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PubMed1988

Spontaneous resolution of rectal polyps in patients with familial polyposis following abdominal colectomy and ileorectal anastomosis.

One hundred sixteen patients were reviewed after abdominal colectomy and ileorectal anastomosis (IRA) for familial polyposis to determine the rate of postoperative spontaneous regression of rectal polyps. The failure of the IRA procedure was correlated with the preoperative number of rectal polyps and the degree of rectal polyp regression. Spontaneous resolution of rectal polyps occurred in 64 percent of the patients (complete 38 percent, partial 26 percent). In those patients initially having complete resolution, 55 percent redeveloped polyps during follow-up. With a mean follow-up of 9.3 years, seven patients have developed rectal cancer. Rectal cancer development was more common in those patients who had innumerable rectal polyps prior to IRA. Initial polyp regression did not preclude later development of rectal cancer. There were 11 deaths during the follow-up period, but only one of these was from rectal cancer. Abdominal colectomy and IRA is an effective treatment for familial polyposis. Spontaneous regression of polyps occurred in 64 percent of patients, but continuous and complete follow-up is necessary to fulgurate recurrent polyps and to screen for the development of cancer.

Adenomatous Polyposis Coli↗
PubMed1988

Small colorectal polyps. Are they worth treating?

The histology of small (less than or equal to 0.5 cm.) colorectal polyps removed during total colonoscopy in 303 patients was reviewed to determine their clinical significance. There were 178 male patients and 125 females, with a median age of 64 years (range, 26 to 97 years). A total of 766 polyps were treated, 60 percent being adenomatous and 22 percent hyperplastic. Hyperplastic polyps were more common in the rectum (71 percent) while adenomas were more common in the colon (63 percent). Hyperplastic polyps in the colon were associated with adenomas in 75 percent of cases and hyperplastic rectal polyps were associated with proximal adenomas in 63 percent. There were six mixed hyperplastic/adenomatous polyps. Of the 458 adenomas, 449 were tubular, eight were tubulovillous, and one was villous. Moderate dysplasia was noted in 23 (5 percent) and severe dysplasia in four (0.9 percent). There were associated large adenomas in 84 patients. Small colonic polyps are usually adenomatous and should be destroyed. Biopsy may be important if no other neoplasm has been identified. Small rectal polyps are usually hyperplastic but may be associated with proximal adenomas. Because of the uncertain significance of hyperplastic polyps they should also be treated, and are a relative indication for total colonoscopy.

Adult↗
PubMed1984

Management of patients with polyps containing malignancy removed by colonoscopic polypectomy.

The management of malignant colonic polyps removed colonoscopically has been a controversial subject. A continuing series is reported of 36 patients with 37 malignant polyps removed by colonoscopic polypectomy (CP) between 1976 and 1982. Fourteen polyps contained carcinoma in situ (CIS); 13 were treated by CP alone; one was treated by CP and colectomy. Nineteen polyps contained invasive carcinoma; 13 were treated by CP alone; six were treated by CP and colectomy. Four patients had sessile polyps resected piecemeal, in which accurate staging was impossible. Two were treated with CP alone, and two had CP plus colectomy. All patients were followed with yearly colonoscopy and/or barium enema. Follow-up has been six to 84 months (mean 36 months). Twenty-seven patients whose polyps were treated by CP alone have had no evidence of recurrent tumor at the polypectomy site. Of the nine patients undergoing colectomy, six had residual tumor at the polypectomy resection site. No patients had involved lymph nodes. Our current approach to this problem is based on the degree of invasion and the status of the resection margins. Polyps containing CIS can safely be treated with CP alone. Polyps with invasive carcinoma and clear resection margins should be treated with CP and either colectomy or frequent repeat colonoscopy. This decision is a clinical one and must involve input from both the clinician and the pathologist. Those polyps whose resection margins are involved or where piecemeal excision precludes accurate pathologic assessment should undergo colectomy.

Adenoma↗
PubMed2000

Gastric polyps: an update of their pathology and biological significance.

