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PubMed1993

Small bowel tumors.

Small bowel tumors include adenocarcinomas, carcinoids, lymphomas, and sarcomas, as well as a variety of benign polyps, which should be excised to rule out malignancy. Although small bowel tumors are traditionally difficult to diagnose, a heightened index of suspicion should be combined with improved diagnostic techniques to increase yield and decrease delays in identification. The management of bioactive carcinoid tumors has rapidly advanced over the past year. Increasing experience with the stable somatostatin analogue octreotide has enabled regulation of hormonal secretion by these tumors both chronically and during acute "carcinoid crisis." In addition, early identification may be facilitated by the use of isotopically labeled variants of the compound. Although the development of sophisticated pharmacotherapeutic probes has improved the management of secretory small intestinal tumors, the prognosis for adenocarcinomas, lymphomas, and sarcomas still primarily reflects on the time of delay in diagnosis and awaits an improved understanding of the pathobiology of these malignant lesions.

Adenocarcinoma↗
PubMed1979

[Nephrogenic adenoma of the urinary bladder with concomitant multiple adenomatous polyps of the large bowel. An abortive form of Gardner's syndrome? (author's transl)].

For the first time, a nephrogenic adenoma of the urinary bladder coinciding with multiple adenomatous polyps of the large bowel, in a 64-year-old male, is reported. The relationship of these tumors at different sites to a known clinical systemic disease is questionable; they could conceivably be ascribed to an abortive form of Gardner's syndrome. On the basis of a case report, the essential aspects of the nephrogenic adenoma of the urinary bladder are reviewed and discussed.

Adenocarcinoma↗
PubMed1992

Neoplasia and hyperplasia of large bowel: focal lesions in an abnormal epithelium.

Expression of brush border hydrolases can reflect the state of differentiation of an epithelium. To determine if expression of these enzymes is disordered in patients with neoplastic or hyperplastic lesions, the activities of alkaline phosphatase, maltase, and dipeptidyl peptidase IV were measured spectrophotometrically in colonoscopic biopsies from the proximal and distal colon and rectum in 50 controls, 17 patients with large bowel adenomas, 29 with carcinoma, and 9 with hyperplastic polyps. In normal controls, a descending cecorectal gradient of alkaline phosphatase activities and an ascending gradient of maltase activities were seen (P < 0.001). Though regional patterns of expression were generally preserved in disease groups, there were significant differences of activities across patient groups for alkaline phosphatase (greater in cancer, adenoma, and hyperplastic groups than in normals; P < 0.05) and for dipeptidyl peptidase IV (greater in hyperplastic polyp group than normals, greater in adenoma than cancer group; P < 0.05). Compared with normal controls, abnormalities of site-specific activities were confined to the rectum in patients with adenoma (maltase decreased, P = 0.02; dipeptidyl peptidase IV increased, P < 0.01) or with carcinoma (alkaline phosphatase increased, P = 0.03) but dipeptidyl peptidase IV activities were increased in all regions in bowels bearing hyperplastic polyps (P < 0.01). These data suggest that neoplastic and hyperplastic lesions, while focal in nature, occur in large bowel epithelium, which is diffusely abnormal in terms of its expression of these enzymes.

Adenoma↗
PubMed1978

Recurrent small bowel obstruction caused by a benign tumor. A report of two cases.

Two cases of primary small bowel tumors causing an acute intussusception are presented. In one case two polyps were found and in the other case a lipoma in the wall of the jejunum. In both cases there were symptoms of recurrent bowel obstruction for several months before the acute condition. Although intussusception caused by a benign tumor of the small bowel is a rare condition it should be taken into consideration in the differential diagnosis of abdominal pain of doubtful origin.

Adult↗
PubMedDate not supplied

Gastrointestinal tissue diagnosis by laser-induced fluorescence spectroscopy at endoscopy.

