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PubMedDate not supplied

Choanal polyp originating from the nasal septum: a case report.

Almost all nasal polyps originate from the mucosa of the lateral walls of the nasal cavity or from the paranasal sinuses. A choanal polyp is the intranasal portion of a cyst that has arisen from the wall of the maxillary sinus near the ostium. Medially based polyps, such as those that arise from the nasal septum, are rare. The literature cites a wide range of incidence rates for polyps originating from this structure, but choanal extension of this type of polyp is extremely unusual. This report describes a polyp that arose from the superior aspect of the posterior nasal septum and extended through the choana into the nasopharynx. The histology of this choanal lesion was typical of nasal polyps, but the site of origin is rare. The ethiopathogenesis of nasal polyps with its common location remains controversial so it is difficult to speculate what mechanism triggered the development of this lesion on the nasal septum. Some form of local inflammation may have induced choanal polyp formation at this atypical site.

Humans↗

PubMed2004

Magnifying endoscopy with indigo carmine contrast for differential diagnosis of neoplastic and nonneoplastic colonic polyps.

This study describes the feasibility of magnifying colonoscopy with indigo carmine dye contrast to distinguish neoplastic and nonneoplastic colonic polyps. This study sampled consecutive patients undergoing colonoscopy using an Olympus CF240ZI from January to October 2000 at Chang-Gung Memorial Hospital, Lin-Kou Medical Center. This study analyzed a total of 270 polyps. Indigo carmine (0.2%) was sprayed directly on the mucosa surface before observing the crypts using a magnifying colonoscope (1.5x-100x). The pit patterns were described using the classification proposed by Kudo. Finally, polypectomy or biopsy was performed for histological diagnosis. The study identified 155 adenomas, 99 hyperplastic polyps, 9 adenocarcinomas, and 7 other nonneoplastic lesions (harmatoma, inflammatory polyps, and mucosal tag). The pit pattern was analyzed for all lesions. Further classification into neoplastic (adenoma and adenocarcinoma) and nonneoplastic (hyperplastic and others) polyps revealed 156 neoplastic and 14 nonneoplastic polyps among the type III to type V pits and 92 nonneoplastic and 8 neoplastic polyps among the type I and II pits. The sensitivity of type III to type V pits in detecting neoplastic polyps was 95.1%, with a specificity of 86.8% and diagnostic accuracy of 91.9%. The positive likelihood ratio was 7.3, and the negative likelihood ratio was 0.06. Magnifying colonoscopy with indigo carmine dye contrast provides morphological detail that correlates well with polyp histology. Small flat lesions with typical type II pit pattern should have minimal neoplastic risk, thus endoscopic resection is not necessary.

Adenocarcinoma↗

PubMed2004

Wireless capsule endoscopy for evaluation of phenotypic expression of small-bowel polyps in patients with Peutz-Jeghers syndrome and in symptomatic first-degree relatives.

BACKGROUND AND STUDY AIMS: Peutz-Jeghers syndrome (PJS) is an inherited gastrointestinal hamartomatous polyposis disorder. Small-bowel intussusception and bleeding are the most common complications, and malignancy may also occur. Survey of the gastrointestinal tract, particularly of the small bowel, is difficult and current recommendations for management syndrome are ambiguous. We evaluated the feasibility of capsule endoscopy for identifying phenotypic expression of small-bowel polyps in patients with full-blown PJS and a previous diagnosis of gastrointestinal polyposis, and in symptomatic kindred of PJS patients with no previous diagnosis of gastrointestinal polyposis. PATIENTS AND METHODS: Two groups were studied: group A consisted of 14 patients with gastrointestinal polyposis, eight of whom had undergone previous small-intestine surgery; group B consisted of six symptomatic first-degree relatives of PJS patients; these patients had previous negative gastrointestinal endoscopic examinations. RESULTS: Numerous polyps were detected in all patients in group A. Most polyps were sessile, but the larger polyps tended to be pedunculated. Polyp density was highest in the jejunum (greater than in the ileum and duodenum). Seven patients had at least one large polyp (> 11 mm) and five of these patients subsequently underwent enteroscopy, which revealed that capsule endoscopy had correctly identified all the patients with large polyps, but had missed 20 % of the total number of large polyps in these patients. No polyps were detected by capsule endoscopy in group B patients, despite the excellent visualization of the small intestine. In all patients, the capsules were expelled within 24 hours, without complications, and the procedure was well tolerated. CONCLUSIONS: Capsule endoscopy is an effective and well-tolerated method for evaluating small-bowel pathology in patients with PJS.