Gastric polyps are clinically important lesions that are frequently encountered in routine pathology (2-3% of all gastroscopies). Polyps may occur sporadically or in polyposis syndromes, such as familial adenomatous polyposis coli (FAP), Peutz-Jeghers syndrome, juvenile polyposis, Cowden's disease and Cronkhite-Canada syndrome. In biopsy specimens taken during routine gastroscopic examinations, it is almost always possible to differentiate between neoplastic and non-neoplastic polyps and to type polyps. In this review, we focus on the morphological spectrum of gastric polyps in an attempt to assist the pathologist and the gastroenterologist in recognising the lesion and in treating patients with gastric polyps, respectively. Further, we propose that the World Health Organization (WHO) classification should be modified to include the following categories: non-neoplastic polyps (WHO: tumour-like lesion), hamartomatous polyps/polyps of polyposis syndromes (WHO: tumour-like lesion), heterotopic tissue polyps (WHO: tumour-like lesion), neoplastic polyps (WHO: epithelial, non-epithelial and endocrine tumours) and reactive polypoid lesions.

Biopsy↗
PubMed2006

Laparoscopic colon resection for polyps: a good novice case?

PURPOSE: Laparoscopic colon resection of the endoscopically unresectable polyp has been considered an ideal case for the surgeon with moderate laparoscopic colectomy experience because tissues are not inflamed and the lymphadenectomy may not need to be as extensive compared with that required for cancer. To assess the appropriateness of this approach, we evaluated the incidence of invasive cancer in a series of laparoscopic colon resections for polyps. METHODS: A retrospective review was performed of 55 consecutive patients undergoing laparoscopic colon resection for endoscopically unresectable polyps during a 35-month period. Colonoscopy data, polyp characteristics, and final colon pathology were reviewed. RESULTS: On final pathologic examination, 18.2 percent of patients had invasive adenocarcinoma. Patient age, gender, indication for colonoscopy, polyp size, polyp location, polyp characteristics, and colonoscopic biopsy pathology were not predictive of adenocarcinoma on final pathology. CONCLUSIONS: A significant number of endoscopically unresectable polyps harbor adenocarcinoma, thereby requiring a formal lymphadenectomy at resection. Caution should be exercised when considering the laparoscopic resection of an endoscopically unresectable polyp as a "learning" case.

Adenocarcinoma↗
PubMed1987

Natural history of untreated colonic polyps.

The natural history of untreated colonic polyps is uncertain. A retrospective review of Mayo Clinic records from a 6-yr period just before the advent of colonoscopy identified 226 patients with colonic polyps greater than or equal to 10 mm in diameter in whom periodic radiographic examination of the colon was elected over excisional therapy. In all patients, follow-up of polyps spanned at least 12 mo (mean, 68 mo; range, 12-229 mo) and included at least two barium enema examinations (mean, 5.2; range, 2-17). During the follow-up period, 83 polyps (37%) enlarged. Twenty-one invasive carcinomas were identified at the site of the index polyp at a mean follow-up of 108 mo (range, 24-225 mo). Actuarial analysis revealed that the cumulative risk of diagnosis of cancer at the polyp site at 5, 10, and 20 yr was 2.5%, 8%, and 24%, respectively. In addition, 11 invasive cancers were found at a site remote from the index polyp during the same follow-up period. These data further support the recommendation for excision of all colonic polyps greater than or equal to 10 mm in diameter. Periodic examination of the entire colon is recommended in this group of patients to identify neoplasms arising at a site remote from the index polyp. Although this study has limitations inherent to any retrospective analysis, comparable prospective data are unlikely to be available in the future because of the current widespread availability of colonoscopy.

Actuarial Analysis↗
PubMed1991

Significance of the smooth muscle cell component in Peutz-Jeghers and juvenile polyps.

We have previously reported the presence of smooth muscle cells (SMCs) in the lamina propria of both tubular and villous adenomatous polyps. In the current study, we investigated the presence and distribution of SMCs with immunohistochemical techniques using anti-alpha smooth muscle actin and anti-desmin antibodies on a series of hamartomatous polyps. In five Peutz-Jeghers polyps, large tree-like branches of SMCs were observed, while in 13 juvenile polyps, rare elongated SMCs were found in the lamina propria, partially surrounding cystically dilated glands. Apart from the quantitative differences, the SMC distribution was similar in the two types of hamartomatous polyps and not dissimilar from the pattern described in neoplastic polyps. These findings make the category "juvenile polyp" less clear and its differentiation from other histologic types of polyp less sharp. Thus, the presence or absence of SMCs cannot form the basis of the differential diagnosis between adenomatous and hamartomatous polyps.

