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PubMed1988

Cronkhite-Canada syndrome associated with colon carcinoma and adenomatous changes in C-C polyps.

A 73-yr-old man with the clinical features of Cronkhite-Canada syndrome developed colonic carcinoma. Radiologic and endoscopic examination revealed numerous polyps involving the stomach and large intestine. Histologic examination of the biopsied polyps revealed polypoidal lesions covered by a single layer of normal columnar mucus-secreting epithelial cells. The stroma of each polyp was composed of well-vascularized edematous lamina propria containing inflammatory cells and glands of variable sizes. Some of the glands were cystically dilated and lined by a single layer of mucin-secreting epithelial cells. These polyps were reminiscent of "juvenile polyps" or retention polyps. Some of these polyps also showed definite adenomatous changes at the surface epithelium. In addition, a large cecal tubulovillous adenoma with foci of well-differentiated adenocarcinoma was noted, indicating that adenomatous and carcinomatous epithelial changes can occur in otherwise nonneoplastic polyposis of the Cronkhite-Canada syndrome as seen in the present case.

Adenocarcinoma↗
PubMed1987

Immunopathological characteristics of nasal polyps.

The presence of immunoglobulins in nasal polyps and surrounding mucosa was studied by direct immunofluorescence in 14 patients. Specific and total IgE were determined in polyps and in the sera of this group. Significant immunofluorescence to IgE was demonstrated in 12 polyps but in only four samples of adjacent mucosa. Eight polyps showed significant immunofluorescence to IgM. Six patients had elevated total IgE levels within polyp sac fluid in the absence of elevated serum values. In seven cases, specific IgE was found in polyp sac fluid which could not be detected on skin or serum testing. These results may suggest local production of IgE and support the concept of nasal polyps being a manifestation of a local allergic phenomenon.

Adolescent↗
PubMed1985

[Pathology of gastric mucosa polyps].

More frequent use of the endoscope to remove gastric mucosal polyps has also led to better knowledge of the pathology of these polyps. Their classification is still a matter of debate, and hence, by way of introduction, the notions of hyperplastic, hyperplasiogenous and hyperplastic-adenomatous polyp, adenoma, borderline lesion protruded type, foveolar hyperplasia and cysts of the gastric glands are presented. The authors give preference to the WHO classification of 1977. Among 196 mucosal polyps examined between 1970 and 1982 84% were hyperplastic (hyperplasiogenous) polyps, 15.5% adenomas and there was a single specimen of hamartomatous polyp. One in every 6 adenomas showed malignant changes and 5 of the 165 hyperplastic polyps were associated with gastric carcinoma. Problems of diagnosis, classification and prognosis are briefly discussed.

Adenoma↗
PubMed1984

Malignant colon polyps--cure by colonoscopy or colectomy?

Although malignant sessile colon polyps usually require colectomy for proper treatment, the vast majority of malignant pedunculated polyps can be removed colonoscopically for cure. The author's experience with 83 consecutively encountered malignant polypoid lesions is reviewed and is the basis for the discussion herein. All 49 malignant pedunculated polyps were removed colonoscopically. Eight of these patients also underwent colectomy because of questionable or definite presence of cancer cells within the stalk portion of the polyp; no residual cancer was identified at the polypectomy site, and all lymph nodes were negative in these patients. Of 34 patients with malignant sessile polypoid lesions, 13 underwent colectomy because of obvious malignancy at colonoscopy. Twenty-one sessile lesions were removed colonoscopically; with malignancy documented, nine of the 21 patients underwent colectomy. Positive findings (either cancer at the polypectomy site or in lymph nodes) at surgery were identified in two of these nine patients. Colonoscopic polypectomy can be considered curative for malignant pedunculated polyps provided the stalk portion of the lesion is totally uninvolved with the malignant process, provided there is no lymphatic or vascular invasion, the malignancy is well differentiated, and follow-up endoscopic examination of the polypectomy site reveals no residual or recurrence. These four criteria must be satisfied in order to consider a malignant pedunculated polyp curatively removed by colonoscopic polypectomy alone. The risk of colectomy in patients satisfying these four criteria is believed to be greater than the risk of metastatic disease and death from this lesion. Colectomy is recommended for all patients with malignant sessile polypoid lesions, provided their general medical condition provides an acceptable operative risk. Although colonoscopic polypectomy is not recommended for obviously malignant sessile polyps, there are instances where sessile lesions are removed colonoscopically and found microscopically to contain focal or minute areas of invasive cancer. In certain of these patients, the risk of colectomy may exceed the risk of recurrence or metastasis, if the polypoid lesion has been totally removed colonoscopically and completeness of the polypectomy has been documented by follow-up colonoscopy. Each patient's clinical history, general condition, and histopathology must be reviewed individually by a clinician experienced in this field in order to reach a wise and proper decision regarding the potential need for colectomy, and limit colectomy to those patients in whom it is absolutely necessary.

