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PubMed2004

[Characteristics and risk factors of synchronous and metachronous polyp in colorectal cancer].

BACKGROUND/AIMS: Detection and removal of adenomatous polyps with colonoscopy is known to be the best preventive method for the colon cancer. With removal of synchronous colon polyps, the risk of metachronous cancer seems to be decreased effectively. However, the preoperative evaluation of entire colon is frequently impossible due to luminal obstructive lesion. Therefore, it is important to evaluate entire colon in postoperative period as earlier as possible. The aim of current study is to analyze the characteristics and risk factors of synchronous as well as metachronous polyps. METHODS: From Jan. 1998 to Dec. 2001, among the patients who received operative treatment for colon cancer in Yonsei University, Severance Hospital, 972 patients, who had underwent preoperative endoscopic evaluation and surveillance above one year after operation, were enrolled. RESULTS: In 617 patients who had completed total colonic evaluation within one year after operation, 45.93% of cases had synchronous polyps, 17.0% advanced polyps, and 5.8% synchronous cancer. The incidence of synchronous and advanced synchronous polyps was high in elderly (>or=60 year), male patients (p<0.05). In 166 patients who had underwent postoperative colonoscopy after one year, 25.3% had metachronous polyps, 3.0% advanced polyps, and 0.6% metachronous cancer. The presence of synchronous polyps was associated with the risk of metachronous polyps (p<0.05). CONCLUSIONS: Complete colonic evaluation during perioperative period should be recommended to identify precancerous lesions, which can contribute to reduce the development of colon cancer.

Adult↗
PubMed2004

[Expression of nitric oxide synthase and its significance in nasal polyps].

OBJECTIVE: To study the expression of nitric oxide synthase (NOS) and its activity in nasal polyps and its significance. METHOD: Septectomy and immunohistochemisty were used to examine NOS activity and identify the expression of inducible NOS (iNOS) and endotheial NOS (eNOS) in human nasal specimens from patients undergoing nasal spectrumtomy (n = 20) or nasal polypectomy (n = 30). RESULT: The activity of NOS was significantly higher in nasal polyps than in nasal mucosa (4.079 +/- 0.655) U/Pro vs (1.526 +/- 0.310) U/Pro (P<0.01). iNOS reaction product was located in epithelial cells, vascular endothelial cells, nasal glands and inflammation cells of nasal polyps. iNOS reaction product almost was not be founded in nasal mucosa. Amount of. iNOS positive cells in nasal polyps was higher than in nasal mucosa (P<0.01). eNOS reaction product were located in nasal polyps and nasal mucosa. There was no quantitative difference of eNOS between in nasal polyps and nasal mucosa. Amount of iNOS positive cells was significantly higher than of eNOS positive cells in nasal polyps (P<0.01). CONCLUSION: iNOS, mainly expressed in nasal polyps, locates in epithelial cells and vascular endothelial cells and nasal glands and inflammation cells in nasal polyps, which produce NO at high concentration that plays an important role in the formation of nasal polyps.

Adult↗
PubMed2004

Peutz-Jeghers syndrome: report of 6 cases in a family and management of polyps with intraoperative endoscopy.

BACKGROUND/AIMS: Peutz-Jeghers syndrome is an uncommon, autosomal dominantly inherited disorder characterized by mucocutaneous melanin pigmentation and gastrointestinal hamartomatous polyps. The purpose of this study was to present six cases of Peutz-Jeghers syndrome in a family. METHODS: Enteroclysis, upper and lower gastrointestinal endoscopy, and thyroid, abdominal, and testicular or breast ultrasonography were performed in all subjects. Tumor markers including CEA, alpha-FP, CA 19-9, CA 15-3, and CA 125 were measured. Management of polyps and complications were evaluated. RESULTS: History of the patients were as follows: patient 1 (40-year-old male) underwent surgery 20 years previously; patients 2 and 3 (19-year-old female and 17-year-old male) had undergone surgery three times between the ages of 11 and 18 years, and two times between the ages of 15 and 17 years, respectively; patient 4 (16-year-old male) had undergone surgery three times at the age of 13 years; patients 5 and 6 (14-year-old and 11-year-old males) had no history of surgery. All surgical procedures had been performed due to intestinal obstruction. Hyperpigmentation of the lips and oral mucosa were observed in all patients except patient 1, whose pigmentation disappeared 20 years previously. Patient 2 also had pigmentation of hands and feet. Enteroclysis showed small bowel polyps in all subjects except patients 1 and 6. During colonoscopy, different sizes of polyps were observed at different locations of the colon, and polyps larger than 1 cm were removed. Patients 2 and 3 underwent surgery due to complication of small bowel polyps; 69 polyps in patient 2 and 17 polyps in patient 3 were removed via intraoperative endoscopic procedure. Hamartomatous lesions were confirmed by histopathological examinations. Microscopic study of polyps of patients 2 and 3 revealed dysplastic changes. None of the patients had evidence of malignancy as of June 2003. Peutz-Jeghers syndrome demonstrated autosomal dominant inheritance in this family. CONCLUSIONS: The major problem during follow-up of patients with Peutz-Jeghers syndrome is the management of small bowel polyps. When encountered during surgery, intraoperative enteroscopic polypectomy should be performed.