Adolescent↗

PubMed1986

Gastroduodenal polyps in familial adenomatous and juvenile polyposis.

Upper gastrointestinal endoscopy revealed gastroduodenal polyps in 45 (90%) out of 50 patients with familial adenomatosis (FA), and in 11 (92%) out of 12 patients with juvenile polyposis (JP). The polyps in the fundic and corpus regions of the stomach were hamartomatous cystic body gland polyps in 28 (56%), and adenomas in 3 (6%) of the FA patients, while 6 (50%) JP patients had hyperplastic polyps in the corresponding region. The polyps in the gastric antrum and duodenum were adenomas in 6 (12%) and 25 (50%) of the FA patients, respectively, while the polyps of the corresponding regions were hyperplastic in 10 (83%) and 2 (17%) of the JP subjects. One focal adenomatous lesion in an antral hyperplastic polyp, and one duodenal adenoma were found in the JP patients. Furthermore, one duodenal adenocarcinoma was observed among the FA subjects. It is concluded that gastroduodenal polyps belong inherently both to adenomatous and to juvenile varieties of gastrointestinal polyposis, and that these two conditions have characteristic histological patterns and topography of polyps in the upper gastrointestinal tract.

Adenomatous Polyposis Coli↗

PubMed2004

Clinical relevance of nasal polyps in individuals recruited from a general population-based study.

OBJECTIVE: To compare the clinical presentations of individuals with nasal polyps detected by endoscopy in a general population sample with those of patients with nasal polyp disease seeking medical attention. MATERIAL AND METHODS: A total of 38 individuals with nasal polyps from a population-based sample were compared with 38 matched controls and a third group consisting of 44 patients who presented to an outpatient clinic with symptoms and diagnosed nasal polyps Upper and lower airway symptoms were registered. Polyp size, peak nasal inspiratory flow (PNIF), olfactory function and health-related quality of life were measured. RESULTS: Compared with the individuals with nasal polyps in the population sample, patients actively seeking medical care for nasal polyposis experienced more symptoms of nasal blockage and an impaired sense of smell, and had more extensive polyps and reduced PNIF. There were equal frequencies of asthma symptoms in these two groups. Compared with the controls, the individuals with nasal polyps in the population sample had a greater frequency of asthma symptoms and aspirin intolerance and also experienced an impaired sense of smell. CONCLUSION: Nasal polyps alone, as seen occasionally, are indicative of airway disease involving the upper and lower respiratory tracts.

Adult↗

PubMed2006

Do topical nasal decongestants affect polyps?

CONCLUSIONS: The hypothesis that decongestants reduce the size of nasal polyps could not be verified. Decongestion is therefore recommended prior to nasal endoscopy, especially in polyp diagnosis, as it does not artificially change the size of the polyps. OBJECTIVE: The role of nasal decongestants in nasal stuffiness is well established and their action is well known. Decongestants are also used prior to nasal endoscopy to achieve a better view of the nasal cavity in order to diagnose polyps. The question is whether this decongestion invalidates the estimation of polyp size in clinical and scientific practice. The aim of this study was to evaluate possible effects of topical decongestants on polyp extension in patients with nasal polyposis. MATERIAL AND METHODS: The effect of the decongestants nafazoline and epinephrine on nasal polyp size was assessed by means of a double-blind, placebo-controlled randomized study. A sensitive endoscopic scoring system, lateral imaging, was used to assess the size and extension of the nasal polyps. RESULTS: No significant effect of decongestion on polyp size could be found for either treatment.

Administration, Intranasal↗

PubMed2006

Expression of acidic fibroblast growth factor and basic fibroblast growth factor in nasal polyps.

