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PubMed2005

Serrated adenomas have a pattern of genetic alterations that distinguishes them from other colorectal polyps.

BACKGROUND: Serrated adenomas are characterized by serrated crypts with dysplasia, and are distinguished from other polyps by their histology, but the genetic basis of serrated adenomas is unknown. We investigated genetic alterations in colorectal polyps to determine if a specific pattern were associated with serrated adenomas. METHODS: Sixty-six small (<10 mm) colorectal polyps were studied, including 11 hyperplastic polyps, 27 serrated adenomas, 9 tubular adenomas, 6 tubulovillous adenomas, and 3 villous adenomas. Allelic imbalance and microsatellite instability were detected by analysis of microsatellites on 5q, 18q, 17p, 2p, and 3p; K-ras mutations were detected by oligonucleotide hybridization. RESULTS: Each polyp subset had its own characteristic mutational signature. Allelic imbalance of 18q was significantly more common (P < 0.05), whereas allelic imbalance of 5q and K-ras mutations were significantly less common (P < 0.05) in serrated adenomas compared with other polyps. Allelic imbalance of 17p was not found in any polyp. CONCLUSIONS: Serrated adenomas are significantly more likely to have allelic imbalance at 18q than other types of adenomas, and significantly less likely to have allelic imbalance at 5q or K-ras mutations. Serrated adenomas seem to evolve through a different genetic pathway than other types of polyps in the colon.

Adenoma↗
PubMed2003

Endoscopic, histological and serologic findings of gastric hyperplastic polyps after eradication of Helicobacter pylori: comparison between responder and non-responder cases.

BACKGROUND: Evidence indicates that eradication of Helicobacter pylori leads to the disappearance of hyperplastic polyps in the stomach. However, there are some exceptions. We have compared endoscopic and serologic findings of responder and non-responder cases with hyperplastic polyps to try to identify the cause(s), other than H. pylori infection, of the formation or growth of gastric hyperplastic polyps. METHODS: We retrospectively studied 33 patients whose hyperplastic polyps disappeared after eradication of H. pylori and 10 patients whose hyperplastic polyps did not disappear after eradication. The patients were examined both endoscopically and serologically before, 1-3 months after and 12-15 months after the eradication. RESULTS: The responder and non-responder groups were similar with respect to age, sex, coexisting diseases, and histologic findings. The number and maximum size of polyps tended to be larger before treatment in the non-responder group than in the responder group. The serum gastrin level was higher in the non-responder group than in the responder group before, 1-3 months after and 12-15 months after the eradication (p=0.0096, p>0.2, p=0.0014). On histologic examination, similar reductions in the degree of inflammatory cell infiltration in the gastric mucosa of the antrum and body were seen in both the responder and non-responder groups. In the non-responders, the size and numbers of the polyps regressed in 5 of the 10 patients. The score of glandular atrophy in the antrum and the serum gastrin levels in the non-regressed cases was higher than those in the regressed cases at 1-3 and 12-15 months after eradication. CONCLUSION: Persistent high gastrin levels were found in the non-responder cases with gastric hyperplastic polyps.

Adult↗
PubMed1993

Histamine metabolism in nasal polyps.

We attempted to determine the relationship of nasal polyps to histamine (HA) metabolism. Compared to that in allergy-related nasal polyps and infection-related nasal polyps, the level of HA in aspirin-induced asthma-related polyps was significantly lower. Large differences between the groups were not observed in HA-synthesizing enzyme activity, but degradative enzyme activity was much higher in aspirin-induced asthma-related polyps than in other types of nasal polyps tested. These findings suggest the possibility that the amount of HA in polyps associated with aspirin-induced asthma was less because of greatly enhanced degradation. We found, in addition, that in nasal tissues such as polyps, histamine-N-methyl transferase, rather than histaminase, was the principal degradative enzyme.

Amine Oxidase (Copper-Containing)↗
PubMed1999

Immunohistochemical staining patterns of MUC1, MUC2, MUC4, and MUC5AC mucins in hyperplastic polyps, serrated adenomas, and traditional adenomas of the colorectum.