Adolescent↗
PubMed2005

Differential expression of WT-1 in serous carcinomas in the peritoneum with or without associated serous carcinoma in endometrial polyps.

Although differential WT-1 expression between ovarian and uterine serous carcinoma has been discussed in the literature, there have been no studies of WT-1 expression in serous carcinomas in the peritoneum with or without concurrent serous carcinoma in an endometrial polyp. This study addresses this issue and includes a small series of uterine and ovarian serous carcinomas for comparison. Nine peritoneal serous carcinomas with coexistent serous carcinoma in an endometrial polyp, 10 peritoneal serous carcinomas without serous carcinoma in an endometrial polyp, 9 uterine serous carcinomas, and 12 ovarian serous carcinomas were stained with antibody to WT-1. Ninety-two percent of ovarian serous carcinomas and 80% of peritoneal serous carcinomas without serous carcinoma involving an endometrial polyp expressed WT-1. In contrast, 12% of peritoneal serous carcinomas with serous carcinoma in an endometrial polyp expressed WT-1 with the serous carcinoma in the endometrial polyp staining concordantly. For uterine serous carcinoma without an endometrial polyp, only 11% expressed WT-1. Peritoneal serous carcinomas without coexistent serous carcinoma in an endometrial polyp have a WT-1 expression pattern similar to ovarian serous carcinoma while peritoneal serous carcinomas with coexistent serous carcinoma in an endometrial polyp have a staining pattern similar to uterine serous carcinoma. The difference in WT-1 expression among serous carcinomas suggests a difference in biology based on the site of origin. Additionally, the difference in WT-1 expression between peritoneal serous carcinomas with and without coexistent serous carcinoma in endometrial polyps suggests that peritoneal serous carcinoma may have different pathogenetic pathways.

Cystadenocarcinoma, Serous↗
PubMed2004

The value of ultrasound harmonic imaging in the diagnostics of gall bladder cholesterol polyps.

The aim of the study was to assess the value of harmonic imaging in US evaluation of gall bladder cholesterol polyps. Material comprises 40 patients with pathology of gall bladder diagnosed in US examination. 10 patients from this group with gall bladder cholesterol polyps diagnosed in US were included into the study. In each patient supplementary US examination in the harmonic mode was performed. The quality of images in the harmonic mode was better. The walls of the gall bladder were more distinct. The polyps were more evident on harmonic images. THI enable more precise measurements of the polyps. In three cases in the standard mode the inspissated bile was found in gall bladder, and in those patients polyps were difficult to assess. Examination of those patients in the harmonic mode excluded the presence of the bile sludge, and facilitates the assessment of the polyps. In four patients on harmonic images more polyps were found than in the standard mode. In the harmonic mode the level of artifacts generated by the body wall is reduced and contrast resolution is increased due to reduction in noise level. The visualization of gallbladder is improved in the harmonic mode. The assessment of gallbladder polyps in the harmonic mode is easier. The polyps are easily seen, assessment of their margins and size is facilitated by harmonic imaging. The number of polyps revealed in US examination is larger in the harmonic mode.

Cholesterol↗
PubMed1990

Sucrase-isomaltase: a marker associated with the progression of adenomatous polyps to adenocarcinomas.

