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Benign fibroblastic polyp of the colorectum.

GOALS: We present the clinicopathologic features, endoscopic appearance, and ultrastructure of a newly described mesenchymal polyp of the colorectum, termed benign fibroblastic polyp. STUDY: A total of 4 cases from our institution are analyzed using routine histopathology, immunohistochemistry, and electron microscopy, and compared with the original series of 14 cases previously described in the pathology literature. RESULTS: Benign fibroblastic polyps appear endoscopically throughout the colorectum as submucosal lesions with a hyperplastic surface component. These lesions are histologically and ultrastructurally distinct, but overlap with other mesenchymal polyps warrants additional immunohistochemical studies for definitive classification. CONCLUSIONS: Benign fibroblastic polyps of the colorectum comprise a recently described distinct entity of mesenchymal polyps that appear to follow an indolent clinical course. Their etiology is uncertain but may be linked to an exuberant tissue response following mucosal injury. Gastroenterologists should be aware of this new entity that will be increasingly diagnosed by pathologists.

Actins↗

Colorectal juvenile polyps: an epidemiological and histopathological study of 144 cases in Jordanians.

The minimal incidence rate of colorectal juvenile polyps in Jordanians was 1.4 per 100 000 in the general population and 2.8 per 100 000 in children under 10 years of age. Out of 144 cases, nine had two to seven polyps and one juvenile polyposis coli. There was male preponderance and a mean age of 8 years: 96.5% of the polyps were in the rectum. Characteristically, stromal oedema, inflammation, ulceration with granulation tissue cap formation and gland regeneration were present. Epithelial hyperplasia was not uncommon and focal dysplastic change was occasionally noted, being always accompanied by hyperplastic change. Focal severe dysplasia was seen in one solitary juvenile polyp. It is concluded that varying degrees of focal epithelial atypia can occasionally develop in solitary juvenile polyps, rarely reaching severe dysplastic change. Malignant transformation in the commonly seen form of juvenile polyp (solitary type) is probably a rare phenomenon, but its frequency needs further evaluation.

Adolescent↗

Choanal and angiomatous polyps of the sinonasal tract.

Choanal and angiomatous polyps can be distinguished from ordinary sinonasal polyps by either a distinctive clinical presentation (choanal) or the histopathologic appearance (angiomatous). Nearly all choanal polyps arise within paranasal sinuses, with the antrochoanal polyp the most common. The angiomatous polyp is most often a secondary change in a choanal polyp and can be mistaken for vascular neoplasms, eg, angiofibroma.

Hemangioma↗

Formation of mucosal polyps in the nasal and maxillary sinus cavities by infection.

Unilateral maxillary sinusitis was experimentally induced in New Zealand White rabbits with Streptococcus pneumoniae serotype 3, Bacteroides fragilis NCTC 9343, and Staphylococcus aureus V8. In another group of rabbits, sinusitis was induced by blocking of the sinus ostium only. Bacteriologic and light microscopic analysis was performed after 5 days to 1 month. Granulation-like polyps developed after deep mucosal inflammatory trauma initiating fibroblast proliferation, angiogenesis, and epithelial migration to cover the polyp. In regions of a more superficial trauma-characterized by epithelial desquamation and fibroblast growth-proliferation and differentiation of basal cells resulted in the formation of microcavities dissecting off edematous polyps. Polyps could be found in all sinusitis groups, irrespective of inducing agent. The cellular events of polyp formation appear to be the result of a continuous inflammatory reaction and are not directly related to the presence of a certain microorganism. Instead, the potential of any microorganism to induce a deep mucosal trauma or epithelial desquamation seems essential for its ability to initiate polyp formation.

Animals↗

Selenium, copper, and zinc concentrations in intestinal cancer tissue and in colon and rectum polyps.

