study may be related to the high incidence of colorectal carcinoma in New Zealand.

Colon↗
PubMed1995

[Incidence of malignancy in millimetric polyps].

This paper is based on the analysis of 178 polyps of 5 mm or less (polyps we have termed "millimetric") studied in the Endoscopy Department of "La Paz" Hospital, Madrid, during 1993. All polyps fulfilling these characteristics detected during this period are included. The 178 polyps represent 43.4% of all polyps (N = 410) found on colonoscopy in this department in this period. The variables considered in the study protocol include age, sex, localization, morphology and histological examination, with particular attention to high risk histological lesions such as signs of possible malignancy.; we also performed a comparative study between the results obtained from the 178 millimetric polyps (Group I) and the 232 polyps greater than 5 mm (Group II) obtained during the same period. The endoscopic technique for the resection of the polyps was evaluated together with its possible complications. Although there were no significant differences found in respect to age, sex and location, there were morphological differences with a greater number of pediculated or semi-pediculated polyps in Group I whilst there were more sessile polyps in Group II. Adenomatous polyps were the most frequent (84%) in both groups. There was a greater incidence of signs of possible early malignant changes in Group II polyps (10) than in Group I (3.3%). The conclusions which may be drawn from our study are that it is clinically advisable to excise all polyps of 5 mm or less as the frequency of high risk histological changes is not negligible (3.3%), and excision is not problematic as the technique is easy and there have been no complications in our series.

Aged↗
PubMed2000

The natural history of isolated rectosigmoid adenomatous polyps: is flexible sigmoidoscopy a safe alternative for surveillance?

PURPOSE: Colonoscopic surveillance is recommended for patients with adenomatous polyps. Significant cost savings would result from identification of subgroups of patients in whom less costly surveillance would suffice. This study was performed to determine the natural history of patients undergoing removal of isolated rectosigmoid adenomas and to establish whether flexible sigmoidoscopy might be adequate for follow-up. METHODS: A retrospective review of a database of 7,677 colonoscopies, from 1990 to 1996, identified patients who had a minimal follow-up of two years after removal of adenomatous polyps isolated to the rectosigmoid. Polyps detected on surveillance colonoscopy were categorized as distal (< or =60 cm from anal verge), proximal (>60 cm from anal verge), and diffuse (proximal plus distal). The risk of polyp formation was determined by actuarial analysis using the Kaplan-Meier method. RESULTS: Sixty-two patients undergoing surveillance for adenomas met inclusion criteria. At the index colonoscopy, 124 isolated rectosigmoid polyps were identified. The median polyp size was 1 cm and median frequency was one polyp. The median follow-up time for the entire cohort (N = 62) was 53 months. At follow-up surveillance colonoscopy, 105 additional adenomas were discovered and removed in 40 patients. No malignant polyps were detected. The pattern of polyps detected were proximal (n = 19), rectosigmoid (n = 16), and diffuse (n = 5). CONCLUSIONS: The majority (65 percent) of patients with isolated rectosigmoid polyps have additional polyps on long-term surveillance, and 60 percent of patients will have these polyps located proximal to the reach of a sigmoidoscope. Therefore, flexible sigmoidoscopy is not a safe alternative for surveillance of patients with isolated rectosigmoid polyps.

Adult↗
PubMed2004

The malignant potential of endometrial polyps.

OBJECTIVES: To determine the pre-malignant and malignant potential of endometrial polyps and to assess whether different clinical parameters are associated with malignancy in the polyps. STUDY DESIGN: Four hundred and thirty consecutive cases of hysteroscopic diagnosis of endometrial polyp were retrieved. The medical records, preoperative vaginal sonography results and histopathology findings were reviewed. Statistical analysis was performed. RESULTS: Hysteroscopy truly identified endometrial polyps in 95.7% of the cases. In 11.4% cases, hyperplasia without atypia was found in the endometrial polyp. In 3.3 and 3.0% of women pre-malignant or malignant conditions were found in the polyp. Older age, menopause status and polyps larger than 1.5 cm were associated with significant pre-malignant or malignant changes, although the positive predictive value for malignancy was low. All the malignant polyps were diagnosed only in postmenopausal women. The presence of postmenopausal or irregular vaginal bleeding, was not a predictor of malignancy in the polyp. CONCLUSIONS: Postmenopausal women with endometrial polyps are at increased risk of malignancy in the polyp. Those patients, whether symptomatic or not should be evaluated by hysteroscopic resection of the polyps. Asymptomatic premenopausal patients with polyps smaller than 1.5 cm can be observed.

Adult↗
PubMed2005

Clinicopathologic review of malignant polyps in stage 1A carcinoma of the endometrium.