CONCLUSION: Up-regulated expression of acidic fibroblast growth factor (aFGF) and basic fibroblast growth factor (bFGF) in nasal polyps may be related to epithelial proliferation and neoangiogenesis associated with nasal polyp growth. BACKGROUND AND OBJECTIVES: aFGF and bFGF are polypeptides that effect mitogenesis, neoangiogenesis and tissue repair. The purpose of this study was to investigate the expression of aFGF and bFGF at both the mRNA and protein levels in nasal polyps. MATERIALS AND METHODS: Tissue samples of nasal polyp and inferior turbinate mucosae were obtained. Reverse transcriptase (RT)-PCR, in situ hybridization, and Western blotting for aFGF and bFGF were performed in nasal polyp and nasal inferior turbinate. RESULTS: RT-PCR showed 50% aFGF and 29% bFGF expression positivity in 14 nasal polyps; however, 13 turbinates revealed no PCR products. aFGF and bFGF expression was localized to some inflammatory cells of nasal polyps by in situ hybridization. Western blotting identified aFGF and bFGF molecular masses of 18 kDa and 24 kDa, respectively, in nasal polyps, and these levels were higher than those observed in nasal turbinates. aFGF and bFGF proteins were also localized in some inflammatory cells of nasal polyps by immunostaining.

Base Sequence↗

PubMed2005

Expression and distribution of ion transport mRNAs in human nasal mucosa and nasal polyps.

CONCLUSIONS: Our results indicate that the electrogenic kidney Na(+)/HCO(3)(-) cotransporter (kNBC), KCl cotransporter (KCC1 and -4) and Ca(2+)-activated Cl(-) channel (CaCC1, -2, -3) mRNAs are expressed in normal nasal mucosa and nasal polyp, suggesting that altered expression of all CaCC mRNAs in nasal polyp may cause impaired electrolyte and water transport across the epithelial cells. OBJECTIVE: Electrolyte transport by nasal epithelia has been suggested to be important for controlling the quantity and composition of the nasal fluid and may play an important role in the development of nasal polyps. Transepithelial transport of ions and water in various fluid-transporting epithelia is strictly dependent on the localization of specific membrane proteins in the polarized epithelial cells. In this study we investigated the expression and distribution of mRNA transcripts for kNBC, pancreatic NBC, KCC1, -2, -3, -4 and CaCC1, -2, -3 gene families in human nasal mucosa and nasal polyp. MATERIAL AND METHODS: The expression and localization of these gene families were investigated in inferior turbinate tissues and nasal polyp using reverse transcriptase polymerase chain reaction (RT-PCR), semiquantitative RT-PCR and in situ hybridization. RESULTS: mRNAs for kNBC, KCC1 and -4 and all the CaCC families (CaCC1, -2 and -3) are expressed in human turbinate mucosa and nasal polyp. The expression levels of kNBC and KCC1 and -4 mRNAs did not differ between nasal mucosa and nasal polyp. However, the expression levels of all the CaCC genes were significantly decreased in nasal polyp. In situ hybridization revealed that the expression of these genes was mainly localized in the epithelial layer and submucosal glands of inferior turbinate mucosa and in the epithelial layer of nasal polyp.

Adult↗

PubMed1994

Eosinophil adhesion to nasal polyp endothelium is P-selectin-dependent.