Adenoma↗
PubMed1981

[Pathomorphology of gastric polyps].

A total of 131 gastric polyps removed by endoscopic polypectomy in 108 patients were examined. According to Elster's classification, foveolar hyperplasia was diagnosed in 21 cases, foveolar hyperplasia with transition into hyperplasiogenic polyp in 3 cases, hyperplasiogenic polyp in 59 cases, hyperplasiogenic polyp with transition into adenomatous polyp in 4 cases, highly differentiated adenoma in 5 cases, adenomatous polyp in 5 cases, and other processes in 34 cases. Hyperplasiogenic polyps are characterized by the presence of chronic erosions (78.3%) and cysts (70%). In the process of reparative regeneration of erosions the emergence of cysts could be followed. The appearance of erosions was preceeded by dystrophic changes of the epithelium during which RNA accumulated in the adjacent epitheliocytes. This may be regarded as the state of "readiness" for reparation even before the defect of the mucous membrane develops.

Adenoma↗
PubMed1981

Histoclinical long-standing follow-up study of hyperplastic polyps of the stomach.

In a series of 2,013 gastric polyps in 1,201 patients, morphological and histopathological studies have been performed. Ninety-three hyperplastic polyps in 56 patients have been followed-up endoscopically and histopathologically for five to 12 years. The incidence of detection of gastric polyps has increased: 1.4% in 1967 to 8.7% in 1979 year by year. Thirty patients (54%) among the 56 showed changes in number, size or shape of polyps during follow-up. Twenty patients (37%) revealed numerical changes (increase in 16 patients, reversion in three patients and vanishing in two patients). Twenty-eight polyps (30%) showed morphological changes, six of them showed continuous enlargement, 18 lesions repeated enlargement, stationary or reduction stages, three lesions were reversed and two polyps disappeared. Histopathologically, three lesions showed transformation from the hyperplastic type to adenoma while demonstrating morphological enlargement. Two of these showed increase in cellular atypia, from the hyperplastic type through adenoma with severe atypia and finally to carcinoma in the polypectomy specimens. From this study, it was concluded that although hyperplastic polyps show changes in size, shape or number with passage of time, malignant changes occur in only a few cases.

Adenoma↗
PubMed1994

Yield of rescreening for colonic polyps using flexible sigmoidoscopy.

OBJECTIVE: To determine the yield of performing screening-flexible sigmoidoscopy 1 yr after a negative examination. METHODS: In a flexible sigmoidoscopy screening program at a chemical factory, over a period of 3 yr, 307 sigmoidoscopies were performed by a single endoscopist in workers greater than or equal to 40 yr old. Of 202 workers screened in the first 2 yr, 32% were found to have polyps (mean age, 52.9 yr). Repeat flexible sigmoidoscopy was recommended to all workers after 1 yr, and 81 complied. RESULTS: The mean (+/- SEM) time to follow-up was 17.0 +/- 0.7 months; of 69 workers who were negative on the first exam, five (7.2%) had a polyp at follow-up. Two of the five patients with polyps were under the age of 50. Of 12 workers who had polyps on the index exam and requested a repeat flexible sigmoidoscopy a yr later, four (33%) again had a polyp. Colonoscopy had been performed in the time interval between the two sigmoidoscopies in 10 of the 12 workers; four (33%) had recurrent polyps. CONCLUSIONS: We conclude that a significant yield of polyps (7.2%) may be found on repeat flexible sigmoidoscopy despite a negative examination within the prior 2 yr. Although the overall yield in this study population was reduced from 32% to 7% by repeat screening, this study supports older American Cancer Society guidelines i.e., to repeat flexible sigmoidoscopy at 1 yr in patients whose first examination was negative. Because half of the positive workers were under age 50, this study also suggests that the American Cancer Society age cutoff may be too stringent.

Chemical Industry↗
PubMed1993

Carcinoma of a gallbladder polyp: treated by laparoscopic laser cholecystectomy.