OBJECTIVES: The aims of this study were to determine the incidence of malignant polyps in stage 1A endometrial cancer, to define the pathological features of such cancers, and to assess whether clinical outcome differs from similar cancers without a malignant polyp. METHODS: We performed a retrospective pathological review of 107 cases of stage 1A endometrial cancer treated at two centers in New South Wales between January 1988 and July 2003. The presence of a malignant polyp was determined and a pathological description made of the tumor. Clinical data were collected, including prior tamoxifen usage, tumor recurrence and survival. The outcome of the malignant polyp group was compared to the same histological subtype not involving a malignant polyp. RESULTS: The incidence of malignant polyps in our series was 32%. Malignant polyps occurred in all 8 cases involving a serous subtype. Precursor lesions of endometrial cancer were identified within malignant polyps. Three out of the four recurrences occurred in high-grade tumor subtypes and all four had a large primary tumor (size > or = 4 cm). When comparing the same subtype of tumor with and without a malignant polyp, there was no significant difference in clinical outcome. CONCLUSIONS: Approximately one-third of stage 1A endometrial cancers are associated with a malignant polyp. Serous carcinoma commonly arises within an otherwise benign endometrial polyp. Malignant polyps offer an opportunity to identify precursors of endometrial carcinoma. Clinical outcome of stage 1A endometrial carcinoma was related to the histological subtype and the size of the tumor rather than the presence of a malignant polyp.

Adult↗
PubMed1999

Accuracy of pathologic interpretation of colorectal polyps by general pathologists in community practice.

BACKGROUND: The histologic features of colorectal polyps often guide colonoscopic surveillance and the need for surgical intervention. Our objective was to evaluate the pathologic interpretation of colorectal polyps by general pathologists in community practice. METHODS: Twenty histologic slides of colorectal polyps were reviewed by 20 randomly selected general pathologists in community practice. There were 5 malignant polyps, 9 adenomas, and 6 miscellaneous polyps. RESULTS: Cancer was correctly identified in 91% of readings and adenoma in 94%. The grade of differentiation of cancer was provided in 55% of readings, and comment regarding whether the resection margin was free of cancer was made by 50% of pathologists. Tubular adenoma was called tubulovillous or villous in 35% of readings, but tubulovillous or villous adenoma was seldom (2%) called tubular. High-grade dysplasia was correctly identified in 47% of 60 readings, was called invasive cancer in 22%, and was missed in 31%. Among miscellaneous polyps, hyperplastic polyp was correctly recognized in 75% of cases, and inflammatory polyp and juvenile polyp each were recognized by 16 of 20 pathologists (80%). Peutz-Jeghers hamartoma was identified by 4 of 20 pathologists (20%), and the polypoid phase of solitary rectal ulcer syndrome was recognized by 2 pathologists (10%). CONCLUSION: Areas of strength with regard to interpretation of colon polyps by general pathologists in community practice included identification of cancer, adenoma, and certain non-neoplastic polyps (e.g., inflammatory and juvenile polyps). Areas of weakness included lack of comment on cancer differentiation and proximity to the resection line, erroneous identification of high-grade dysplasia, and identification of rare lesions. The results of this study suggest areas on which to focus continuing education and continuous quality improvement efforts with regard to polyp interpretation.

Adenocarcinoma↗
PubMed2003

Recurrent endometrial polyps in postmenopausal breast cancer patients on tamoxifen.

OBJECTIVES: Endometrial polyps are the most common endometrial pathology described in association with postmenopausal tamoxifen exposure, with an incidence of up to 10.7% of malignancy. Some women tend to develop recurrent polyps. However, no one has yet described any risk factors for the development of recurrent endometrial polyps in postmenopausal breast cancer tamoxifen-treated patients. METHODS: We compared various clinical features of 64 postmenopausal breast cancer tamoxifen-treated patients with a primary endometrial polyp (Group I), with those of 27 similar patients with recurrent polyps (Group 2). RESULTS: Previous exposure to hormone replacement therapy was significantly more common and duration of tamoxifen treatment, up to the diagnosis of primary endometrial polyp, was significantly shorter in Group II patients (P = 0.0217 and P = 0.0148, respectively). Logistic regression analysis revealed that the combination of shorter tamoxifen exposure before the diagnosis of primary polyp, lower parity, lower menopausal age at the diagnosis of primary polyp, and higher years of tamoxifen treatment was found to increase significantly the risk of developing recurrent endometrial polyps. Any additional year of tamoxifen treatment may increase by fivefold the risk of developing recurrent polyps. There was no significant difference in ultrasonographic endometrial thickness measured before resection of the primary polyps in both groups and before the resection of recurrent polyps in Group II. CONCLUSIONS: Previous use of HRT, shorter duration of tamoxifen exposure, and additional years of tamoxifen treatment may significantly increase the risk of developing recurrent endometrial polyps in postmenopausal breast cancer tamoxifen-treated patients.