An endoscope-compatible, optical fiber system has been developed which can be used to obtain laser-induced fluorescence spectra of mucosal abnormalities during endoscopy in real time. The results of our previous in vitro studies have suggested that laser-induced fluorescence tissue spectra are sufficiently unique that they can be used to accurately diagnose mucosal abnormalities in some systems. To test this hypothesis in vivo, laser-induced fluorescence spectra were obtained during colonoscopy from 31 colonic adenomas, 4 hyperplastic polyps, and 32 examples of normal mucosa in 20 patients. The resulting spectra could be used to correctly differentiate adenomas from normal colonic mucosa and hyperplastic polyps in 97% of the specimens studied with the resulting sensitivity, specificity, and positive predictive value of 100%, 97%, and 94%, respectively. These results, although preliminary in nature, suggest that laser-induced fluorescence spectra can be used in the recognition and differential diagnosis of mucosal abnormalities at endoscopy.

Adenoma↗
PubMed1993

Sex differences in the incidence of colorectal cancer: an exploration of oestrogen and progesterone receptors.

Sex differences exist in the site specific incidences of colorectal cancer. The increased incidence of colonic cancer in women with breast cancer and the protective effect of increasing parity suggest a role for sex hormones. To explore the molecular basis, the expression of messenger RNA for oestrogen and progesterone receptors in the large bowel has been studied. With northern and dot blot analyses mRNA coding for oestrogen receptor and progesterone receptor in large bowel cancers and corresponding normal mucosa and in adenomatous polyps has been identified. There were no significant differences in receptor mRNA concentrations between males and females or between cancers, normal mucosae, and polyps, except for rectal cancers, which had higher progesterone receptor concentrations than corresponding normal tissue. Oestrogen and progesterone receptor mRNA concentrations were strongly correlated in both cancers and normal tissues. Enzyme immunoassay for oestrogen receptor gave values of 1.2-7.4 fmol/mg total protein, an amount similar to that seen in normal breast tissue. Oestrogen receptor protein and mRNA for oestrogen receptor and progesterone receptor are present in the large bowel.

Adenocarcinoma↗
PubMed2005

Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes.

OBJECTIVES: At present, surveillance of premalignant small bowel polyps in hereditary polyposis syndromes has a number of limitations. Capsule endoscopy (CE) is a promising new method to endoscopically assess the entire length of the small bowel. METHODS: We prospectively examined 40 patients with hereditary polyposis syndromes (29 familial adenomatous polyposis (FAP), 11 Peutz-Jeghers syndrome (PJS)). Results were compared with push-enteroscopy (PE) results in FAP and with esophagogastroduodenoscopy, PE, (MR)-enteroclysis, and surgical specimen in PJS patients. RESULTS: A total of 76% of the patients with FAP with duodenal adenomas (n = 21) had additional adenomas in the proximal jejunum that could be detected by CE and PE. Moreover, 24% of these FAP patients had further polyps in the distal jejunum or ileum that could only be detected by CE. In contrast, in FAP patients without duodenal polyps (n = 8), jejunal or ileal polyps occurred rarely (12%). CE detected polyps in 10 of 11 patients with PJS, a rate superior to all other reference procedures employed. Importantly, the findings of CE had immediate impact on further clinical management in all PJS patients. CONCLUSIONS: Our results suggest that CE may be of clinical value in selected patients with FAP, whereas in PJS, CE could be used as first line surveillance procedure.

Adenomatous Polyposis Coli↗
PubMed1978

[Debatable and unclear questions concerning the morphogenesis of cancer of the large intestine and rectum].

The analysis of the pertinent literature shows that there is no reliable evidence on the essential importance of intestinal adenomatous polyps in carcinogenesis. The villous and glandular-villous tumours very often are considered to be highly malignant. However the growth pattern as well as histological, iltrastructural, histochemical, immunological, and other characteristics of villous tumours are close to those of adenocarcinomas. Therefore, villous tumours without invasion can be referred to as either carcinoma in situ of superficial cancer. The combination of experimental investigations and studies on human material indicates that colonic cancer prodeminantly develops de novo, that is, without preceeding morphological changes.

Adenocarcinoma↗
PubMedDate not supplied

Double versus single contrast gastrointestinal radiology.