The prospective randomized trial was used to determine Se, Zn, and Cu concentrations in intestinal cancer tissue and colorectal polyp. We also determined the relationship among the trace element levels in cancer tissue, the localization of neoplasms, and the stage of their development. The concentrations of these trace elements were examined in cancer tissue of the colorectum in 67 patients and in the colon and rectum polyps in 42 patients using the total-reflection X-ray fluorescence (TRXRF) method. The mean concentration of Se in colorectal cancer was 0.86 microg/g tissue and was statistically higher than in the case of polyps (0.57 microg/g). The mean concentration of Zn in colorectal cancer was higher than in the polyp (14.8 microg/g and 9.84 microg/g, respectively). The determined average concentration of Cu in colorectal cancer was 3.87 microg/g tissue and was a little lower than the level of this metal in the polyp (3.94 microg/g). There was no difference in the levels of these trace elements depending on the location of the neoplasm and the stage of its development. Also, there was no difference between the concentrations of these trace elements in the cancer tissue of malignant and benign tumors after taking into consideration the sex and age of patients. During the examination, we determined significantly higher concentrations of only selenium and zinc in the cancer tissue and not in the polyp. The level of copper was lower in a malignant tumor than in a benign one.

Adult↗

Relationships between cigarette smoking, alcohol drinking, the ALDH2 genotype and adenomatous types of colorectal polyps in male self-defense force officials.

Alcohol drinking as well as cigarette smoking has been associated with development of colorectal polyps, Asians such, as Japanese, Chinese and Korean have high frequency of genetic polymorphism in low Km aldehyde dehydrogenase (ALDH2) gene which greatly regulates alcohol intake. In the present study, we investigated associations of this polymorphism and lifestyles with colorectal polyps in self-defense forces personnels in Japan. All subjects received colonoscopy at a retirement health examination. The ALDH2 genotype was determined using polymerase chain reaction and restriction fragment length polymorphism method. Frequency of the ALDH2 genotype was not different between those with colorectal polyps (n=69) and those without the polyps (n=131). Smoking was associated with development of colorectal polyps (OR=4.7, 95% confidence interval=1.9-11.5) in the ALDH2 proficient genotype. The association appeared to be enhanced by drinking alcohol since a synergistic effect of smoking and alcohol drinking (> or =60 ml/day) was indicated (OR=9.9, 95% confidence interval=2.9-34.1) by logistic regression analysis. In the ALDH2 deficient genotype, however, we could not evaluate interactions of smoking and alcohol drinking on colorectal polyp development because of the small sample size of heavy alcohol drinkers. The genotype analysis would be useful in evaluating effects of environmental factors on outcomes for each genetically defined subpopulation.

Adenomatous Polyps↗

Histologic structure of antrochoanal polyps.

The antrochonanal polyp (ACP) is defined as a maxillary sinus polyp that originates in the maxillary sinus, passes through the sinus ostia, and extends into the choana. The aim of this study was to compare the histologic findings of 40 cases of ACP with those of allergic and non-allergic nasal polyps, and so possibly to elucidate the pathogenesis of ACP. No allergy could be verified in any of the ACP patients. Inflammatory cell infiltration was significantly more severe in the ACP group than in the allergic polyp group. Eosinophilic infiltration was significantly less severe in the ACP group than in the allergic polyp group. Edema was not significantly different between the ACP, allergic, and non-allergic groups. In the ACP group, the presence of submucous glands was significantly less pronounced than in the ordinary nasal polyp groups. The fibrous type was present significantly more often than the infiltrative or granulating type in the ACP group. The histologic findings and clinical features of the ACP indicate that it has little causal relationship with nasal allergy but is all the more intimately associated with inflammatory processes. The paucity of submucous glands suggests that the ACP results from edematous hypertrophy of the respiratory epithelium rather than from distension of the glandular structures.

Adolescent↗

Epidemiology of polyps in the rectum and sigmoid colon. Discriminant analysis for identification of individuals at risk of developing colorectal neoplasia.

In an endoscopic population screening examination for detection of colorectal polyps among 324 men and women aged 50-59 years, adenomas greater than or equal to 5 mm in diameter were found in 38 individuals, and 212 were polyp-free. Dietary registration was performed by 155 individuals on a case/control basis. At 2 years' follow-up study polyps less than 5 mm in diameter were also removed. This rendered a total of 39 adenoma patients and 59 polyp-free individuals available for a combined analysis of both case history and dietary information. Application of a linear discriminant model on the combined clinical and dietary information enabled us to select a possible set of variables to characterize 88 out of 98 individuals (90%) correctly as adenoma patients or polyp-free individuals. However, when only case history information was used for the total material of 38 adenoma patients and 212 polyp-free individuals, only 189 out of 250 individuals (76%) were correctly classified. Although age, smoking habits, and a family history of colorectal cancer appeared as useful variables in the discriminant function, this study demonstrated the importance of nutritional factors in characterization of adenoma patients in the present age group of 50-59 years. In the present study we could not find any set of case history information which could indicate the usefulness of a questionnaire-based 'pre-screening' to guide recommendations for endoscopic screening examination.