Adenocarcinomas of the colon arise from adenomatous polyps. We hypothesized that sucrase-isomaltase (SI), a glycoprotein hydrolase, found in normal small intestine, fetal colon, and colon carcinomas is a marker associated with progression of adenomatous polyps with dysplasia to adenocarcinomas. To examine this hypothesis, we performed immunostaining using a polyclonal antihuman SI antibody in 32 adenomatous polyps with varying degrees of dysplasia. In addition, sucrase enzyme activity was determined in three sets of simultaneously harvested polyps, cancer, and adjacent normal mucosa from the same patient. All severely dysplastic polyps (6/6) exhibited SI staining. Most polyps (85%) with 3+ staining (i.e., greater than 10% of polyp positive for SI) had severe dysplasia, whereas those with mild dysplasia had either 1% to 5% staining or no staining in 95% of the cases. These data indicate that the extent of SI immunostaining in polyps correlates with the degree of dysplasia (p = 0.0001). Sucrase-isomaltase activity in the polyps was 18.1 +/- 1.8 mU/mg (mean +/- SD); in adjacent carcinoma SI activity was 29.1 +/- 1.8 mU/mg. Adjacent mucosa showed no activity in all cases. In summary, our results suggest that SI expression correlates with the progression of dysplastic adenomatous polyps to carcinoma. Sucrase-isomaltase expression may be useful as a clinical marker to improve our prognostic capabilities in patients with dysplastic lesions of the colon, that is, inflammatory bowel disease.

Adenocarcinoma↗
PubMed1991

[The relation between granulocyte elastase activity in cervical mucus and gestational cervical polyp].

Granulocyte elastase activity in cervical mucus (elastase activity) was measured in pregnant women (10-20 gestational weeks) with cervical polyp and controls (gravida with no cervical polyp). Elastase activity in the cervical polyp group was 86 +/- 44 U/l, and that in the control group was 22 +/- 13 (p less than 0.01). Elastase activity after polypectomy was 44 +/- 24. It decreased significantly compared with prepolypectomy (p less than 0.05). A high level of elastase activity continued in cases without polypectomy. Immunohistochemical staining of elastase for cervical polyps was also performed. In the low elastase staining group there was low elastase activity (46 +/- 26 U/l). Elastase activity in the moderate staining group was 89 +/- 31, and that in the intense staining group was 114 +/- 31. As for the prognosis of patients with cervical polyps, the occurrence rate of chorioamnionitis is 9% in the control group, 14% in the polyp with polypectomy group and 40% in the polyp without polypectomy group. There was a significant difference between the polyp without polypectomy group and other groups (p less than 0.01). These data suggest that cervical polyp is a focus of inflammation and that it may cause chorioamnionitis. We conclude that cervical polyp during pregnancy should be removed. If polypectomy could not be performed, local anti-inflammatory and anti-infectious therapy would be needed.

Cervix Mucus↗
PubMed1991

Carcinoembryonic antigen in serum of patients with colorectal polyps: correlation with histology and smoking status.

To measure the concentration of carcinoembryonic antigen (CEA) in serial serum specimens of 47 healthy subjects and in serial sera of 59 patients with colorectal polyps of confirmed histology, obtained before or after (sometimes both) polypectomy, we used the Roche EIA and the Hybritech Tandem-E double monoclonal immunoenzymometric assays. Both methods gave comparable results for the healthy subjects but discordant values for some polyp patients. The Tandem-E test gave increased CEA results more frequently for two groups of polyp patients, the group of ex-smokers with neoplastic polyps (n = 14) and the group of smokers (n = 20). Smokers had significantly greater (P less than 0.025) mean concentrations of serum CEA than did nonsmokers, irrespective of whether they were healthy or had colorectal polyps. Smokers with recurrent polyps demonstrated significantly greater (P less than 0.050) mean concentrations of serum CEA than did smokers with a first occurrence of polyps. Polypectomy was followed by statistically significant decreases (P less than 0.050) of mean concentrations of serum CEA, primarily in polyp patients who were smokers. However, although CEA increases occurred frequently in polyp patients who smoked, these abnormalities did not fully correlate with polyp histology.

Adult↗
PubMed1990

[Intestinal polyps in childhood].