With experience, air contrast examination of the esophagus, stomach, and duodenum can be performed routinely as quickly and easily as the standard UGI. The air contrast examination is superior for detection of small gastric polyps and the Japanese have found it superior for detection of early carcinoma. The postoperative stomach and the fundus and cardia are most easily examined by air contrast. Clear superiority in the diagnosis of peptic ulcers and peptic esophagitis has not been proved. The most accurate routine examination may be a multiphasic or combined approach utilizing air contrast views as well as filled compression views and careful fluoroscopy. With respect to the colon, we do not suggest that air contrast BE must be done exclusively. However, it is superior for the detection of polyps and small carcinomas. The technique should be available in all radiology departments and should be an integral part of the evaluation of patients at increased risk of developing carcinoma. This includes patients over 40 years of age, with chronic ulcerative colitis, familial multiple polyposis or Gardner's syndrome, family history of inherited cancer, and medical history of adenomatous polyps, colorectal cancer, or female genital cancer. In addition, air contrast enema should be utilized for the sensitive and accurate evaluation of early inflammatory bowel disease. Finally, with respect to the colon examination one fact must be stressed. Irregardless of full column or air contrast method, most missed lesions are due to poor bowel preparation, poor technique, or perceptive error by the radiologist. There can be no substitute for a clean colon, meticulous attention to technical details, and careful review of the radiographs.

Air↗
PubMed1984

Are metaplasias in colorectal adenomas truly metaplasias?

Five thousand seven hundred seventy-eight adenomas or adenomas containing carcinoma from 3215 patients were examined by routine histologic methods for the presence of epithelial metaplasias. Three forms of epithelial metaplasia were encountered: squamous cell metaplasia (0.44%), Paneth cell metaplasia (0.20%), and melanocytic metaplasia (0.017%). In several instances multiple forms of metaplasia were encountered in the same polyp. In those cases in which the paraffin blocks were available, a Grimelius stain was performed. Grimelius-positive cells were present in 63% of the adenomas containing a metaplastic cell type. All cases with Paneth cell differentiation were immunoreactive for lysozyme; all lesions containing areas of squamous differentiation were immunoreactive for keratin except 2. The histopathologic features of these cases are discussed, and it is concluded that rather than representing a true metaplastic process, Paneth cell, squamous cell, and melanocyte differentiation represent the full range of cellular differentiation that endodermally derived tissues can exhibit, particularly when they undergo neoplastic alterations.

Adenoma↗
PubMed2004

Prevalence of occult celiac disease in patients with iron-deficiency anemia: a prospective study.

BACKGROUND: Occult celiac disease has been reported in 0 to 6% of adults presenting with iron-deficiency anemia. Most prior studies have been retrospective or screened only a selected population of patients with small bowel biopsies. To more accurately define the true prevalence of this disorder in patients presenting with iron-deficiency anemia (with or without stool hemoccult positivity), we initiated this prospective study. METHODS: Esophagogastroduodenoscopy with small bowel biopsies and colonoscopy were performed in all iron-deficiency anemia patients (including those with hemoccult-positive stools) referred to the gastroenterology service during a 2-year period (1998-2000). Inclusion criteria included iron-deficiency anemia as defined by a serum ferritin < 25 ng/ml and anemia with hemoglobin < 12 g/dl. Patients were excluded for documented prior erosive, ulcerative, or malignant disease of the gastrointestinal tract, previous gastrointestinal surgery, overt gastrointestinal bleeding within the past 3 months, or inability to access the duodenum for biopsy. All patients underwent upper endoscopy with more than two biopsies of the distal duodenum and colonoscopy. A serum immunoglobulin A antiendomysial antibody test was to be performed in those patients with a positive small bowel biopsy to confirm the diagnosis of celiac disease. RESULTS: One hundred five of 139 consecutive patients with iron-deficiency anemia met the inclusion criteria and were enrolled in the study. Fifty-seven men (mean age, 51.6 yr) and 48 women (mean age, 54.1 yr) constituted the study population. The demographics of this study population included 36 blacks, 38 Hispanics, and 22 whites. Nine patients were of mixed or unknown ethnic background. Forty-three and eight-tenths percent of the men and 37.5% of women had hemoccult-positive stools, accounting for a total of 40.9% of the study patients. Upper endoscopic findings included gastritis in 22.8%, gastric ulcers in 9.5%, duodenitis in 8.5%, esophagitis in 7.6%, Barrett's ulcer in 2.8%, duodenal ulcer in 2.8%, gastric polyp in 2.8%, and celiac disease in 2.8%. Colonoscopic findings included colon polyps in 21.9%, diverticula in 10.4%, and hemorrhoids in 16.1%. Multiple findings were found in 32.3% of patients, and there were no findings in 28.5% of patients. CONCLUSION: The prevalence of occult celiac disease in this prospective study of patients presenting with iron-deficiency anemia was 2.8%. A significant number of other gastrointestinal lesions amenable to therapy were also found on upper and lower endoscopy in these patients. Given the treatable nature of celiac disease, it should be screened for in patients with unexplained iron-deficiency anemia with or without hemoccult-positive stools.