To define the significance of polyps of the gallbladder, we undertook a retrospective review of all gallbladders removed over a 10-month period in our institution. The discovery of polyps are usually incidental and treated as benign. Polyps can form because of cholecystitis, cholesterolosis, hypertrophy of the epithelial lining (adenoma or papilloma), or carcinoma. Of 461 gallbladder specimens, 12 had polyps with one containing carcinoma, and two more specimens had carcinoma. All but one case were treated by laparoscopic cholecystectomy. Herein is described a case of a symptomatic patient presenting with a 1.1-cm polyp treated by laparoscopic laser cholecystectomy. An aggressive approach for gallbladder polyps with laparoscopy is proposed, especially in symptomatic patients or for polyps larger than 1 cm.

Adenocarcinoma↗
PubMedDate not supplied

[Non-neoplastic polyps of the colon].

Non-neoplastic colon polyps are benign lesions with normal histology components, we present our experience with colonoscopy polypectomy in 10 years. We resected 187 polyps in 96 patients (50 males) with medium age of 49.3 years and range 2-82. Most common indication was hemorrhage (37%) taking out the hyperplastic polyps who were found in asymptomatic patients with the highest frequency (41%). Juvenile polyps follows with 25%. 71% polyps were unique but hamaetomatous polyps of Peutz-Jeghers syndrome were multiple (39%). Juvenile (retention) polyps were found among the youngest patients (average 13.2 years) and frequently had hemorrhage (21-25). Lipomas were found in elder patients (range 52.5 years). We had no major complications with hemorrhage or mortality, minor complications were found in 3.09%.

Adolescent↗
PubMed1995

Malignant transformation of benign epithelial gastric polyps.

OBJECTIVES: To compare the malignant potential of hyperplastic polyps and adenomas in relation to different histological classifications and to try to follow the natural history of the BEGP-carcinoma sequence. METHODS: During a 13-yr period (1981-1993), 811 BEGP were discovered in 432 patients in consecutive esophagogastroscopic examinations in our department. Adequate endoscopic biopsies or polypectomy specimens were histologically diagnosed as hyperplastic polyp in 751 (92.6%) and adenoma in 60 (7.4%) of the lesions, according to WHO classification. Hyperplastic lesions were further divided into two subgroups: 268 were polypoid foveolar hyperplasia (FH) and 483 were typical hyperplastic polyps (HP), according to Elster's classification. Special attention was paid to focal malignancy at the first examination or malignant transformation of BEGP during follow-up. Ninety-six patients with 220 BEGP were followed for 1-11 yr, with an average of 2 yr and 8 months. RESULTS: According to Elster's classification, there were 10/483 (2.1%) HP and 6/60 (10.0%) adenomas with focal carcinoma. Moreover, in 19/265 patients (7.1%) with HP and in 4/30 patients (13.3%) with adenomas, carcinoma was found elsewhere in the stomach. During our follow-up, 5/131 HP showed different steps of histological transformation: focal intestinal metaplasia in two, focal dysplasia in one, and focal carcinoma in two of them, which is 1.6%, 0.8%, and 1.6%, respectively. In 1/23 adenomas, focal carcinoma developed after 1 yr of observation (4.3%). Separate gastric carcinomas developed outside polyps during follow-up in 2/58 (3.5%) patients with hyperplastic polyps only. None of those with FH had focal carcinoma either at primary biopsy or during long-term observation. All proportions concerning gradual transformation of hyperplastic polyps classified as only one group according to WHO were lower. CONCLUSIONS: In contrast to hitherto existing opinions, our results give support to the idea that gastric HP, like adenomas, are susceptible to malignant transformation. It seems sensible to separate a subgroup of FH from HP, since FH have no malignant potential until they change their histology to HP. The treatment of FH and HP as one group is the main reason why the malignant potential of hyperplastic polyps is still underestimated.

Adenoma↗
PubMedDate not supplied

Juvenile polyps and their distribution in pediatric patients with gastrointestinal bleeding.

Juvenile polyps (JPs) are the most common colonic tumor in childhood. The total number and anatomical distribution have changed significantly since the introduction of flexible colonoscopy. This article reviews our experiences treating 29 pediatric patients with JPs, and evaluates the 66 polyps we removed and their distribution in the colon. Thirteen patients (45%) had multiple polyps and 35% of all polyps were found proximal to the sigmoid colon. In the 14 patients who underwent a complete colonoscopy, eight had multiple polyps and 55% of these polyps were found proximal to the sigmoid colon. As a result, we conclude that there is a trend toward more polyps per patient and a more distal colonic distribution in children with JPs than previously reported. We recommend that a complete colonoscopy and possible polypectomy be performed on all children with unexplained rectal bleeding.