Tissue eosinophilia is a characteristic feature of a number of inflammatory diseases including asthma and nasal polyposis. Eosinophil migration into tissues is controlled in part by interactions between eosinophil adhesion receptors and counter-structures on the vascular endothelium. To determine the receptors used by eosinophils to adhere to vascular endothelium in allergic inflammation we have adapted the Stamper-Woodruff frozen section assay (FSA) to study eosinophil adhesion to nasal polyp endothelium. Immunohistology indicated that intercellular adhesion molecule 1 (ICAM-1), E-selectin and P-selectin were well expressed by nasal polyp endothelium, whereas expression of vascular cell adhesion molecule 1 (VCAM-1) was weak or absent. Unstimulated human peripheral blood eosinophils adhered specifically to nasal polyp endothelium. Adherence was temperature and divalent cation-dependent and saturable at cell densities > 5 x 10(6) cells/ml. Eosinophil adhesion was almost completely inhibited by a monoclonal antibody (mAb) against P-selectin and by a chimeric molecule consisting of the Fc portion of human IgG and the lectin binding domain of P-selectin, which binds to the P-selectin ligand on leucocytes. Anti-Mac-1 mAb partially inhibited eosinophil adhesion whereas mAb against E-selectin, L-selectin, ICAM-1, VCAM-1, very late activation antigen 4, and lymphocyte function-associated antigen 1 had no effect. P-selectin is stored in intracellular granules within the endothelial cell and in vitro is only transiently expressed. To determine if P-selectin was expressed on the membrane of the nasal polyp endothelium we compared P-selectin expression in normal skin and nasal polyps after acetone fixation, which permeabilizes cells, and paraformaldehyde, which only allows staining of membrane expressed receptors. In the skin, good expression was seen with acetone fixation but no expression was seen after paraformaldehyde treatment, whereas in nasal polyps, similar expression was observed with both fixatives. In addition immunofluorescence with confocal microscopy demonstrated lumenal staining of nasal polyp endothelium indicating that P-selectin was located on the surface of endothelial cells while in skin only an intracellular granular distribution was apparent. Lastly, whereas eosinophils bound consistently to nasal polyp endothelium, no binding was observed to blood vessels in normal skin further supporting the idea that eosinophils were binding to membrane expressed and not intracellular P-selectin. The importance of P-selectin in eosinophil adhesion to nasal polyp endothelium suggests that P-selectin antagonists may be effective at inhibiting eosinophil accumulation at sites of allergic inflammation.

Adult↗

PubMed2001

Hyperplastic polyps of the esophagus and esophagogastric junction: histologic and clinicopathologic findings.

Hyperplastic polyps of the esophagus and esophagogastric junction region (EGJ) are uncommon lesions characterized by hyperplastic epithelium (foveolar-type, squamous, or both) with variable amounts of inflamed stroma. They have been reported almost exclusively in the radiologic and clinical literature as occurring predominantly in association with gastroesophageal reflux disease (GERD). Comprehensive histologic and clinicopathologic evaluation of these polyps, their association with background mucosal pathology, and their association with Barrett's esophagus has not been previously performed. We studied 30 hyperplastic polyps from 27 patients and characterized the histologic, endoscopic, and clinical features of both the polyps and the background esophagus. Hyperplastic polyps were most common in the region of the EGJ (67%), followed by the distal esophagus (30%) and mid-esophagus (3%). Most (80%) were composed of predominantly cardiac-type mucosa, predominantly squamous mucosa (17%), or an admixture (3%). Intestinal metaplasia of the polyp was present in only 7% and low-grade dysplasia in only 3%. In the majority of cases (67%) hyperplastic polyps were associated with concurrent or recent ulcers or erosive esophagitis. In most cases (48%) esophageal injury was associated with GERD, but other potential etiologies included medications, infection, anastomotic or polypectomy sites, vomiting, and photodynamic therapy. Four patients (15%) had Barrett's esophagus, three of whom had or developed dysplastic Barrett's mucosa. These results underscore the pathogenesis of esophageal/EGJ region hyperplastic polyps as a mucosal regenerative response to surrounding mucosal injury. Careful clinical history and biopsy of the nonpolypoid mucosa are essential for determining the clinicopathologic context in which the polyps have developed.

Adolescent↗

PubMed2004

Benign fibroblastic polyps of the colon: a histologic, immunohistochemical, and ultrastructural study.