From 1965 to 1987, 230 polypectomies were performed in patients between 8 month to 16 years old, 147 boys and 83 girls. The most frequent symptom was rectal bleeding and the most frequent location was the rectosigmoid (96%). The polyps measured from 0.8 to 2 cm., in only one case the polyp measured more than 5 cm. causing duodenal obstruction and it was associated with a gastric polyp. Solitary polyps represented 93.9% of all cases, Peutz-Jeghers syndrome 1.73 and juvenile polyposis 0.87%. In that period 3 cases of colonic carcinoma in children over 9 years old were diagnosed. The histology of 200 polyps were reviewed. In 21 cases the diagnosis was modified (10.5%). The juvenile polyp (J.P.) was the most frequent type (93%). The usual histopathological pattern was observed in 71.5% of the J.P., early lesions (26.3%) and hyperplastic changes (2.1%). Six cases were tubular adenoma and one tubulovillous. The multiple juvenile polyposis was found in girls (13 and 14 years old). None of the patients with Peutz-Jeghers syndrome had gonadal tumor. Endoscopic polypectomy in children is a safe and effective treatment for colorectal polyps. This study provides information on the clinicopathologic findings in argentinian children with intestinal polyps treated by polypectomy over a 22 year period. It emphasizes that juvenile polyps is the most frequent pattern however other lesions can be present in gastrointestinal tract and also associated with others tumors. Patients with polyps should be followed at regular intervals which can be modified according to the histologic type and family history.

Adenoma↗
PubMed1989

[The probability of malignant degeneration of stomach polyps].

A retrospective analysis of the endoscopic diagnostic data on 151 cases of gastric polyps of various histological structure was carried out. A relationship between the risk of malignant transformation of gastric polyps, on the one hand, and their histology, presence and degree of dysplasia, on the other, was established. Epithelial dysplasia, in pronounced degree included, was observed in 33.7% of patients with hyperplastic polyps and in all cases of gastric adenoma. Epithelial dysplasia of hyperplastic polyps was mild or moderate in most cases while that of adenomatous polyps was moderate or grave. Gastric cancer as a consequence of malignant transformation of polyps was detected in 15 (9.9%) patients (hyperplastic polyps--2; adenomatous polyps--13). No objective endoscopic criteria for establishing the risk of polyp transformation were developed. Grave epithelial dysplasia, i.e. precancerous lesions in the gastric mucosa, may be suggested as such criterion. Moderate or grave dysplasia of the polyp epithelium should be considered in forming the group at risk first and foremost.

Adenoma↗
PubMedDate not supplied

[Polyps with an invasive degenerated focus].

Advances in technology of flexible endoscopes have greatly changed the management of patients with adenomatous polyps of the colon and rectum. Some controversy still exists concerning the best treatment for invasive polyps. For some authors, invasive polyps need radical operation, while others think that unless cancer goes beyond the bounds of a removed polyp, endoscopic resection is an adequate procedure. We designed a study of 65 patients presenting an invasive carcinoma arising in adenomatous polyps and who underwent a colorectal resection thereafter, in order to determine which endoscopic and histological features correlated best with a curative treatment by polypectomy. When the group of "non-curative polypectomies", (carcinoma in the surgical specimen: 34 patients) was compared to the group of "curative polypectomies" (carcinoma in the surgical specimen: 31 patients), there was no significant difference in the number of pedunculated or sessile polyps but a polyp's size exceeding 30 mm was significantly more frequent in the group of "non-curative polypectomies" (P less than 0.005) as well as a tubulo-villous or villous histological type (P less than 0.001) and presence of vascular neoplastic invasion (P less than 0.01). In conclusion, a surgical resection after endoscopic polypectomy of a polyp containing an invasive carcinoma is necessary for a polyp's size exceeding 30 mm, for a villous or tubulo-villous type and in the presence of vascular neoplastic invasion in the pathological analysis of the removed polyp.

Adenoma↗
PubMed1986

Study of nasal surface basophilic cells in patients with nasal polyp.

