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PubMed2006

[Colorectal polyps in children. A study of 34 patients].

AIM: To assess the frequency and the clinical features of polyps of the colon and rectum in children. METHODS: A total of 34 patients (20 boys and 14 girls, mean age: 5.4 years) were enrolled in this 14-years retrospective study. Diagnosis was done for almost all patients by colonoscopy (n=8) or recto-sigmoidoscopy (n= 19). After endoscopic polypectomy, polyp's type is determined by histological examination. RESULTS: Minimal and relapsing rectal bleeding was the most frequent finding of polyps of the colon and rectum (85.3%) followed by spontaneous emission of polyp (n=3), rectal prolapses (n=2), chronic constipation (n=1) and abdominal pain (n=1). The polyp was unique in all cases and with a mean size of 12 mm. The majority of polyps were localized in the rectum or sigmoid (97%) and were pediculate (81.2%). Endoscopic polypectomies concerned 26 polyps while two small polyps were left. Most of the polyps corresponded histologically to juvenile polyps (96.2%). The immediate post-op course was uneventful for 26 children. CONCLUSION: Our study suggests that rectal bleeding is the most frequent finding of polyps of the colon and rectum in childhood. Outcome after endoscopic polypectomy is good.

Adolescent↗
PubMed1991

The sentinel hyperplastic polyp: a marker for synchronous neoplasia in the proximal colon.

We prospectively screened 129 asymptomatic subjects (mean age 64 yr) with flexible sigmoidoscopy. Colonoscopy was performed at a later date, regardless of the sigmoidoscopic result. Our intent was 1) to establish the prevalence of proximal neoplasms in patients with and without hyperplastic polyps within reach of the 60-cm sigmoidoscope and 2) to determine whether a distal (sentinel) hyperplastic polyp predicts the presence of synchronous neoplastic polyps higher up in the colon. Our results show that 15% of asymptomatic adult subjects without polyps on sigmoidoscopy have adenomas in proximal colonic segments that can be diagnosed only by colonoscopy. By comparison, proximal neoplasms were detected in 32% (p less than 0.05) and 37% (p less than 0.05) of patients when hyperplastic or adenomatous polyps, respectively, were present on the sigmoidoscopic examination. This finding suggests that a distal (sentinel) hyperplastic polyp by itself may be a marker for neoplastic polyps in proximal colonic segments. Also, the "index" adenoma and "sentinel" hyperplastic polyp may be equivalent for predicting the presence of proximal neoplasms. The observed detection rates for these polyps were both significantly higher than expected when compared to patients who did not have polyps in the distal colon or rectum. If these results can be confirmed by a larger prospective trial, then full colonoscopy for detection of proximal neoplasms may be indicated when either an index adenoma or sentinel hyperplastic polyp is detected by sigmoidoscopy.

Aged↗
PubMed1990

[Expression of MG7 corresponding antigen in gastric polyp and its relation to gastric carcinoma].

Forty-nine cases of gastric polyp (GP) were studied by histologic classification and immunohistochemical localization of monoclonal antibody MG 7 against gastric carcinoma. There were 12 cases (24.5%) of inflammatory polyp; 19 cases (38.8%) of hyperplastic polyp and 18 cases (36.7%) of adenomatous polyp. 3 cases (6.1%) of GP were malignant, among which 2 (11.1%) were adenomatous polyp and 1 (5.3%) was hyperplastic polyp. Seventeen cases (34.7%) of GP were MG 7 positive by ABC method, including 7 (36.8%) of hyperplastic polyp and 10 (55.5%) of adenomatous polyp. The inflammatory polyps were negative, and all of the cases with malignancy were strongly positive. The results showed that both GP and gastric carcinoma express MG 7 related antigen. These suggest that adenomatous polyp and hyperplastic polyp are closely related with gastric carcinogenesis.

Antibodies, Monoclonal↗
PubMed1990

Double-contrast barium examination and endoscopy in the detection of small polyps of the large intestine.