Mesenchymal proliferations presenting as mucosal polyps are relatively uncommon and are represented by gastrointestinal stromal tumors, smooth muscle and neural tumors, and inflammatory fibroid polyps. In this report, we describe the clinicopathologic features of a distinctive type of mucosal polyp composed of cytologically bland spindled cells with fibroblastic features. Fourteen cases with histologic features of"fibroblastic polyps" were identified from our case files from January 2000 to December 2003. The clinical and endoscopic findings were reviewed. Immunohistochemistry using a panel of antibodies (vimentin, smooth muscle actin, desmin, CD31, CD34, Bcl-2, c-Kit, S-100, and epithelial membrane antigen) was performed in all cases, and electron microscopy was performed in two cases. The lesions were solitary in all cases and not associated with an identifiable polyposis syndrome. Associated adenomata and/or hyperplastic polyps at different sites were present in 10 cases and hyperplastic polyps were seen in close association in 3 cases. These polyps were characterized by a monomorphic spindle cell proliferation in the lamina propria, without necrosis or mitotic activity. The lesions were intimately associated with the muscularis mucosae and resulted in wide separation and disorganization of the colonic crypts. Immunohistochemical analysis revealed strong and diffuse positivity for vimentin only. Weak and focal reactivity was noted in 2 cases for CD34 and smooth muscle actin, while staining for other antibodies was negative. Electron microscopy revealed sparse cytoplasmic organelles and many intermediate filaments. The histology and ultrastructural and immunohistochemical findings are suggestive of fibroblastic differentiation of these spindle cells. In summary, these lesions represent a distinctive type of colonic mucosal polyp that should be distinguished from other stromal polyps of the gastrointestinal tract.

Actins↗

PubMed1996

Estrogen and progesterone receptor expression in endometrial polyps.

Endometrial polyps are a frequent cause of abnormal uterine bleeding, but their pathogenesis is poorly understood. This study was undertaken to investigate if endometrial polyps result from localized overexpression of estrogen receptors (ERs) or reduced expression of progesterone receptors (PRs). Fourteen cases of endometrial polyps, in which normal cycling endometrium was also present on the same slide, were immunostained for ERs and PRs. Percentages of positive cells in glands and stroma for each receptor were subjectively assessed to the nearest 5%. The intensity of staining was recorded on a scale from 1+ to 4+. The level and intensity of staining in polyps were compared with the staining in normal endometrium. Fewer stromal cells in polyps expressed ERs and PRs compared with cycling endometrium (% ER = 55.9 +/- 25.8 vs. 74.3 +/- 25.8, p = 0.03; % PR = 56.1 +/- 28.2 vs. 87.5 +/- 10.1, p = 0.002). Stroma in polyps also had significantly reduced intensity of staining for PRs, but not for ERs (intensity PR = 2.7 +/- 1.4 vs. 3.5 +/- 0.7, p = 0.015; intensity ER = 2.1 +/- 0.7 vs. 2.4 +/- 0.8, p = 0.45). There were no significant differences in expression of ERs and PRs in the endometrial glands in endometrial polyps compared with normal endometrium (% ER = 75.4 +/- 32.5 vs. 70.7 +/- 39.2. p = 0.25; % PR = 79.6 +/- 32.8 vs. 80.4 +/- 34.4, p = 0.8; intensity ER = 2.7 +/- 0.9 vs. 2.4 +/- 1, p = 0.15; intensity PR = 2.9 +/- 1.4 vs. 3.4 +/- 0.7, p = 0.15). We conclude that endometrial polyps may result from a decrease in ER and PR expression in stromal cells. Because of these receptor-negative stromal cells, endometrial polyps may be relatively insensitive to cyclic hormonal changes.

Adult↗

PubMed1999

The stromal component of large endometrial polyps.

Benign endometrial polyps belong in the differential diagnosis of adenofibroma and adenosarcoma. There is, however, little information about the range of stromal mitotic activity, stromal cellularity, and stromal atypia in benign endometrial polyps, rendering the differential diagnosis with the aforementioned tumors problematic. In this study, the stroma of 66 polyps 1 cm or more in greatest dimension from 56 patients was analyzed for stromal mitotic activity, cellularity, and atypia. Sixteen (24%) had an almost completely fibrotic stroma that had rare mitoses, little cellularity, and no atypia. However, 50 polyps (76%) had stroma that was predominantly endometrial or was a mixture of endometrial-type stroma and fibrous stroma. In these polyps stromal mitoses were relatively common, averaging 1.2/10 MFs/HPFs (range, 0-5.8 MFs/10 HPFs). Stromal cellularity was frequently equal to or mildly increased over adjacent nonpolypoid endometrial stroma and mild nuclear atypia (enlarged stromal nuclei) was also common. Twelve polyps (24%) from the group of 50 had two or more MFs/10 HPFs, a mitotic rate present in some adenosarcomas. None of these polyps had other features necessary for the diagnosis of adenofibroma or adenosarcoma and follow-up in all patients was uneventful (average follow-up, 96 months). It is concluded that benign polyps that retain areas of endometrial-type stroma often have mitotic activity and that significant stromal mitotic activity (> or = 2 MFs/HPFs) is relatively common. These polyps do not have significant stromal atypia nor do they have a marked increase in stromal cellularity. Thus, in the absence of other supportive features, stromal mitotic activity alone should not be regarded as a worrisome finding.