Adolescent↗
PubMed1986

Microbiologic analyses of nasal polyp tissue.

Nasal polyps from 40 patients were cultured within 2 1/2 hours after surgical removal to determine whether microorganisms were present. The first 20 polyps were cultured for aerobic and anaerobic bacteria, viruses, fungi, mycoplasmas, and mycobacteria. Of these 20 polyps, eight were sterile by all tests, one grew Cryptococcus albidus, one grew Sporobolomyces, one had large numbers of Peptostreptococcus micros and Propionibacterium acnes, greater than 10(6) colony-forming units per gram (cfu/gm), and nine had aerobic bacteria including 10 different species at levels less than 10(5) cfu/gm. The second 20 polyps were cultured for aerobic bacteria only; 11 polyps were positive. Overall, 14 of 26 polyps from patients with asthma and two of 14 polyps from patients without asthma were positive for aerobic bacteria at levels greater than 10(3) cfu/gm (p less than 0.05). Multiple aerobic bacterial species tended to occur in polyps from patients with asthma (11 of 26) more frequently than in those from patients without asthma (one of 14) (p less than 0.01). There was a highly significant positive correlation between tissue neutrophilia and bacterial count (r = +0.9; p less than 0.001). The results indicate that patients with asthma have a significantly higher number and a tendency to a greater variety of aerobic bacteria in nasal polyp tissue than patients without asthma and that the number of infiltrating neutrophils is directly related to the number of bacteria.

Adolescent↗
PubMed1995

Cervical polyp in the menopause and the need for fractional dilatation and curettage.

OBJECTIVE: To investigate the need for fractional dilatation and curettage following excision of symptomatic versus asymptomatic cervical polyps. STUDY DESIGN: A prospective study was carried out on 467 women who were referred for treatment of symptomatic (accompanied by vaginal bleeding or discharge) or asymptomatic cervical polyps, from January 1, 1990 to December 31, 1992. Of these, 204 were premenopausal and 263 postmenopausal. Every excision of a cervical polyp was followed by a dilatation and curettage. The histological data were evaluated statistically using the chi 2-test. RESULTS: Postmenopausal women had more asymptomatic than symptomatic cervical polyps (P = 0.004). Cervical polyps were associated with more endometrial polyps in the postmenopausal than in the premenopausal women (P = 0.0009). Postmenopausal women with symptomatic cervical polyps had more endometrial abnormalities on histological examination than those with asymptomatic ones (P < 0.0001); this difference was not significant in the premenopausal group (P = 0.49). CONCLUSIONS: While neither symptomatic nor asymptomatic cervical polyps are an indication for dilatation and curettage (following excision) in women in their reproductive years, and do not affect their management or prognosis, this is not the case in postmenopausal women. Symptomatic cervical polyps after the menopause must be excised and followed by mandatory fractional dilatation and curettage, because there is a marked incidence of associated severe pathological conditions in this age group.

Adult↗
PubMed2006

Are the site, diameter, and number of endometrial polyps related with symptomatology?

OBJECTIVE: The objective of the study was to evaluate the relationship among polyp site, number, diameter, and symptomatology in endometrial polyps in reproductive and postmenopausal women. STUDY DESIGN: One hundred fifty-five subjects with endometrial polyps were evaluated retrospectively. Sociodemographic characteristics, endometrial thickness, polyp number, diameter, and site were reviewed, and their relations with abnormal uterine bleeding were tested. RESULTS: A total of 36.1% of the patients in the postmenopausal group and 44.4% of the patients in the reproductive-aged group were asymptomatic. In addition, 37.3% of polyps in the reproductive-aged and 29.2% in the postmenopausal group were multiple. Polyp number, diameter, and site were not different among the 2 groups (P = .282, P = .469, and P = .485, respectively). When patients were evaluated as a whole, symptomatology was not related with polyp number, diameter, and site (P = .677, P = .334, and P = .699, respectively). CONCLUSION: Many endometrial polyps are asymptomatic and multiple in nature. Polyp site, number, and diameter do not correlate with symptomatology.