We studied the distribution of the four human apomucins MUC1, MUC2, MUC4, and MUC5AC in hyperplastic polyps, serrated adenomas, and traditional adenomas of the colorectum using immunohistochemical techniques, with the aim of comparing and contrasting their patterns of expression. A series of 12 hyperplastic polyps, 27 serrated adenomas, and 20 traditional adenomas was studied. No significant change in apomucin expression was observed in traditional adenomas compared with normal colorectal epithelium, except for MUC5AC, which was present in 12 of the adenomas (60%) and only 20% of the normal samples. In both hyperplastic polyps and serrated adenomas, MUC2 and MUC5AC mucin expression was consistently and markedly increased. In 50% of the hyperplastic polyps, MUC4 was reduced but in the remaining cases was similar to normal. Loss of MUC4 expression was observed in all serrated adenomas. MUC1 was not increased in the hyperplastic polyps but increased expression was seen in 17 of the serrated adenomas (63%). Similar altered distribution patterns of MUC2, MUC4, and MUC5AC were seen in hyperplastic polyps and serrated adenomas, whereas traditional adenomas showed little change from normal patterns of expression. Although hyperplastic polyps are commonly defined as benign lesions without neoplastic potential, the similar phenotypes of hyperplastic and serrated adenomas and the existence of mixed polyps suggest that these lesions may represent a histogenetic continuum.

Adenoma↗
PubMed1991

Origin of nasal polyps.

The nasoethmoid complexes from 6 patients with nasal polyps were systematically examined. First, the location and place of the origin of the polyps were recorded and photographed. The polyps and their places of origin were removed, serial sectioned, and examined. In all 6 patients, the polyps originated from the nasal mucosa. Most of the polyps extended laterally from the mucosa into the anterior part of the middle meatus. Several polyps originated from the mucosa near the ethmoid cell ostium or directly from the mucosa lining the edge of the ostium. The ostia themselves were not blocked by the polyps, and there was no indication of polyp formation in the ethmoid cells.

Aged↗
PubMed1992

The early stages of polyp formation.

The purpose of this study is to describe polyp formation in the mucosa of the middle ear as a possible model for the pathogenesis of nasal polyps. In 65 Wistar rats, the eustachian tube was occluded on the left side for up to 20 months; 60 right-sided, nonoccluded ears served as controls. Following occlusion, the middle ear mucosa was examined for signs of polyps. Signs of polyp formation or fully developed polyps were seen in 14 (22%) of the middle ears, and were only seen in middle ears with signs of actual or previous infection. It was established that the first stages of polyp formation include epithelial rupture, proliferation of fibrous tissue through the epithelial defect, and epithelialization of the prolapsed fibrous tissue by proliferation and migration of epithelial cells from the surrounding epithelium until there is full epithelial covering of the polyp. This report discusses whether the described middle ear model may form basis for the explanation of the pathogenesis of nasal polyps.

Animals↗
PubMed2006

Polyp measurement using CT colonography: agreement with colonoscopy and effect of viewing conditions on interobserver and intraobserver agreement.

OBJECTIVE: This article presents inter- and intraobserver agreement for estimates of polyp diameter using CT colonography, including the effects of different visualization displays and prior experience. MATERIALS AND METHODS: Four observers, three of whom had prior experience with CT colonography, estimated the maximum diameter of 48 polyps using three different visualization displays: 2D colonography window, 2D abdominal window, and 3D surface rendering. Each re-measured a subset of 10 polyps. Polyps measured 2 to 12 mm according to a colonoscopic reference. Inter- and intraobserver agreement and agreement with the reference measurement were determined using the Bland-Altman method, paired Student's t testing, analysis of variance, and analysis of covariance (ANCOVA), and by calculating the components of variance. RESULTS: CT measurements overestimated polyp diameter, a phenomenon found least using the 2D abdominal display. Generally, 95% limits of agreement encompassed different size categories for individual polyps: the widest spanned 14.6 mm (-4.6 mm to 10.0 mm) for an experienced observer using the 3D display. When using the 2D abdominal display, no significant difference was found between estimates and the reference value for the other two experienced observers (p = 0.83 and 0.23). All the observers' measurements were significantly different from the reference when using the 3D display (p < 0.001). The novice was significantly different from the experienced observers in some analyses. Inter- and intraobserver agreement were poorest for the 3D display. CONCLUSION: Measurement of polyp diameter from CT colonography is subject to variation contingent on the observer's experience and the viewing display used. Although 3D visualization display is commonly used for polyp detection, it should not be used for measurement.