The purpose of this study was to compare double-contrast barium examination (DCBE) and endoscopy in detection of small colonic polyps. In 57 patients DCBE revealed 106 polyps in the large intestine. On total colonoscopy, 62 polyps could be verified. The size of the polyps excised ranged from 2 to 15 mm. Compared with DCBE, colonoscopy verified 48 true positive, 44 false positive and 14 false negative polyps. In revealing a polyp less than 5 mm, DCBE had a sensitivity of 72%, whereas in detection of larger polyps the sensitivity was 81%. Histological verification was available in 52 of the 62 removed polyps. A tubular adenoma was found in 12 of the 29 diminutive polyps verified with histology. DCBE and colonoscopy could not differentiate between adenomas and hyperplastic polyps. Since a polyp less than 5 mm may represent an adenoma, a precancerous lesion, its removal is indicated during colonoscopy after DCBE has detected it.

Adenoma↗
PubMed1989

Large colorectal polyps: colonoscopy, pathology, and management.

Between 1984 and 1987, we reviewed all large (greater than or equal to 3.0 cm) colorectal polyps to determine the efficacy of colonoscopic polypectomy from both an oncologic and technical viewpoint. Forty-eight polyps greater than or equal to 3.0 cm were identified in 46 patients. Twenty polyps were entirely benign, 20 polyps contained noninvasive carcinoma, and invasive carcinoma was present in eight polyps. Four of the invasive cancers were associated with residual adenoma; the remaining four were polypoid carcinomas. Among the eight cases of invasive carcinoma, four had tumors that did not extend through the submucosa. Invasive cancer was more prevalent in left-side sessile lesions but was absent in all 10 right-sided polyps. Thirty-two polyps were removed by colonoscopic polypectomy. Four patients required colectomy after polypectomy for the following reasons: incomplete excision (N = 1), presence of invasive carcinoma at the resection margin (N = 1), and inability to define the level of carcinoma on pathologic examination (N = 2). Two polyps with cancer confined to the submucosa were successfully excised colonoscopically. Complications of polypectomy included three cases of minor hemorrhage. Sixteen polyps (the majority located in the right colon) were removed by primary surgical colectomy. We conclude that colonoscopic polypectomy is oncologically and technically successful for most large colorectal polyps. A minority of large polyps require colectomy because of incomplete removal or the presence of invasive cancer that is not curable with colonoscopic excision.

Adenoma↗
PubMed1988

Follow-up colonoscopy in patients with colorectal adenomatous polyps.

Multiple follow-up colonoscopies were performed in 44 asymptomatic patients after polypectomy of colorectal adenomatous polyps. Twenty-six patients (59%) developed new adenomatous polyps. In 81% the new polyps were located in the same segment of the colon where a previous polyp had been totally removed. Polyps removed during follow-up, compared with the initial polyps, revealed significantly more benign and smaller polyps. The number of initial polyps together with occurrence of atypia were factors determining a short time interval for developing new adenomatous polyps. The mean time for developing a 5-mm or larger polyp was significantly longer than polyps less than 5 mm in diameter.

Adenoma↗
PubMed1988

Small colon polyps.

One thousand forty-eight small (up to 6 mm) colorectal polyps, removed during colonoscopy, have been analyzed. Sixty-one percent of these small polyps were neoplastic, the remainder being equally divided between hyperplastic polyps and polypoid mucosa with normal-appearing glands. The number of polyps was evenly distributed throughout the colon. Proximally, neoplastic polyps predominated, accounting for 73% of all polyps in the right colon. This was reversed in the distal colon where non-neoplastic polyps comprised 65% of all polyps in the rectum. The incidence of carcinoma was extremely low in small colon polyps, 0.1%. All polyps should be removed when encountered during colonoscopy due to the high prevalence of adenomas among small colon polyps.

Adult↗
PubMed1985

Gastric polyps--a clinical study.