Age Factors↗
PubMedDate not supplied

Solitary juvenile polyps in children and colon cancer.

BACKGROUND/AIMS: Solitary Juvenile Polyps (SJP) are quite common in preschool children, although they may occur at any age. It is not known whether the existence of a single juvenile polyp in a child predisposes to future development of new SJP or is related to colorectal neoplasia. The present study was designed to follow up young patients who had undergone polypectomy for SJP and their first degree relatives to elucidate the development of adenomatous polyps or colon cancer. MATERIALS AND METHODS: From 31 children polypectomized for histologically proven SJP between 1983-1995, we were able to contact and gather information on 24. From our records and the information collected we studied age, gender, site of the polyp in the bowel, personal history, and family history. RESULTS: Mean time of follow up was 4.1 years (range 0.4-10, SD +/- 3.1) Mean age was 4.6 years (Range 3.5-9, SD +/- 1.2). There were 14 boys and 10 girls (ratio 1.4/1). Eighteen polyps were located at the rectosigmoid area, 5 in the lower descending colon, and one in the splenic flecture. From the 24 children, only one girl developed rectal bleeding at the age of 15 years, 8 years after polypectomy. However, subsequent evidence from the large bowel did not reveal any abnormality and the symptom was attributed to hemorrhoidal bleeding. Thorough investigation of the history of 146 first degree relatives (dead or alive) siblings, parents, and grandparents revealed that none of them were diagnosed with adenomatous polyps or colorectal cancer. CONCLUSION: SJP does not predispose to future development of new juvenile polyps and is not associated with a high risk of colorectal malignancy.

Adenomatous Polyposis Coli↗
PubMed1997

[Hyperplastic polyps arising in islands of gastric mucosa in the duodenum].

Hyperplastic polyps originating from islands of gastric mucosa can be observed in the duodenum. We report 3 cases of duodenal hyperplastic polyps on antral or fully developed fundic mucosa. They macroscopically presented as small confluent polyps or as large villous polyps. Their microscopic features were the same as those observed in hyperplastic gastric polyps. This type of polyp must be added to the list of tumor like lesions of the duodenum that may endoscopically present as polyps.

Adult↗
PubMed1998

Genomic changes in endometrial polyps associated with tamoxifen show no evidence for its action as an external carcinogen.

Eighty-eight endometrial specimens from 36 postmenopausal breast cancer patients treated with tamoxifen were investigated cytogenetically and molecularly using fluorescence in situ hybridization with appropriate probes for the HMGIC and HMGIY genes. Twenty control specimens, 10 endometrial polyps, and 10 endometrial biopsy specimens were investigated in the same way. Of the 88 specimens, 44 were from endometrial polyps; 3 were from endocervical polyps; 7 were from cystic endometrium; 30 were from normal or atrophic endometrium, normal endocervix, or myometrium; and 4 were from endometrial carcinomas. Chromosome investigation of the endometrial polyps showed the nature of the chromosome changes in tamoxifen-induced polyps to be the same as that in the controls and in sporadic endometrial polyps described in the literature. HMGIC and HMGIY gene rearrangements in both groups were identical as shown by fluorescence in situ hybridization, which also allowed for the detection of seven hidden paracentric inversions involving 12q15, one of which occurred in a cystic endometrium. The carcinomas did not exhibit any of these changes. Because abnormal expression of HMGIC or HMGIY as a consequence of structural chromosome changes in 12q15 or 6p21, respectively, is invariably associated with benign neoplasia, tamoxifen-associated endometrial polyps are unlikely to undergo further malignant transformation, and a mode of action of tamoxifen as an external carcinogen is unlikely.

Antineoplastic Agents, Hormonal↗
PubMed1998

[Mast cells in eosinophilic and neutrophilic nasal polyps. Cytological and histological examinations].

In 10 patients with nasal polyps mast cells were counted in smears and in polyp tissues. In smears from neutrophilic polyps (n = 4) no mast cells were found, in eosynophilic polyps (n = 6) mast cells were found on an average of 7.5%. Histological examinations showed that an average number of mast cells in the connective tissue was similar in both types of polyps. In the epithelial layer of neutrophilic polyps the number of mast cells was slightly greater than in eosynophilic polyps. In an atopic patient the number was 12 times greater than in the other cases. No dependence was found between the number of mast cells in smears and in the tissue.

Adult↗
PubMed1985

Extracolonic polyps in familial polyposis coli and Gardner's syndrome.