Colonic Polyps↗
PubMed2004

The effect of diagnostic confidence on the probability of optical colonoscopic confirmation of potential polyps detected on CT colonography: prospective assessment in 1,339 asymptomatic adults.

OBJECTIVE: We sought to evaluate the effect of interpreter confidence on the likelihood that a lesion detected on CT colonography (CTC) will correspond to a matched polyp seen on optical colonoscopy. SUBJECTS AND METHODS: Same-day CTC and optical colonoscopy were performed on 1,339 asymptomatic adults. A standard matching algorithm for polyp size and location was used. For each potential polyp detected on CTC, the level of diagnostic confidence was prospectively rated on a 3-point scale (1, least certain; 2, intermediate; and 3, most certain). RESULTS: For CTC-detected lesions 6 mm or larger, diagnostic confidence levels of 1, 2, and 3 corresponded to matched polyps on optical colonoscopy in 33.3% (45/135), 50.0% (103/206), and 66.8% (157/235) of cases, respectively (p < 0.01). Similar trends were present for categories of lesions that measured 6-7 mm, 8-9 mm, and 10 mm or larger, rising to a match rate of 82.1% (55/67) for lesions 10 mm or larger that were diagnosed with a level-3 confidence rating. The likelihood that a matched polyp was adenomatous increased with greater levels of diagnostic confidence. Of note, level-3 confidence for lesions measuring 8-9 mm on CTC more often yielded a matching neoplasm on optical colonoscopy than level-1 or level-2 confidence for lesions measuring 10 mm or larger (60.3% [35/58] vs 20.8% [10/48]; p < 0.0001). CONCLUSION: Greater diagnostic confidence for an individual lesion detected on CTC correlates with a significantly increased likelihood that a matching polyp will be found on optical colonoscopy and that this matched polyp will be neoplastic. Although polyp size represents the primary criterion for CTC screening algorithms, this data could help guide the decision to opt for noninvasive CTC surveillance versus optical colonoscopy for polypectomy.

Aged↗
PubMed2005

Polyp detection with MDCT: a phantom-based evaluation of the impact of dose and spatial resolution.

OBJECTIVE: The objective of our study was to evaluate the impact of dose and spatial resolution on the detection of colonic polyps using a 4-MDCT scanner. MATERIALS AND METHODS: Twenty-four latex phantoms that simulate the large bowel and contain artificial polyps of different sizes and shapes were constructed. The polyps were divided into three size groups (diameter, 0-2, 2-5, and 5-10 mm) and were classified into four shape groups: pedunculated; broad-based; ulcerated or depressed; and sessile or flat. The colon phantoms were submerged in a water tank and scanned on a 4-MDCT scanner using 12 protocols with various settings of slice thickness, pitch, and tube current. The images were independently evaluated by three radiologists using axial 2D multiplanar reconstruction images and a 3D surface-rendering technique (fly-through). RESULTS: At a constant dose (i.e., dose-length product [DLP]), the polyp detection rate increased with increasing axial spatial resolution. For the standard protocol (2.50-mm slice thickness, 1.5 pitch), the detection rate for all polyp sizes decreased from approximately 70% at 100 mA to 55% at 40 mA. Between a 60- and 100-mA tube current, the detection rate for the largest polyps (> 5 mm) was almost constant, close to 90%. CONCLUSION: The detection of polyps in the large bowel using a standard protocol can be improved without dose penalty by increasing the axial spatial resolution of the image acquisition and adjusting the tube current setting. If the analysis can be restricted to polyps larger than 5 mm, the dose can be substantially reduced without compromising the detection rate.

Colonic Polyps↗
PubMedDate not supplied

Distribution of mast cells and eosinophils in nasal polyps from atopic and nonatopic subjects: a morphometric study.