In 72 of 13,500 patients who underwent endoscopy of the upper digestive tract during an 8-year period, 99 gastric polyps were found. All the polyps were biopsied; 18 were also removed. Histological examination of the 99 polyps showed that 25 were inflammatory, 23 hyperplastic, 17 hyperplasiogenic, 10 adenomatous, 3 hamartomatous, 3 with intestinal metaplasia and 18 with normal mucosa. The histological diagnosis was changed following polypectomy in 50% of the polyps that had been removed. Dysplasia was discovered in two adenomatous polyps; no carcinoma was found. In two cases the polyps were syncronous to carcinoma; in two other cases, they were metachronous to carcinoma. Inflammatory polyps were found in association with inflammation of the upper gastrointestinal tract, such as duodenal and gastric ulcer, esophagitis, gastritis and duodenitis. No correlation was demonstrated between the symptoms and the type or location of the polyps. In 10 patients, who were under observation for an average duration of 3.5 years, 3 polyps disappeared, 1 was removed and 11 had not changed. We conclude that endoscopic polypectomy of gastric polyps may not always be indicated and should be reserved for polyps that were adenomatous, according to the biopsy, or that had grown and changed their shape in a follow-up endoscopy.

Adenocarcinoma↗
PubMed1993

Are endoscopic measurements of colonic polyps reliable?

Many clinical studies of colorectal adenomatous polyps rely on endoscopic estimation of polyp size. To examine the reliability of such measurements, we conducted a study using artificial polyps in an endoscopy teaching model. Eight experienced endoscopists estimated the size of 13 polyps in two separate sessions 2 wk apart. Endoscopic estimates of polyp size tended to be significantly lower than the true polyp size for all polyps and all endoscopists at both sessions. We also found a statistically significant difference in the magnitude of the underestimation between the first and second session (p < 0.0001). At the first session, polyps tended to be estimated at 64% of their true size, and at the second session, the estimates tended to be at 77% of the actual polyp size. We estimate the magnitude of the variation in polyp measurements due to individual polyps, endoscopist, and examination session, and discuss the impact these sources of variation have in planning of clinical trials.

Colonic Neoplasms↗
PubMed2004

Adenomatous colonic polyps are rare in ulcerative colitis.

BACKGROUND: Uncertainty exists as to whether dysplastic polyps in ulcerative colitis should always be managed as dysplasia-associated lesions/masses requiring colectomy, or whether some can be managed by polypectomy. The prevalence of non-inflammatory polyps in ulcerative colitis is unknown. AIM: To compare dysplastic polyp occurrence in patients with ulcerative colitis and in patients without inflammatory bowel disease. METHODS: The clinical, endoscopic and histological records of 150 ulcerative colitis patients (median disease duration, 10 years; 57% with pancolitis) undergoing colonoscopy were scrutinized for any polyp history. Two hundred and five patients undergoing colonoscopy for altered bowel habit, but without features suggestive of polyp presence, were used as a control group. Immunohistochemical staining of flat and polypoid mucosa for p16, beta-catenin, p53 and cyclo-oxygenase-2 was compared in the two groups. RESULTS: Only six (4%) ulcerative colitis patients had ever had dysplastic polyps. Two had single adenomatous polyps proximal to the colitis segment. Of the four patients with dysplastic polyps within colitic mucosa, two were treated endoscopically, but in two the lesions were considered to be dysplasia-associated lesions/masses and colectomy was advised. In contrast, 24 controls had at least one adenomatous polyp (chi(2) = 6.7, P < 0.01). Ten (6.7%) ulcerative colitis patients and 24 (12%) control patients had metaplastic polyps (N.S.). Immunohistochemical staining was not discriminatory. CONCLUSION: Despite the increased cancer risk in long-standing ulcerative colitis, adenomatous polyps arise less frequently in ulcerative colitis patients than in patients without ulcerative colitis.

Adenomatous Polyposis Coli↗
PubMed2003

Frequent loss of hMLH1 by promoter hypermethylation leads to microsatellite instability in adenomatous polyps of patients with a single first-degree member affected by colon cancer.