Colonic Polyps↗

Polymorphisms in PTGS1 (=COX-1) and risk of colorectal polyps.

Two isoforms of prostaglandin H synthase (PTGS = COX) are key enzymes in prostaglandin synthesis and primary targets for aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Use of aspirin or other NSAIDs is associated with a lower risk and reduced recurrence of colorectal adenomas, established precursors of adenocarcinoma. This study investigated risk of colorectal adenomatous and hyperplastic polyps associated with several polymorphisms in the coding region of PTGS1. Within the Minnesota polyp case-control study, patients with colorectal adenomatous (n = 521) or hyperplastic (n = 194) polyps and n = 621 polyp-free controls were genotyped for four PTGS1 polymorphisms (R8W, L15-L16del, P17L, L237M); these had been predicted to affect protein function based on sequence-homology software. Age- and sex-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed. Whereas there was no appreciable difference in adenoma or hyperplastic polyp risk associated with R8W, P17L, and L237M, an increased risk was observed for individuals heterozygous for the L15-L16del polymorphism (OR = 3.6, 95% CI 1.2-11.2). The variant L15-L16del allele appeared to be associated with a stronger increase in adenoma risk among nonusers of aspirin/other NSAIDs. The reduced risk observed with aspirin/other NSAID use was limited to those wild type for P17L [PP users: OR = 0.6 (0.5-0.8) versus PP nonusers: 1.0 (referent) (P interaction = 0.03)]. To our knowledge, this study represents the first investigation of polymorphisms in PTGS1 and risk of colorectal polyps. The L15-L16del variant allele may result in an increased risk of colorectal adenomas, whereas P17L may be relevant to the pharmacogenetics of aspirin. These preliminary findings require confirmation in larger studies of colorectal neoplasia.

Adenomatous Polyps↗

[Endoscopic treatment of colorectal polyps in a digestive endoscopy outpatient department].

The aim of this report was to evaluate the effectiveness of the endoscopic treatment of colonic polyps to allow secondary prophylaxis in order to prevent the onset of cancer arising from adenomas. From October 2002 to January 2004 we performed 487 colonoscopies on a patient group with the following indications: screening prior to kidney transplant; screening for colorectal cancer (patients positive at faecal occult blood testing); follow-up of patients who had undergone colonic resections for colorectal cancer; patients with other diseases. Colorectal polyps were diagnosed in 15 males and 15 females, with a mean age of 63 years. All the neoplasms were resected during colonoscopy and specimens sent for histological study. The histological examinations yielded the following results: 4 hyperplastic polyps; 9 tubular adenomas (6 with mild, 2 with mild-to-moderate, and 1 with severe dysplasia); 8 tubulo-villous adenomas (3 with mild, 1 with mild-to-moderate, and 4 with moderate dysplasia); 4 villous adenomas (3 with mild and 1 with severe dysplasia); 1 adenocarcinoma; 1 inflammatory polyp; in 3 cases we were unable to retrieve the polyps after polypectomy. Colonoscopic detection of a neoplasm allows us to remove it and send to the pathology laboratory for definitive histological diagnosis. Moreover, snare polypectomy can be a radical treatment for dysplastic polyps without stromal axis and basal membrane infiltration. We therefore conclude that colonoscopy allows not only early diagnosis of colonic neoplasms, but also radical curative treatment in the early stages.

Ambulatory Surgical Procedures↗

[The association of obesity and left colonic adenomatous polyps in Korean adult men].