Surface basophilic cells in samples obtained from the inferior concha of nasal polyp patients were examined microscopically. Although the cells were believed to be specific to nasal allergy patients, we were also able to observe them in nasal polyp patients without nasal allergy. These cells were found in 5% of normal controls, in 14% of patients with chronic sinusitis without nasal polyp, in 65% with nasal polyp and in 91% with nasal allergy. In patients with unilateral nasal polyp the surface basophilic cells increased on the side with nasal polyp but not on the side without nasal polyp. As the nasal polyp grew in size, so the number of cells grew. After the polyp was removed, the cells decreased appreciably in number. With regard to other nasal diseases, surface basophilic cells were observed in 80% of tracheotomized patients, in 88% of laryngectomized patients due to laryngeal cancer, in 100% of patients with a tumor in nasal cavity, in 100% of patients with irradiation treatment of the nasal cavity and in 90% of patients with atrophic rhinitis. The surface basophilic cells seem to increase in number through some mechanism induced by a blockage of nasal airway by nasal polyp.

Basophils↗
PubMed1985

Benign epithelial polyps of the stomach.

It is clear that benign gastric epithelial polyps form a heterogeneous group with distinct pathologic features. Variability exists in regard to malignant potential and association with various polyposis syndromes. The most important aspects of these lesions are as follows: The only gastric polyps with a direct malignant potential are the neoplastic polyps. Since these lesions are most commonly solitary and antral, and such lesion identified at endoscopy or radiographically should be removed. The hyperplastic polyps, the most common of gastric polyps, are frequently associated with carcinoma, but probably do not have any malignant potential over and above that of the atrophic gastritis which usually accompanies them. Fundic-gland hyperplasia, a poorly recognized but common entity, carries no malignant potential. The diagnosis of FGH should be suspected in cases where the fundus and body of the stomach are carpeted with sessile 1 to 5 mm polyps. Since these lesions may spontaneously regress, no therapy is needed other than biopsy to confirm the diagnosis. However, because of the association with familial polyposis and Gardner's syndrome, patients with FGH should be evaluated for the possibility of one of these syndromes. Since in some cases several types of polyps may occur in the same stomach, it may be necessary to biopsy several in order to be sure a neoplastic polyp is not present. In cases of multiple gastric polyposis in which variability of gross appearance is noted, polyps of several types should be biopsied. Since the neoplastic polyps tend to be larger, pedunculated, and antral in location, lesions with these characteristics should be removed.

Adenoma↗
PubMed1996

Gastric epithelial polyps: a retrospective endoscopic study of 12974 symptomatic patients.

This is a retrospective endoscopic study on the incidence of gastric epithelial polyps (adenomas, hyperplastic, inflammatory) in 12,974 consecutive symptomatic Greek adults submitted to endoscopy during a 4-year period, in two endoscopy units. A total of 258 polyps were found in 157 patients (1.2%), 80 males and 77 females (age: 22-87 years); 67.5% of these patients were older than 60 years. Two hundred and two (202) polyps were totally removed. In 43 patients (27%), more than one polyp was found. Polyps were mainly hyperplastic (75.6%). Adenomas were found in 6.6%, and only in patients older than 50 years. Hyperplastic and inflammatory polyps were equally distributed in males and females. A male predominance was observed in adenomas (2:1). Most of the polyps were in the antrum (43.8%) and were hyperplastic (75.2%). Of 501 previously operated patients (gastrectomy or gastrojejunostomy), 26 (5.2%) had polyps. No adenomas were seen in the anastomosis area. Most of the polyps (61.9%) were smaller than 0.5 cm; 13.3% were greater than 1 cm. No coincidence of polyps with gastric cancer was observed.

Adenoma↗
PubMed1977

Histology of nasal polyps of different etiology.

The aim of the present study is to elucidate the correlation between etiology and histology in nasal polyps with special regard to cystic fibrosis (CF). Nasal polyps from 15 children with CF and a control group of non-CF polyps from 15 adult patients were examined by light-microscopy. The histological evaluation was carried out on a blind basis in order to avoid bias. Among the parameters used, the tissue eosinophilia proved to be the most valuable factor in the differentiation between CF and non-CF polyps, as only few eosinophils were found in the CF-polyps. The polyp glands were few and generally pathological. Some characteristics abnormalities in the grandular morphology are apparently more common in CF polyps. It is concluded, that the histological examination of nasal polyps is of importance for the correct classification of the patient, but the diagnosis of CF cannot be made based on microscopy of polyps. Further studies including blinded histological examination of nasal polypous tissue might contribute to a more differentiated diagnose of nasal polyposis.

Adolescent↗
PubMed1995

The risk of adenomatous polyps in asymptomatic first-degree relatives of persons with colon cancer.