The first-degree relatives of patients affected by colorectal cancer, who do not belong to familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer families, have a doubled risk of developing tumors of the large intestine. We have previously demonstrated that subjects with a single first-degree relative (SFDR) with colon cancer have a doubled risk for developing colorectal adenomas, and in these cases, polyps recur more frequently. The mechanism underlying this predisposition has not been clarified. In this study, we evaluated the frequency of microsatellite instability (MSI) using the five markers suggested by the National Cancer Institute workshop, target gene mutations, hMLH1 and hMSH2 expression, and hMLH1 promoter hypermethylation in the adenomas of patients with and without a SFDR affected by colon cancer. Seventy polyps were obtained from 70 patients: 27 with a single FDR with colon cancer and 43 without such a history. Of the 70 polyps, 12 were MSI-H (17.1%), 20 were MSI-L (28.6%), and 30 were microsatellite stable (42.9%). Of the 27 patients with positive family history, 8 polyps (29.6%) were MSI-H compared with those with negative history in which 4 polyps (9.3%) were MSI-H (P < 0.02). Of the 12 MSI-H polyps, all of the polyps obtained from patients with positive family history had loss of hMLH1 immunostaining versus one with negative family history (P < 0.02). Of the MSI-H polyps, 2 had a somatic frameshift mutation of the MBD4 gene, 1 of MSH6, 1 of BAX, and 2 of transforming growth factor betaRII. Furthermore, 6 of 8 polyps from patients with positive family history with MSI-H and loss of MLH1 had hypermethylation of the MLH1promoter versus none of the MSI-H with negative family history (P < 0.02). All 6 polyps of the 27 from SFDR positive subjects, with hMLH1 promoter hypermethylation loss of hMLH1 and MSI, were located in the right colon (P < 0.02). Hypermethylation of the promoter of hMLH1, consequent loss of hMLH1 expression, and MSI are at the basis of approximately 25% of adenomatous polyps developed in subjects with a SFDR affected by colorectal cancer.

Adaptor Proteins, Signal Transducing↗
PubMed1998

[The yield of endoscopic follow-up after removal of adenomatous polyps from the colon].

OBJECTIVE: To determine the results of follow-up endoscopy after resection of adenomatous polyps from the colon. DESIGN: Retrospective. SETTING: De Heel Hospital, department of Internal Medicine, Zaandam, the Netherlands. PATIENTS AND METHOD: The 124 patients, 66 males and 58 females, with a mean age of 53 years (range: 23-74), in whom a colonpolyp had been removed endoscopically, who had no colonic carcinoma and no positive family history, were registered for follow-up after one year and after 3 or 5 years. In 1997, data were collected on the polyps found and removed at follow-up. RESULTS: At the original coloscopy, 68 patients (55%) had one polyp, 46 (37%) had two to four polyps and 10 (8%) > or = five polyps. The localizations of the polyps were: rectum 17%, sigmoid 66%, descending colon 12%, transverse colon 3%, ascending colon 1% and caecum 1%. Over one-third of the polyps were larger than 1.5 cm. Ninety-eight patients underwent a first follow-up endoscopy after an average of 12 months (range: 0.4-57); one or more polyps were found and removed in 37 of them (38%). At a second follow-up endoscopy after an average of 28 months (range: 5.4-68 months), polyps were again found and removed in 26 of the 57 patients (46%). If two or more polyps had been removed at an earlier coloscopy, the risk of polyps being found again at the next coloscopy was larger (p < 0.001).

Adenomatous Polyposis Coli↗
PubMed1989

Spatial clustering of multiple hyperplastic, adenomatous, and malignant colonic polyps in individual patients.