Adult↗
PubMed2006

The use of 3D surface fitting for robust polyp detection and classification in CT colonography.

In this paper we describe the development of a computationally efficient computer-aided detection (CAD) algorithm based on the evaluation of the surface morphology that is employed for the detection of colonic polyps in computed tomography (CT) colonography. Initial polyp candidate voxels were detected using the surface normal intersection values. These candidate voxels were clustered using the normal direction, convexity test, region growing and Gaussian distribution. The local colonic surface was classified as polyp or fold using a feature normalized nearest neighborhood classifier. The main merit of this paper is the methodology applied to select the robust features derived from the colon surface that have a high discriminative power for polyp/fold classification. The devised polyp detection scheme entails a low computational overhead (typically takes 2.20min per dataset) and shows 100% sensitivity for phantom polyps greater than 5mm. It also shows 100% sensitivity for real polyps larger than 10mm and 91.67% sensitivity for polyps between 5 to 10mm with an average of 4.5 false positives per dataset. The experimental data indicates that the proposed CAD polyp detection scheme outperforms other techniques that identify the polyps using features that sample the colon surface curvature especially when applied to low-dose datasets.

Algorithms↗
PubMed2005

A large inflammatory fibroid polyp of the colon treated by endoclip-assisted endoscopic polypectomy: A case report.

Inflammatory fibroid polyp is a rare benign polypoid lesion of the gastrointestinal tract. Histologically, inflammatory fibroid polyp is characterised by an admixture of numerous small vessels, fibroblasts and oedematous connective tissue, accompanied by marked inflammatory infiltration by eosinophils. A 40-year-old man visited our hospital for the purpose of colorectal screening due to a positive faecal occult blood test. A pedunculated and reddish polyp was found endoscopically in the ascending colon. The polyp was large but was resected endoscopically without any problems. Histologically, the abnormal tissue of the polyp was located in the submucosal and mucosal layer. Proliferation of spindle cells and infiltration of inflammatory cells, such as plasma cells and eosinophils, were observed. Immunohistochemically, the spindle cells were positive for CD34, which was localised in the cytoplasm. These cells were also positive for S100 protein but were negative for c-kit and muscle markers. These findings are compatible with the histological diagnosis of inflammatory fibroid polyp. The surgical margin of the polyp was free of the tumour. Inflammatory fibroid polyp is more commonly found in the stomach or small intestine, and rarely in the colon, and therefore our case is a rare example of large and pedunculated colonic inflammatory fibroid polyp, which was treated successfully by endoscopic polypectomy.

Adult↗
PubMed2006

Analysis of gene expression profiles of normal human nasal mucosa and nasal polyp tissues by SAGE.

BACKGROUND: A systemic determination of gene expression profiles in nasal polyp compared with normal nasal mucosa would contribute considerably to the investigation of the disease marker in various rhinopathy and general knowledge on the formation of human nasal polyp. OBJECTIVE: The aim of this study was to identify the transcriptome of the normal human nasal mucosa and nasal polyp by the serial analysis of gene expression. METHODS: mRNA was extracted from normal inferior turbinate mucosa and nasal polyp. Short sequences (tags), each one usually corresponding to a distinct transcript, was isolated and concatemerized into long DNA molecules, which were cloned and sequenced. RESULTS: We detected 65,305 tags for normal nasal mucosa and 55,829 tags for nasal polyp, representing 20,629 and 17,636 potential transcripts species, respectively. Of the unique tags encountered more than once, 92% (normal nasal mucosa) and 90% (nasal polyp) matched known genes or expressed sequence tags, whereas the remainder did not match any GenBank sequences. Therefore, 504 and 539 novel transcripts were identified in normal nasal mucosa and nasal polyp, respectively. Although the expression levels of most transcripts in both libraries were similar, 114 transcripts were differentially expressed at a statistically significant level (P < .05)-that is, 65 and 49 transcripts among them were expressed at a higher level in normal nasal mucosa and nasal polyp, respectively. CONCLUSION: This information should be very useful for basic knowledge as well as for future studies on pathophysiological conditions of human nasal mucosa, providing some clues to evaluate the altered factors in a variety of rhinopathies. CLINICAL IMPLICATIONS: The results of this study might contribute to general knowledge on the formation of human nasal polyp.