The pathogenetic mechanism of nasal polyps remains unknown, although polyps seem to be an expression of chronic nasal inflammation of both allergic and nonallergic origin. The goal of our study was to compare the distribution mast cells and eosinophils (cells traditionally associated with allergic inflammation) in nasal polyps from well defined atopic and nonatopic patients, using advanced morphometric analysis system. Nasal polyps were removed during routine nasal polypectomy performed in 17 atopic and 19 nonatopic patients. Parafin sections of nasal polyps were stained with haematoxilin/eosin, chromotrope R2 or toluidine blue, and light microscopy, assisted with computerized picture analysis system, was used to count the number of cells in the superficial and stromal layer of the mucosa. Regardless of the presence or absence of atopy, eosinophils were predominant cells in the polyps, and both eosinophils and mast cells were more abundant in the superficial layer than in the stromal layer of the mucosa. The density of eosinophils in both layers and mast cells in the stromal layer was similar in atopic and nonatopic patients. Only the density of mast cells in the superficial layer of the mucosa was slightly higher (p < 0.005 in atopic compared to nonatopic patients): In both groups of patients a significant correlation between the number of mast cells and eosinophils in the superficial layer of the polyp mucosa was found (r = 0.84; p < 0.001). Our study demonstrates that eosinophils and mast cells are abundant in nasal polyps from both atopic and nonatopic patients and that mast cells seem to be more superficially distributed in atopic compared to nonatopic patients.

Adolescent↗
PubMedDate not supplied

The relationship of nasal polyps, infection, and inflammation.

The role of infection as cause or effect in nasal polyps is debated. In experimentally induced sinusitis in rabbits, polyps are frequent. The initial polyp formation sequence involves multiple epithelial disruptions with proliferating granulation tissue. Regenerating epithelial branches spread into the underlying connective tissue, where intraepithelial microcavities give rise to a polyp body from the adjacent mucosa. Clinical as well as experimental studies indicate that nasal polyp formation and growth are activated and perpetuated by an integrated process of mucosal epithelium, matrix, and inflammatory cells, which in turn may be initiated by both infectious and noninfectious inflammation. The complexity of the pathophysiologic events in nasal polyposis is reinforced by the finding that epithelial desquamation, combined with infection or inflammation, will initiate polyp formation. Systemic glucocorticosteroids inhibit polyp formation as well as growth of pathogenic bacteria in the sinuses of rabbits with experimental infection. Therapeutic use of corticosteroids in polyp disease, combined with antibiotics or surgery, should be modified in relation to long-term progression, intensity variations, and predisposing conditions.

Animals↗
PubMed1993

Arachidonic acid metabolites in human nasal polyps.

Arachidonic acid metabolites (AAMs) are known to be involved in inflammation. It is suggested that AAMs play an important role in the pathogenesis of nasal polyp. We have measured the levels of prostaglandin E2, 6-keto prostaglandin F1 alpha, thromboxane B2, leukotriene B4 and a mixture of leukotriene C4, D4 and E4 in both nasal polyp and maxillary sinus mucosa by radioimmunoassay. Our results showed that arachidonic acid metabolism in nasal polyps from allergic patients was more active than that from non-allergic patients. The arachidonic acid metabolism in nasal polyp was more active than in maxillary sinus mucosa among allergic patients. On the other hand, arachidonic acid metabolism in maxillary sinus mucosa was more active than that in nasal polyps among non-allergic patients. On the basis of these results, we hypothesized the causal mechanisms of nasal polyps as follows: The nasal polyp in allergic patients is caused by primary inflammation of the nasal mucosa, and sinusitis occurs secondarily. In non-allergic patients, the primary side of inflammation is located in the maxillary sinus mucosa, leading to the secondary formation of nasal polyp.

6-Ketoprostaglandin F1 alpha↗
PubMed1995

Polyp pathogenesis--a histopathological study in experimental otitis media.

We examined the mucosa of 50 rat middle ears in an experimental model of acute otitis media, in order to obtain information on the mechanisms of polyp formation. The right middle ear of 25 rats was inoculated with type 3 pneumococci, and the left ear served as a control. The animals were killed, the middle ear bulla removed, and the mucosa was dissected from the bone, stained PAS-alcian blue and embedded as a whole-mount. The whole-mounts were examined in a light microscope for polypous mucosal prominences. Serial sections were made of all polyps, and of relevant parts of the mucosa. 15 polyps were found in 11 (44%) of 25 infected ears; none were found in normal control ears. Goblet cell density was increased in polyps and the surrounding epithelium. Epithelial microruptures were seen in areas with widespread intra-epithelial liquid vacuoles and subepithelial accumulation of liquids, luminally migrating inflammatory cells, increased vascularization and edema. Connective tissue of the lamina propria was prolapsed through most ruptures. Some prolapses showed signs of re-epithelialization, while others had a full epithelial lining that resembled a fully developed polyp. Our findings support our earlier theory on nasal polyp pathogenesis, based on the following stages: i) Localized rupture of the epithelial lining. ii) Luminal protrusion of the lamina propria through the epithelial defect. iii) Re-epithelialization of protruded tissue, and formation of a polyp.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