Analysis of relative polyp locations in 426 consecutive patients with multiple colonic polyps found on colonoscopy showed novel findings. First, synchronous and metachronous neoplastic polyps showed spatial clustering in individual patients. For example, patients with their largest neoplasm in the cecum or proximal ascending colon, had 34.3 percent +/- 4.6 percent (standard error) of their other colonic neoplasms in the same location. Second, hyperplastic polyps showed spatial clustering in individuals that was statistically significantly greater than expected from the increased hyperplastic polyp concentration in the rectum and sigmoid. Third, hyperplastic polyps showed spatial clustering with neoplastic polyps; this clustering was similar in magnitude to clustering for exclusively hyperplastic or neoplastic polyps. In contrast, lipomas were not spatially clustered with hyperplastic and neoplastic polyps. The magnitude of clustering between hyperplasia and neoplasia showed a closer association between these histologic types than previously appreciated. Because of clustering, regions with prior polyps appear to merit closer surveillance. These findings suggest clinical study, using a randomized controlled clinical trial, of whether a patient who had only rectal and sigmoid adenomas on initial and follow-up colonoscopy should have surveillance with flexible sigmoidoscopy alternating annually with colonoscopy. A patient with a prior cecal adenoma should have surveillance only with a complete colonoscopy or adequate cecal views on barium enema.

Adenoma↗
PubMed1995

Endoscopic and histologic correlates of colorectal polyp bleeding.

Until now, the exact mechanism of bleeding from colorectal polyps has not been demonstrated. The present study aimed to identify macroscopic factors and the main source of polyp bleeding. One hundred fifty-seven cases of single colorectal polyp from a variety of clinical situations were investigated to determine whether surface area, shape, color, and location in the colon were correlated with a positive result in the fecal occult blood test. We also searched for the site of bleeding on the surface of polyps under a dissecting microscope and investigated the relationship between bleeding and microerosion and thin surface epithelium on the maximal vertical cross-section of the polyp. The presence of fecal occult blood was found to be correlated with the surface area of colonic polyps. We demonstrated that a red color tone of polyps was caused largely by microerosion and that the area of both microerosion and thin surface epithelium was significantly larger on polyps associated with a positive fecal occult blood test result. The extent of microerosion and thin surface epithelium was found to be correlated with the polyp surface area and villous component. These observations strongly suggest that the area of microerosion and thin surface epithelium tends to increase as the surface area expands, resulting in a higher rate of detection of polyps with malignant potential by the fecal occult blood test.

Adenocarcinoma↗
PubMed1995

Hydrosonography in the evaluation of colorectal polyps.

Prewarmed saline enemas and transabdominal ultrasound (hydrosonography) were used to evaluate 17 consecutive children with rectal bleeding before colonoscopy. Twelve patients with polyps were identified (10 by ultrasound, 10 by endoscopy): these included multiple hyperplastic polyps (1), multiple polyps (1), solitary polyps (9), and pseudopolyps (1). Ultrasound identified 11 polyps in 10 patients, missing two patients with small polyps less than 0.5 cm in diameter. The polyps were hyperechoic ovoid masses fixed to the colonic wall, with a stalk (7), submucosal infolding (5), and intraluminal floating (5). There was one false positive. Colonoscopy was refused by one patient and failed to reach beyond the distal sigmoid in another following previous surgery for malrotation. Colonoscopy was superior in identifying finer mucosal detail (colitis, ulcers, proctitis, anal fissure) and in detecting smaller polyps (sessile polyps, hyperplastic polyps). Hydrosonography of the colon is a simple, relatively non-invasive procedure that provides an alternative, radiation-free examination of the whole colon before colonoscopy. It is complementary to colonoscopy in the management of rectal bleeding in children.

Child↗
PubMed1996

Colorectal polyp detection with CT colography: two- versus three-dimensional techniques. Work in progress.