Adult↗
PubMed2001

Comprehensive analysis of SMAD4 mutations and protein expression in juvenile polyposis: evidence for a distinct genetic pathway and polyp morphology in SMAD4 mutation carriers.

Juvenile polyposis syndrome (JPS; OMIM 174900) is a rare disorder which is characterized by the presence of hamartomatous polyps throughout the gastrointestinal tract and an increased risk of gastrointestinal malignancy. Mutations of the SMAD4 gene on chromosome 18q21.1 have been shown to cause a subset of JPS cases, with estimates ranging from 20% to >50%. Characterization of the genes that cause the remainder of JPS cases relies on the certainty that SMAD4 is not the causative gene. We have undertaken a comprehensive analysis of germline SMAD4 mutations in a cohort of JPS patients to define the spectrum of mutations that cause JPS. We have analyzed a series of polyps from these patients for SMAD4 protein expression. We have also performed a blinded assessment of polyp material to look for morphological differences between polyps from patients with and without a germline SMAD4 mutation. The results indicate that almost all germline SMAD4 mutations are readily detectable by screening genomic DNA using polymerase chain reaction-based methods; SMAD4 can be excluded as the causative gene in the majority of our JPS cohort. Loss of SMAD4 expression occurs in most polyps from SMAD4 mutation carriers, even those with missense germline mutations. SMAD4 loss in polyps is, however, not a feature of cases that are not caused by SMAD4 mutations, indicating that these polyps develop along a SMAD4-independent pathway. The morphology of polyps from SMAD4 mutation carriers is subtly different from other JPS polyps, notably including a more prominent epithelial component in the former.

Amino Acid Sequence↗
PubMed1986

An appraisal of endoscopic removal of malignant colonic polyps.

The issue of whether patients who have invasive carcinoma in an otherwise benign polyp should undergo surgical resection of that bowel segment is controversial. We examined the records of 83 patients with such polyps that were removed endoscopically between 1978 and 1981. After exclusion of 18 patients from the study for various reasons, our study group consisted of 65 patients who had undergone complete endoscopic removal of 69 polyps that contained a malignant process. Carcinoma in situ was found in 34 polyps, and 3 patients with such polyps had a recurrent malignant lesion of the same degree. These recurrent tumors were treated successfully by aggressive endoscopic removal. Seventeen polyps that contained invasive carcinoma were treated endoscopically without resection, and two patients in this group subsequently had recurrent carcinoma at the site of the original polyp. These recurrent lesions were resected, and neither patient had evidence of nodal metastasis. Of the 18 patients who underwent immediate resection of invasive carcinoma, 2 had residual carcinoma at the time of the resection, although no lymph node metastasis was found. We conclude that colonic polyps with carcinoma in situ can be treated safely with complete endoscopic removal. Invasive carcinoma in a polyp can be treated safely with complete polypectomy, and immediate resection may not be necessary. This group of patients, however, should undergo thorough follow-up studies and periodic endoscopic reexamination.

Adenocarcinoma↗
PubMed2002

Natural history of uterine polyps and leiomyomata.