[Histological and immunohistochemical study of nasal polyps].

Nasal polyps, in general, have been histologically classified as edematous, adenocystic and fibrous types. It has recently been pointed out that eosinophilic infiltration in nasal polyps has increased along with an increase in nasal allergy. The purpose of this study was to classify the nasal polyps histologically and to examine the mode of infiltration and activation of eosinophils by means of immunohistochemistry. The subjects were 101 patients who underwent surgery for nasal polyps. There were 66 males and 35 females ranging in age from 12 to 76 years. Resected polyps were fixed in formalin, embedded in paraffin, and sliced at a thickness of 4 microns. Hematoxylin-eosin staining and streptavidin- biotinyl peroxidase complex staining were used to detect eosinophils. The results were as follows: 1) The nasal polyps were, histologically, edematous in 88.1%, adenocystic in 47.5%, and fibrous in 19.8%. 2) The number and distribution of EG1-positive cells and EG2-positive cells were almost the same in the superficial layer of the lamina propria. This study suggests that eosinophilic infiltration into nasal polyps occurs mainly in edematous polyps and that the majority of the infiltrating eosinophils are activated.

Adolescent↗
PubMed2000

The risk of premalignant and malignant pathology in endometrial polyps.

OBJECTIVE: To evaluate the risk of premalignant and malignant pathology among endometrial polyps. DESIGN: Prospective cohort study. SETTING: Minimal Access Surgical Training (MAST) center in a large teaching hospital. METHODS: Among 248 patients seen in outpatient hysteroscopy clinic (1996-97), 62 had endometrial polyps. All patients had endometrial sampling for histological assessment. To determine the magnitude of malignant potential among polyps, we compared the pathological findings in polyps (cases) with non-polypoidal specimens (controls). RESULTS: Out of 62 polyps, histologically 53 (85.5%) were benign, seven (11.3%) had hyperplasia, and two (3.2%) were associated with malignancy. Hyperplasia was more frequent in endometrial specimens with polyps than in those without (11.3% vs 4.3%, p=0.04), but the incidence of carcinoma in the two groups was the same (3.2% vs 3.2%, p= 1.0). CONCLUSION: In abnormal uterine bleeding, hyperplasia was, but cancer was not, more common in women with endometrial polyps compared to those without polyps.

Cohort Studies↗
PubMed2000

Isolated small gallbladder polyps: an indication for cholecystectomy in symptomatic patients.

To evaluate patients with gallbladder polyps and to compare them with patients with chronic acalculous cholecystitis, 301 patients with chronic acalculous disease of the gallbladder, of which 45 had polyp disease of the gallbladder, were reviewed out of 7181 cholecystectomies performed from June 1985 through June 1995. Of the 45 patients, 30 (Group A) were diagnosed preoperatively by ultrasound and 15 (Group B) postoperatively on pathologic examination. In each group, the most common polyp was cholesterol type (19/45) with multiple lesions in 10 of these 19 patients. Chronic cholecystitis was present elsewhere in the gallbladder in 40 per cent of Group A and 80 per cent of Group B patients (P = 0.02). Forty-three patients had polyps less than 5 mm in diameter, one a 1.5-cm gallbladder cholesterol polyp, and one a 1.3-cm tubulovillous polyp with a focus of carcinoma in situ. During this same period, 17 patients had primary malignancy of the gallbladder, none of which were found in polypoid lesions. In Group A patients there were significantly fewer preoperative tests than in typical acalculous patients [2.3 versus 3.8 (P<0.03)], including upper endoscopy (P<0.02) and hepatobiliary scintigraphy (P<0.00001). Of the patients with polyps, 42 of 45 (93.3%) had resolution of symptoms postoperatively with a mean follow-up of 178.9+/-505.0 days (range 1-2438 days). Most patients with biliary tract symptoms and a small (<5-mm) gallbladder polyp underwent fewer preoperative diagnostic tests than patients with chronic acalculous cholecystitis. This abbreviated preoperative workup appears warranted in view of the high incidence of symptom resolution.