BACKGROUND & AIMS: Increasing evidence indicates that inherited susceptibility is important in the pathogenesis of colorectal neoplasia. The aim of this study was to clarify whether having only one first-degree relative with colorectal cancer increases the risk of developing adenomatous polyps and whether total colonoscopy is an appropriate screening measure in these patients. METHODS: The frequency of such a history was evaluated in 397 asymptomatic patients who underwent total colonoscopy. Of these patients, 155 had colorectal polyps and the remaining 242 did not have polyps. RESULTS: Among polyp cases, 27 of 155 (17.4%) had a positive history; among those without polyps, 12 of 242 (5.0%) had a positive history. Alternatively expressed, 27 of 39 patients (69%) with family history and 128 of 358 patients (36%) without family history had adenomas. The estimated risk for polyps associated with family history was 1.9. Among polyp cases, 14 of 27 patients (51.9%) with family history and 32 of 128 patients (25.0%) without family history had only proximal polyps (chi 2 test; P = 0.006; odds ratio, 3.2), In the same groups, frequency of high-grade dysplasia was 8 of 27 patients (29.6%) and 16 of 128 patients (12.5%), respectively (chi 2 test; P = 0.04; odds ratio, 2.9). CONCLUSIONS: Relative to subjects with no family history, asymptomatic patients with one first-degree relative with colorectal cancer had nearly double the risk of developing adenomatous polyps, greater frequency of severely dysplastic lesions, and significantly higher frequency of proximal polyp location. This suggests that total colonoscopy screening is indicated in these subjects.

Adenomatous Polyposis Coli↗
PubMed2006

Energy integration between the solitary polyps of the clonal coral Lobophyllia corymbosa.

Clonal integration in the coral Lobophyllia corymbosa was studied from two perspectives: transfer of carbon among clonemates and allorecognition. This coral forms colonies in the early post-metamorphic stages. In later ontogeny, the tissues interconnecting polyps die, transforming the colony into a clone of solitary polyps. These polyps continue to live in close proximity but without tissue continuity. Isolated polyps labeled with radioactive carbon in the light showed oriented transfer of assimilates towards adjacent, injured polyps. No significant transfer of carbon was observed towards intact, isogeneic polyps or allogeneic polyps. Grafting of coral tissues resulted in intra-clonal fusion, but only when polyps were previously sectioned. Allogeneic sectioned grafts were always rejected. Intact polyps were unresponsive towards isogeneic and allogeneic counterparts when grafted. Our results show that isolated Lobophyllia polyps not only recognize their clonemates as such, but also help them when necessary, although no tissue continuity exists between them.

Animal Communication↗
PubMed1999

Patterns of expression of trefoil peptides and mucins in gastric polyps with and without malignant transformation.

The expression of two trefoil peptides (TFF1 and TFF2) and four mucins (MUC1, MUC2, MUC5AC, and MUC6) was evaluated by immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR) in 29 gastric polyps, 10 hyperplastic and 19 adenomatous, eight of which displayed malignant transformation. The aims of this study were to characterize the expression profile of these molecules in each type of polyp and to investigate possible modifications of the profile during the process of malignant transformation. All hyperplastic polyps displayed immunoreactivity for TFF1, MUC5AC, and MUC1 in more than 75 per cent of the cells. In adenomatous polyps, three main phenotypes could be identified: complete gastric phenotype (co-expression of TFF1 and MUC5AC)-nine cases (47.4 per cent); incomplete gastric phenotype (TFF1-positive and MUC5AC-negative)-seven cases (36.8 per cent); non-gastric (intestinal) phenotype (no expression of TFF1 or MUC5AC)-three cases (15.8 per cent). Data yielded by immunohistochemistry and RT-PCR showed a good correlation for both TFF1 and TFF2. One hyperplastic and seven adenomatous polyps with villous architecture displayed foci of diffuse and intestinal-type carcinoma, respectively; in all of these cases, MUC1 expression and signs of gastric differentiation were observed in both the non-malignant and the carcinomatous component. It is concluded that gastric differentiation is a feature of hyperplastic polyps and of a subset of adenomatous polyps which is shared by early carcinomas arising in some of these polyps, regardless of the histological type of polyp and of carcinoma.

Adenomatous Polyps↗