OBJECTIVES: We wanted to evaluate the relationship between obesity and left colonic adenomatous polyps in Korean adult men. METHODS: This study was conducted among 575 adults men (aged between 40 and 69), who had colonoscopy done from January to December 2002 during a routine health examination at Health Promotion Center, Ulsan University Hospital. The patients' colons were examined up to splenic flexure by using fiberoptic colonoscopy. A questionnaire survey on behavioral factors and physical measurements were also done. The body mass index (BMI) and waist-hip ratio (WHR) were used as the indices of obesity. The BMI was categorized into three levels: normal (BMI < or = 22.9), overweight (23 < or = BMI < or = 24.9), and obese (BMI > or = 25.0). The WHR was categorized into four levels with cut-off points at the 30th, 60th, and 90th percentile of the control group. Age, education, smoking, alcohol use and exercise were controlled for by performing multiple logistic regression analysis. RESULTS: There were 99 cases of colonic adenomatous polyps. Four hundred seventy six subjects with normal colonoscopy findings served as the control. The BMI and WHR were associated with the adenomatous polyps (odds ratio, 1.81 [95% CI=1.02-3.19] for a BMI > or = 25.0 as compared with a BMI < or = 22.9, odds ratio, 3.94 [95% CI = 1.77-8.77] for a WHR > or = 0.95 as compared with a WHR < or = 0.86). The BMI was not associated with the risk of adenomatous polyps after additional adjustment was made for the WHR, but the association between the WHR and adenomatous polyps was still positive and independent of the BMI (odds ratio, 4.15 [95% CI=1.63-10.59]). CONCLUSIONS: The results support that obesity, and particularly abdominal obesity, can be associated with an increased risk of incurring colonic adenomatous polyps.

Adenomatous Polyps↗

A retrospective study of colonic polyps in King Chulalongkorn Memorial Hospital.

To evaluate and classify polyps from colon in Thai patients, the authors retrospectively analyzed the 776 polyps from 696 subjects in King Chulalongkorn Memorial Hospital during the past five-year period from 1999 to 2003. All colonic polyps were included in the study. There were 461 (59%) male and 315 (410%) female with the mean age of 51 years. Non-neoplastic and neoplastic polyps were documented 50% each. Hyperplastic polyp was the most frequent diagnosis (39%), followed by tubular adenoma (36%). According to neoplastic polyp, 8%, 3%, and 14% cases were identified as high-grade dysplastic change, intramucosal carcinoma, and invasive carcinoma, respectively.

Adenomatous Polyps↗

[Determination of cell nuclear DNA content in polyps and cancerous degeneration in the large intestine].

Nuclear DNA content was measured by microspectrophotometry in 40 biopsy specimens from patients with large bowel polyps (10 juvenile polyps and inflammatory polyps, 25 adenoma subdivided into 3 groups with 10 Grade I, 10 Grade II and 5 Grade III, 5 cancerous degeneration), and 5 normal epithelium of large intestine. The mean DNA value increased steadily as follows: normal epithelium of intestine (13.54 +/- 1.76 Au); juvenile polyps and inflammatory polyps (14.89 +/- 0.40 Au); adenoma Grade III (21.96 +/- 0.92 Au); cancerous degeneration (24.47 +/- 1.48 Au). The difference in DNA value in these groups was statistically significant (P less than 0.05-0.01). These results suggest that measurement of nuclear DNA content may serve as an objective quantitative parameter for diagnosis of large bowel carcinomatous change of polyps and classification of polypoid adenomas.

Adenoma↗

[Ambulatory treatment of patients with malignant polyps of the distal parts of the large intestine].

The article deals with the evaluation of treatment of polyps which had undergone malignant degeneration and polypoid carcinoma of the sigmoid and rectum in immediate and late-term follow-up periods. There were 106 patients under observation. Histological study revealed adenocarcinoma in 19 patients, lymphosarcoma in one patients, and malignant degeneration of polyps in the remaining patients. The polyp was located in the rectum in 86 and in the sigmoid colon in 20 patients. The polyps were removed in most cases through a transanal approach in out-patient clinics. The polyp recurred only in 2 cases 6 and 12 months after removal. Timely recognition and removal of malignant polyps of the rectum and sigmoid colon can be achieved in any outpatient clinic and do not need any complex medical equipment, are not attended by complications, and leads to radical cure of the patient.

Adult↗

[Myocardial infarction and rectocolonic polyps].