Adult↗

PubMed1988

Risk factors for blood loss from adenomatous polyps of the large bowel: a colonoscopic evaluation with histopathological correlation.

In 27 patients with 74 colonic polyps we prospectively evaluated polyp-related risk factors and specific histopathological characteristics that might result in blood loss from these lesions. Each polyp was endoscopically bathed in saline which was then aspirated back into a syringe through a catheter and tested for presence of blood on a Hemoccult II slide. Forty-nine polyps were excised. We found the following: 1) A relatively small proportion of adenomas (approximately 11%) have a propensity to bleed. 2) Approximately 22% of polyp-bearing patients have a bleeding adenoma. 3) Risk factors for bleeding include polyp size greater than 1.0 cm, presence of a stalk, and cherry-red color; associated histopathological findings include marked vascular congestion and intramucosal lakes of blood. 4) Clinically detectable bleeding occurs after intramucosal hemorrhage in the polyp head and dissection of blood into the bowel lumen through the glandular or surface epithelium. Most polyps are small, sessile and pink, without histopathological features of hemorrhage and are unlikely to bleed. Therefore, patients with Hemoccult-positive stools in whom such neoplasms are found should undergo further study to detect other causes of gastrointestinal blood loss. High-risk polyps in otherwise asymptomatic patients can be held responsible for bleeding; in them colonoscopic polypectomy with follow-up Hemoccult testing is sufficient management. Only if bleeding persists is study of other parts of the gut essential.

Adenoma↗

PubMed1991

Gastric mucosa in female patients with fundic glandular polyps.

To evaluate the characteristics of the gastric mucosa in women with fundic glandular polyps, we examined gastric acid secretion, fasting serum levels of pepsinogen I and gastrin, and gastric histology in 11 female patients with fundic polyps, and compared the results with 30 female controls without endoscopic abnormalities and 50 female patients with gastric foveolar hyperplastic polyps. No significant difference was found in gastric and secretion and fasting serum levels of pepsinogen I and gastrin between the patients with fundic glandular polyps and the control subjects. Histological examination showed that atrophic gastritis was generally not found in the patients with fundic glandular polyps. In contrast, gastric acid secretion and fasting serum levels of pepsinogen I were significantly lower and serum gastrin levels were significantly higher in the patients with foveolar hyperplastic polyps than in the other two groups. Also, patients with foveolar hyperplastic polyps had a higher prevalence and further advanced atrophic gastritis in the fundus than did the other two groups. Our investigations demonstrated that fundic glandular polyps arise from gastric mucosa without atrophic gastritis, whereas foveolar hyperplastic polyps develop from mucosa affected by atrophic gastritis, especially type A gastritis.

Female↗

PubMed2002

Gastric polyps and nodules in children receiving long-term omeprazole therapy.