PURPOSE: To compare detection of colorectal polyps with two-dimensional (2D) computed tomographic (CT) colography only, three-dimensional (3D) CT colography only, and a combination of 2D and 3D CT colography. MATERIALS AND METHODS: A total of 11 computer-simulated polyps (1-10 mm) were placed randomly in five identical CT data sets for images of a 72-year-old man's polyp-free, rectosigmoid colon. Fifteen CT colographic data sets were produced: five with 2D CT images only, five with 3D CT images only, and five with 2D and 3D CT images. Two radiologists randomly, blindly, and independently evaluated all 15 data sets to detect the simulated polyps. RESULTS: No polyps 2 mm or smaller were detected. No statistically significant differences in the detection of colorectal polyps were found between the three techniques. However, the combination of 2D and 3D CT colography resulted in polyp detection rates that were greater than or equal to those of 2D or 3D CT colography alone. Flat polyps were more difficult to detect than sessile polyps. Five false-positive findings occurred with 2D CT colography. CONCLUSION: A combined display of 2D and 3D CT images likely provides the greatest rate of detection of colorectal polyps.

Aged↗
PubMedDate not supplied

Proliferative activity and cytometric characteristics in polyps of the nasal cavity and paranasal sinuses.

Although several investigations have revealed the influence of cytokines, allergy, and environmental factors in polyp development, the etiology of nasal polyps is still unknown. To estimate the biology of this common disease the operative specimens of 50 patients who underwent surgery for polyps of the nasal cavity and the paranasal sinuses were examined; of these, 10 patients had recurrent disease and 23 patients had an allergy. The investigations included routine histology and quantitative DNA measurements, along with immunohistochemical identification of proliferation markers (i.e., MIB-1; proliferating cell nuclear antigen, PCNA). Histologically, most polyps revealed an infiltration with lymphocytes, eosinophilic granulocytes, and plasma cells. Twenty-five percent had a squamous metaplasia of the respiratory epithelium. Quantitative DNA analysis demonstrated diploid stemlines and lack of aneuploid cells with a DNA content exceeding 5c in most cases. Immunohistochemical detection of proliferation markers showed low proliferation rates in all cases. In 27 polyps no MIB-1 expression was detected, and in 7 polyps no PCNA expression was detected. The polyps of the 23 patients with proven allergic diathesis did not reveal higher scores for the parameters of DNA analysis (i.e., ploidy status and percentage of aneuploid cells) and proliferation scores. Nasal polyps of 10 patients with recurrent disease displayed higher scores for proliferation markers, and in five cases aneuploid cells with 5c exceeding rate (5cER) of 1.5-11.7% were detected. According to these results, polyps of the nasal cavity and paranasal sinuses showed low proliferation scores and were diploid. The data demonstrated that there was no increase of proliferation activity or ploidy shift toward aneuploidy in patients with allergy. Nevertheless, in recurrent disease some increase in proliferation activity and some changes in the parameters of the DNA analysis occurred, indicating more aggressive behavior of recurrent polyps in single cases.

Adolescent↗
PubMed1992

Reliability of in situ measurements of colorectal polyps.

A reliable and sensitive in situ method for measuring polyp size is fundamental for growth studies of colonic polyps. A measuring probe inserted through a colonoscope can give a visual assessment of polyp diameter, and from a picture of the polyp the area of the polyp on the picture can be calculated by computerized analysis. To test the reliability and sensitivity of these two in situ measurements, 43 colonic polyps (mean diameter, 8.5 mm; range, 4-20 mm) removed by snare diathermy resection were examined. The maximal diameter was measured, and two Polaroid pictures taken of each polyp. After polypectomy each polyp was subjected to extracorporeal reassessment of diameter and measurement of weight and volume. By computerized analysis of the pictures the following variables were estimated: 1) area of the polyp on the picture; 2) largest diameter; 3) maximum width 90 degrees on the largest diameter; 4) maximum distance from centre of gravity; and 5) minimum distance from centre of gravity. Results showed good correlation between diameter measured in situ and after removal (r = 0.93), diameter raised to the 3rd power and weight (r = 0.93), and also to volume (r = 0.77). Area analysis compared with weight was less good (r = 0.72). A very high correlation was demonstrated between weight and volume (r = 0.99). We conclude that the measurement of diameter in situ with a measuring probe is sensitive and somewhat more reliable than computerized analysis of size. The present 3-year follow-up and intervention study will show which of the two methods is preferable for evaluation of polyp growth.

Colonic Polyps↗