OBJECTIVE: To estimate the incidence and regression rates of uterine leiomyomata and polyps in a cohort of asymptomatic, premenopausal women. METHODS: Saline infusion sonography was performed twice, 2.5 years apart, in a cohort of 64 initially asymptomatic women. Subjects completed a questionnaire that assessed the development of abnormal uterine bleeding. RESULTS: The mean age of women (at second ultrasound) was 44 years. In four of seven women with polyps at the original ultrasound, their polyps regressed. Polyps that regressed tended to be smaller than polyps that persisted. Ten women had endometrial polyps at the second ultrasound for a point prevalence of 16% and a cumulative incidence rate of 12% per 2.5 years. A higher percentage of women with uterine polyps had complaints of abnormal uterine bleeding than women with no uterine abnormalities (70% versus 33%, P =.04). Six leiomyomata in four women were no longer detected in the second ultrasound. Leiomyomata that regressed were in older premenopausal women and were smaller than leiomyomata that persisted. The point prevalence and incidence rates of leiomyomata were 27% and 13% per 2.5 years, respectively. Leiomyomata grew an average of 1.2 cm per 2.5 years, but great variation in growth rates were noted. CONCLUSION: Small uterine polyps frequently regressed spontaneously, whereas larger polyps were more likely to persist and were associated with the development of abnormal bleeding. Smaller leiomyomata in older premenopausal women also regressed whereas larger leiomyomata tended to grow while often remaining asymptomatic.

Adult↗
PubMed1994

Nasal polyps: effects of seasonal allergen exposure.

Nasal polyps are characterized by chronic eosinophilic inflammation and often coexist with rhinitis and asthma. Many patients with polyps have no detectable allergy, and it is considered that allergy, at least in many cases, is not relevant to polyp to pathogenesis. To explore the association of nasal polyps with allergy, 16 patients with polyps and ragweed allergy (PRW +) and 16 patients with polyps who were not allergic to ragweed (PRW-) were compared with patients without polyps, 16 who were allergic to ragweed (NPRW +) and 16 who were not allergic to ragweed (NPRW-), before and during the ragweed season. The level of ragweed allergy was comparable in the PRW+ and NPRW+ populations as determined by ragweed skin test wheal diameter, ragweed IgE RAST percent binding, and total serum IgE. Symptom scores before the ragweed season recorded on visual analog scales for the symptoms of blockage, sneezing, decreased smell, itch, postnatal drip, and runny nose were high in patients in the PRW+ and PRW- groups and did not change during ragweed season. Mean symptom scores were low in the NPRW+ group before ragweed season and increased during the season to levels similar to those of patients in the PRW+ and PRW- groups. Preseason nasal lavage albumin concentration was higher in subjects with polyps than those without polyps (58.5, 98) versus (13.6, 15 micrograms/ml) (p = 0.02) and did not change significantly in any group with seasonal exposure. Data are presented as mean, 1 SD; comparisons are made with unpaired t tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Nasal polyposis: immunohistochemistry and bioelectrical findings (a hypothesis for the development of nasal polyps).

Nasal polyps and turbinates were obtained from individuals undergoing surgery for symptomatic nasal obstruction caused by nonatopic rhinosinusitis or allergic rhinosinusitis. One part of the tissue from each patient was fixed in neutral buffered formalin and prepared for study by histochemical and immunohistochemical methods. Monoclonal antibodies were used to identify macrophages, lymphocytes, and plasma cells. In most cases (12 of 16, 75%) the remainder of the polyp and turbinate samples was treated with protease to achieve disaggregation of the epithelial cells. Those cells were cultured on permeable collagen matrix supports. Transepithelial potential difference and resistance were measured daily. At the time of maximal transepithelial potential difference, the epithelial cells were mounted in modified. Ussing chambers and exposed to a sodium-positive channel blocker (amiloride hydrochloride) and to selected chloride-negative channel agonists (isoproterenol bitartrate and adenosine triphosphate). Middle turbinates and polyps were found to have more macrophages, lymphocytes, plasma cells, HLA-DR-positive cells, and eosinophils than the inferior turbinates. Epithelial cells obtained from polyps exhibited higher transepithelial potential differences and equivalent short-circuit currents than turbinate cell cultures. The responses to amiloride, isoproterenol, and adenosine triphosphate were also greater for polyp than for turbinate cultures. A theory for the pathogenesis of nasal polyps is proposed. Local release of inflammatory mediators could cause sodium absorption and chloride permeability to be higher in polyps than in turbinate epithelia. Increased sodium absorption is consistent with the hypothesis that epithelial fluid absorption contributes to the development of nasal polyps and is a result of the increased recruitment of inflammatory cells, which are present in nasal polyps.

Adenosine Triphosphate↗