OBJECTIVE: Multiple gastric polyps have been reported to occur in adults receiving omeprazole therapy. There are little published data in children. We report our experience in monitoring the gross and histologic appearance of the stomach in children receiving long-term omeprazole therapy. METHODS: This was a retrospective review of the charts of children who received omeprazole for more than 6 months for reflux esophagitis between 1989 and 1998. All patients had repeated endoscopic examinations until healing of the esophagitis was confirmed and then annually thereafter. At endoscopy, gastric mucosal swellings were classified as polyps or nodules based on histology. RESULTS: Thirty-one children had long-term endoscopic follow-up while receiving omeprazole. Seven of 31 children had gastric polyps and/or nodules, noted between 10 and 48 months (mean = 28 months) of omeprazole therapy. Four had nodules only, one had a sessile hyperplastic polyp, and two had both a polyp (one hyperplastic and one fundic gland polyp) and nodules. All lesions were found in the gastric body. Nodules in four of the six children disappeared spontaneously while the children continued to receive omeprazole. The polyps persisted. There were no dysplastic changes in the gastric mucosa or polyps in any of the patients. There were no significant differences between the 7 children with and the 24 without polyps/nodules with respect to age, gastrin concentrations, or dose and duration of omeprazole therapy. CONCLUSIONS: Gastric polyps and nodules may be found in children receiving long-term omeprazole therapy. The gastric changes in our patients were benign during the mean observation period of 31 months.

Adolescent↗

PubMed2004

Two cases of inverted hyperplastic polyps of the colon and association with adenoma.

Here we report two cases of inverted hyperplastic polyps of the colon. The first patient showed three inverted hyperplastic polyps in the ascending colon, one of which was associated with adenoma. We immunostained this adenoma-associated polyp using anti-beta-catenin antibody and found accumulation of beta-catenin in the cytoplasm of the adenomatous lesion but not in the inverted hyperplastic polyp. This suggested an adenomatous polyposis coli (APC) mutation in the adenomatous region but not in the inverted hyperplastic polyp. The inverted hyperplastic polyp in the second patient was located at the caecum and was studied using magnifying colonoscopy. The polyp appeared to be flat and elevated with a depressed pit in the centre. After spraying with methylene blue dye, the pit pattern of the lesion was observed and small asteroid pits on the polyp were found, consistent with a hyperplastic gland pattern. From these results, we diagnosed inverted hyperplastic polyp of the colon by colonoscopy.

Adenoma↗

PubMed2005

Fibroepithelial polyp of the lower urinary tract in adults.

OBJECTIVE: Fibroepithelial polyps of the urinary tract are rare with most cases reported in children. DESIGN: We report the clinicopathologic features of 12 fibroepithelial polyps of the lower urinary tract in adults. PATIENTS: There were 9 males, 2 females, and 1 patient where the gender was unknown (median age, 44 years; range, 17-70 years). RESULTS: Chief clinical symptoms were hematuria, urinary urgency, and hesitancy. Five patients were asymptomatic, where the lesions were discovered incidentally. Most lesions were located near the verumontanum or the bladder neck. Ten patients were treated by transurethral resection. Of the 10 patients with follow-up information, none showed recurrence (mean, 20 months; median, 17 months). Histologically, all of the fibroepithelial polyps were lined by normal-appearing urothelium, with in one lesion the additional finding of a columnar epithelial lining. There were three overall architectural patterns seen within fibroepithelial polyps. The most common pattern (Pattern 1) seen in 5 cases consisted of a polypoid mass with club-like projections resembling a cloverleaf with florid cystitis cystica et glandularis of the nonintestinal type in the stalk. The second pattern (Pattern 2) seen in 4 cases consisted of a papillary tumor composed of numerous small, rounded fibrovascular cores containing dense fibrous tissue. The last morphologic pattern (Pattern 3) consisted of a polypoid lesion with secondary tall finger-like projections, which was seen in 3 cases. All lesions lacked prominent edema and inflammation seen in polypoid cystitis. Fibroepithelial polyps contained broader stalks with dense fibrous tissue, in contrast to the thin delicate loose fibroconnective tissue seen in the stalk of papillomas. One lesion contained atypical degenerative-appearing stromal cells. CONCLUSIONS: Although fibroepithelial polyps have been considered to be congenital, we think that some of these polyps could develop after birth because all of our patients first showed clinical symptoms in adulthood. Because fibroepithelial polyps in adults are rare, some of these cases can be misdiagnosed as urothelial neoplasms or reactive conditions. Recognition of the precise histologic features of fibroepithelial polyp can facilitate its correct diagnosis.

Adolescent↗