The prevalence of polyps in the rectum and sigmoid colon was estimated in 103 patients with recent myocardial infarction and 200 controls. All patients were asymptomatic and older than 35 years. A flexible proctosigmoidoscopy was performed. One or more adenomatous polyps were found in 19.6 p. 100 of patients with myocardial infarction and in 16.2 p. 100 of controls (difference not statistically significant). In males, the odds ratio for adenomatous polyps was 0.92 (confidence limits, 0.43-1.93). Acceptability of the flexible rectosigmoidoscopy was excellent in controls and poor in patients with myocardial infarction (1.0 p. 100 and 26.4 p. 100 of patients respectively refused this procedure). Tolerance, bowel preparation and the length of the explored rectosigmoid were not different. There was no statistically significant difference in the site, number or size of polyps. This study shows a high prevalence of polyps in patients with myocardial infarction and control groups although not statistically different. Consequently, a screening procedure for polyps is not indicated in patients with myocardial infarction.

Adult↗

Unscheduled DNA synthesis in mononuclear leukocytes from patients with colorectal polyps.

The mononuclear leukocytes from peripheral blood samples of individuals with (n = 30) and without (n = 48) colonic polyps were examined for their abilities to carry out unscheduled DNA synthesis (UDS) induced by N-acetoxy-N-2-fluorenylacetamide (N-AcO-2-FAA). Individuals with polyps had significantly reduced UDS values compared to the nonpolyp group (P less than 0.01). Furthermore, in a more comprehensive study, patients with hyperplastic polyps had N-AcO-2-FAA-induced UDS values not significantly different from control individuals who were asymptomatic and free from colonic disease as judged by complete colonoscopy. However, patients who had had adenomatous polyps in their large bowel had significantly reduced levels of N-AcO-2-FAA-induced UDS in their mononuclear leukocytes (P less than 0.005). When N-AcO-2-FAA binding to DNA determinations were made in parallel and DNA repair proficiency indices were calculated (i.e., N-AcO-2-FAA-induced UDS/N-AcO-2-FAA binding to DNA), the patients with adenomatous polyps were still shown to be deficient in carrying out DNA repair synthesis. Since adenomatous polyps of the large bowel are considered the premalignant lesion for colorectal cancer, we postulate that reduced UDS may be a genetically sensitive marker that is useful in studying the mechanisms of genetic predisposition to colorectal cancer.

Acetoxyacetylaminofluorene↗

[Surgical tactics in small polyps in patients with polyposis of the large intestine].

Experience with the treatment of patients with multiple polyps of the colon is analyzed. They had large polyps and polyps with the diameter not more than 0,5 cm. The findings of morphological examination of such polyps and results of the dispensary observation of patients with non-ablated small polyps are described. A conclusion is made of the expediency of more active surgical tactics in relation to polyps less than 0,5 cm in diameter in this group of patients.

Adenoma↗

[The malignancy potential of colorectal polyps--histomorphometric, histochemical and immunohistochemical study of the dysplasia-carcinoma sequence].

Colorectal polyps are usually diagnosed endoscopically and are simultaneously removed. Since adenomatous polyps tend to become malignant, these deserve special attention. In order to prevent carcinomas arising from pre existing adenomas, a precise analysis of the lesions in the mucous membrane of the polyps with regard to their malignancy potential is very important. Morphometric methods and determination of proliferation kinetics enable the dignity of a neoplasia to be assessed. Sporadic colorectal polyps were examined to what extent the morphometric analysis of nuclear area, the silver staining of nucleolar organizer regions (AgNORs) and the immunohistochemical staining of the Ki67 antigen permit further differentiation of the growth pattern of the tumor. Tissue from 50 hyperplastic polyps, 50 tubular and 50 tubulovillous adenomas was endoscopically removed and investigated, whereas pure villous adenomas were not examined due to their relative infrequency. These tissues were compared with biopsies of normal colonic mucosa and also with invasive adenocarcinomas. The Ki67 score shows that the proliferative activity is not significantly different between normal colonic mucosa and hyperplastic polyps, however there is a noticeable difference between the proliferation of the former types and colorectal neoplasias. The staining of the NORs does not reveal differences between the various grades of dysplasia in the adenomas, and therefore proves to be inadequate for differentiation, whereas morphometric and immunohistochemical measurements reveal appreciable selectivity. No correlation is observed between the parameters from the morphometric, histochemical and immunohistochemical analysis. Using the methods mentioned above the dysplasia-carcinoma-sequence can be clearly differentiated, however the validity of the different measurements is very variable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