Endoscopy and biopsy of the upper gastrointestinal tract and terminal ileum were performed in 24 patients with familial polyposis or Gardner's syndrome in order to further define the incidence of extracolonic adenomatous polyps. Polyps, usually multiple and small in size, were detected in the gastric fundus (12.5 percent), antrum (29.1 percent), duodenum (66.6 percent), and terminal ileum (41.7 percent). Histology showed hyperplasia of the fundic glands and cystic dilatation in the polyps of gastric fundus, and adenomas in several cases of antral (three patients) or duodenal polyps (14 patients). Polyps of the terminal ileum were either adenomas (five patients) or lymphoid aggregates. Patients with stigmata of Gardner's syndrome, desmoids or mesenteric fibromatosis presented a major incidence of adenomas in the duodenum, but not in other parts of the digestive tract investigated. Subsequent checkup after an average of 33 months in ten patients revealed an increase of lesions only in the duodenum in two patients. These findings confirm that adenomatous polyps are not limited to the colon and rectum, as previously believed, but can affect the whole gastrointestinal tract. Periodic surveillance of mucosa seems to be indicated, especially for the duodenum, since degeneration of adenomas into carcinoma is possible.

Adolescent↗
PubMed1999

Decrease in serum levels of vitamin A and zeaxanthin in patients with colorectal polyp.

OBJECTIVE: Several retrospective and prospective epidemiological investigations have demonstrated that a diet rich in carotenoids could prevent the development of pre-cancerous and neoplastic lesions of the digestive tract. The aim of this examination was to analyse the correlation between colorectal polyps with different histological classifications and serum carotenoid levels. DESIGN AND METHODS: A 10 ml blood sample was taken from all of the patients after the colonoscopic diagnosis. The serum levels of vitamin A, lutein, zeaxanthin, alpha- and beta-cryptoxanthin, alpha- and beta-carotene were measured in patients with adenomatous colorectal polyp (n = 59, 35 males, 24 females) by high-pressure liquid chromatography (HPLC) and compared with those in healthy subjects (n = 20, 10 males, 10 females). The patients were separated into four groups depending on their histological findings. RESULTS: The serum levels of vitamin A and zeaxanthin were significantly lower in all patients with polyps (vitamin A: 0.913 +/- 0.112 micromol/l, zeaxanthin: 0.071 +/- 0.012 micromol/l) than in the control healthy group (vitamin A: 2.036 +/- 0.354 micromol/l, zeaxanthin: 0.138 +/- 0.048 micromol/l). The lowest levels were found in patients with focal adenocarcinoma in the polyp. There were no significant differences in the serum levels of other carotenoids. The serum levels of cholesterol, haemoglobin, total protein and albumin were normal in these patients. CONCLUSIONS: There are close and inverse correlations between the serum level of carotenoids and colorectal polyps with different histological grades. The low mean carotenoid levels in patients with adenocarcinoma in the polyp indicate that deficiency of carotenoids may be an important factor in the development of colorectal cancer.

Adenocarcinoma↗
PubMed2000

Family history of colorectal adenomatous polyps as a risk factor for colorectal cancer.

The aim of this study was to evaluate the risk of common colorectal cancer among first-degree relatives of patients with colorectal adenomatous polyps. In a population screening programme, 59406 subjects underwent an immunochemical faecal occult blood test. In a medical check-up-based cross-sectional study, 6139 subjects had a colonoscopic examination. They were divided into two groups, according to the results of a questionnaire on family history of colorectal adenomatous polyps, and the detection rates for colorectal cancer were compared in the groups positive or negative for a family history of colorectal adenomatous polyps. In the screening programme-based cross-sectional study, the detection rate for colorectal cancer was 0.57% (95% confidence interval (CI): 0.38-0.76) and 0.15% (95% CI: 0.12-0.18) in subjects with and without a family history of colorectal adenomatous polyps, respectively, showing a significant difference in the detection rate for colorectal cancer between the two groups (P<0.05). In the medical check-up-based cross-sectional study, the detection rate for colorectal cancer was 2.31% (95% CI: 1.15-3.47) and 0.53% (95% CI: 0. 34-0.72) in subjects with and without a family history of colorectal adenomatous polyps, respectively, indicating a significant difference between the two groups (P<0.05). These findings indicate that first-degree relatives of patients with colorectal adenomatous polyps have an elevated risk for common colorectal cancer, and that people with a family history of colorectal adenomatous polyps should be considered as a priority group for colorectal cancer screening.

Adenomatous Polyposis Coli↗