Antineoplastic Agents, Phytogenic↗
PubMed2000

Inflammatory cells in nasal mucosa and nasal polyps.

OBJECTIVE: Since some controversy exists concerning the frequency of inflammatory cells in nasal polyps, we have compared the frequency of tissue inflammatory cells (lymphocytes, neutrophils, eosinophils and plasma cells) including 11 kinds of lymphocyte subsets in the same specimens of nasal mucosa and nasal polyps. METHODS: Histopathological observations and flow cytometric analyses were performed on eight mucosal specimens of the inferior turbinates of patients with nasal polyps and on 13 polyp specimens. RESULTS: Nasal polyps contained significantly more eosinophils, neutrophils and plasma cells than nasal mucosa, and EG2+ cells (activated eosinophils) were significantly more frequent in nasal polyps than in nasal mucosa. Flow cytometric analysis showed that there were no significant differences in the frequencies of lymphocytes and lymphocyte subsets (CD1+, CD2+, CD3+, CD5+, CD7+, CD4+, CD8+, CD10+, CD19+, CD20+ and HLA-DR+ cells) including CD4/8 ratios between nasal mucosa and polyps, though, both nasal mucosa and polyps contained significantly more lymphocytes than eosinophils, neutrophils or plasma cells. The T cell lineage (CD2+, CD3+, CD5+ and CD7+ cells) was found in high frequency and B cell lineage (CD10+, CD19+ and CD20+ cells) in low frequency in both nasal mucosa and polyps. The frequency of HLA-DR+ cells (most of which were activated T cells) was not significantly different between nasal mucosa and nasal polyps. CONCLUSION: Histopathological and flow cytometric analyses were performed on the composition of inflammatory cells in nasal mucosa of the inferior turbinates and in polyps from the same patients. The elevated numbers of activated eosinophils, neutrophils and plasma cells in nasal polyps compared with nasal mucosa suggest that inflammatory processes play important roles in the pathophysiology of nasal polyps. The frequencies of lymphocytes and lymphocyte subsets were not significantly different between these two tissues.

Adolescent↗
PubMed2003

Is the distal hyperplastic polyp a marker for proximal neoplasia?

CONTEXT: The current literature is unclear about the association between distal hyperplastic polyps and synchronous neoplasia (adenomatous polyps and cancer) in the proximal colon. OBJECTIVE: To estimate the prevalence of proximal neoplasia associated with distal hyperplastic polyps. DATA SOURCES: Database searches (medline and embase from 1966 to 2001) and manual search of the bibliographies of included and excluded studies, case reports, editorials, review articles, and textbooks of Gastroenterology. STUDY SELECTION: Studies describing the prevalence of proximal neoplasia in persons with distal hyperplastic polyps. DATA EXTRACTION: Demographics, clinical variables, study design, and prevalence of proximal neoplasia associated with various distal colorectal findings. DATA SYNTHESIS: Of 18 included studies, 12 involved asymptomatic individuals in which the pooled absolute risk of any proximal neoplasia associated with distal hyperplastic polyps was 25% (95% confidence interval [95% CI], 21% to 29%). In 4 studies where colonoscopy was performed irrespective of distal findings, the absolute risk was 21% (95% CI, 14% to 28%). The relative risk of finding any proximal neoplasia in persons with distal hyperplastic polyps was 1.3 (95% CI, 0.9 to 1.8) compared to those with no distal polyps. Among 6 studies of patients with symptoms or risk factors for neoplasia, the absolute risk of proximal neoplasia was 35% (95% CI, 32% to 39%) in persons with distal hyperplastic polyps. In 2 studies of screening colonoscopy, advanced proximal neoplasia (cancer, or a polyp with villous histology or severe dysplasia, or a tubular adenoma >/=1 cm) was present in 4% to 5% of persons with distal hyperplastic polyps, which was 1.5 to 2.6 times greater than in those with no distal polyps. CONCLUSIONS: In asymptomatic persons, a distal hyperplastic polyp is associated with a 21% to 25% risk for any proximal neoplasia and a 4% to 5% risk of advanced proximal neoplasia, and may justify examination of the proximal colon. Further study is needed to determine the risk of advanced proximal neoplasia associated with size and number of distal hyperplastic polyps.

Colonic Neoplasms↗