Adult↗
PubMed2001

Suppression of intestinal polyps in Msh2-deficient and non-Msh2-deficient multiple intestinal neoplasia mice by a specific cyclooxygenase-2 inhibitor and by a dual cyclooxygenase-1/2 inhibitor.

Epidemiological studies suggest that nonsteroidal anti-inflammatory agents decrease the risk of colorectal cancer. This is believed to be mediated, at least in part, by inhibition of cyclooxygenase (COX) activity. There are two COX isoenzymes, namely the constitutively expressed COX-1 and the inducible COX-2. COX-2 is overexpressed in adenomas and colorectal cancers, and COX-2-specific inhibitors have been shown to inhibit intestinal polyps in Apc(Delta716) mice more effectively than dual COX-1/COX-2 inhibitors such as sulindac. Various Apc knockout mice, including the multiple intestinal neoplasia (Min) mouse and the Apc(Delta716) mouse, are limited by their lack of large numbers of colonic adenomas and aberrant crypt foci, the putative precursors of large-bowel polyps and cancers. Our DNA mismatch-repair-deficient Min mouse model (Apc+/-Msh2-/-) has genetic features of both familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, and most importantly, rapidly develops numerous small- and large-bowel adenomas, as well as colonic aberrant crypt foci. The purpose of this study was to determine the effects of COX inhibitors on intestinal adenomas and colonic aberrant crypt foci in this accelerated polyposis, mismatch-repair-deficient Min mouse model, in addition to a standard Min mouse model. Weanling Apc+/-Msh2-/- and Min mice were fed diets containing no drug, sulindac, or a specific COX-2 inhibitor (MF-tricyclic). Apc+/-Msh2-/- and Min mice were sacrificed after 4 weeks and 5 months on diet, respectively. Apc+/-Msh2-/- mice treated with MF-tricyclic had significantly fewer small-bowel polyps (mean +/- SD, 178 +/- 29) compared with mice on sulindac (278 +/- 80), or control diet (341 +/- 43; P < 0.001). There was no difference in numbers of large-bowel polyps or aberrant crypt foci in mice in the three groups. MF-tricyclic was also effective in reducing both small- and large-bowel polyps in Min mice. Western analysis demonstrated COX-2 expression in both large- and small-bowel polyps from mice of both genotypes. This study demonstrates that a specific COX-2 inhibitor is effective in preventing small-bowel polyps in mismatch-repair-deficient Min mice and both small- and large-bowel polyps in standard Min mice. Therefore, specific COX-2 inhibitors may be useful as chemopreventive and therapeutic agents in humans at risk for colorectal neoplasia.

Adenoma↗
PubMed2001

[Polyps (single or multiple) and juvenile polyposis].

The authors underline the important aspects of juvenile familial polyposis (JFP), a disease transmitted as an autosomal dominant trait. A case of JFP characterized by the presence of hundreds of polyps in the colo-rectal intestinal tract, is analyzed. The single juvenile polyp, multiple polyps (=/>5 polyps) and the sporadic form are examined. These are mucous hamartomas which can undergo neoplastic transformation (in carcinoma in 68% of untreated cases), a behaviour similar to that of adenomatous polyps. They differ from the later due to the following features: epidemiology (earlier appearance age), anatomopathology (stroma), clinical observation (self-recovery in some cases) and genetics (10q23.3-18q21, genetic mutations in a locus different those of adenomatous polyps). It is also necessary to determine its extension by means of colonoscopy, ileoscopy, gastroscopy and small bowel barium enema. Patients' screening through construction of the genealogical family tree is fundamental. Isolation of possible degenerative aspects of the polyps through biopsy is also fundamental. Single or multiple polyps are treated endoscopically, the juvenile polyposis is treated surgically (colectomy, total colectomy). A rigorous follow-up of the patients and their family members is recommended.

Adenomatous Polyposis Coli↗