Anemia, Iron-Deficiency↗
PubMed2003

Bannayan-Riley-Ruvalcaba syndrome: further delineation of the phenotype and management of PTEN mutation-positive cases.

Bannayan-Riley-Ruvalcaba syndrome (BRRS) is characterised by macrocephaly, intestinal hamartomatous polyps, lipomas, pigmented maculae of the glans penis, developmental delay and mental retardation. The syndrome follows an autosomal dominant pattern of inheritance. In 1997 reports on two BRRS patients with a deletion at 10q23.2-q24.1 were published. In the same year, the first two families with BRRS and a mutation of the PTEN gene were reported. Mutations in the PTEN gene have also been demonstrated in patients with Cowden syndrome (CS), which shows partial clinical overlap with BRRS, and in families with cases both of BRRS and CS. PTEN mutation positive BRRS and CS are likely to be different phenotypic presentations of the same syndrome. If BRRS and CS are one single condition, the question arises whether patients with BRRS should be screened for malignant tumours, since patients with Cowden syndrome have an increased risk of breast, endometrial, thyroid and renal cancer. We present two isolated cases and one family and confirm that BRRS and CS are allelic. Furthermore, we review the PTEN mutation positive BRRS cases, to further delineate the phenotype and to compare the cases with a genomic deletion with the cases with a point mutation. We recommend offering BRRS cases with a mutation in PTEN the same surveillance protocol for (malignant) tumours as is currently recommended for CS. In addition, we propose a yearly haemoglobin test from early infancy for the early detection of intestinal hamartomas, which are likely to give severe complications, especially in BRRS cases.

Adult↗
PubMed1976

The precursor tissue of ordinary large bowel cancer.

Hyperplastic polyps are 10 times as common as adenomas and must be distinguished from them since they are unrelated as a precursor tissue to either adenomas or carcinomas. Only adenomas are relevant to the development of the common moderately and well-differentiated large bowel cancer. Depending on three related factors (increasing size, a sessile rather than pedunculated mode of growth, and a villous rather than tubular microscopic architecture), one may find minute (1 to 2-mm) or microcancer with increasing frequency in adenomas. However, despite unlimited opportunity to do so, minute or microcancer has not been observed in normal mucosa, i.e., unassociated with adenomatous tissue. The same findings obtain in familial polyposis. In this condition, in grossly normal areas of mucosa, adenomas (but not carcinomas) as small as one or two crypts have been found. Direct one-step transformation from normal crypt cells to cancer, without formation of adenomatous epithelium, does not seem to be the usual pathway.

Adenoma↗
PubMed1997

A sigmoidoscopy-based case-control study of polyps: macronutrients, fiber and meat consumption.

We conducted a large, sigmoidoscopy-based case-control study to examine the relation of intake of macronutrients, meat, and fiber to occurrence of adenomas of the large bowel. Cases were subjects diagnosed for the first time with one or more histologically confirmed adenomas. Controls had no polyps of any type at sigmoidoscopy, had no history of polyps, and were individually matched to cases by gender, age, date of sigmoidoscopy, and Kaiser Center. The response rate was 84% for cases and 82% for controls. Complete dietary data for 488 matched pairs were available. All odds ratios are from matched analyses adjusted for energy. We observed positive associations with risk of adenomas for calories, animal fat, saturated fat, red meat, and the ratio of red meat to poultry and fish. Protective effects were observed for vegetable protein, carbohydrates, and dietary fiber. The fiber effects diminished after adjusting for fruits and vegetables. Results after mutually adjusting for the effects of saturated fat, fiber and the ratio of red meat to chicken and fish suggest that each of these variables has an effect on risk of adenomas that is independent of the other 2 exposures.

Aged↗
PubMed1986

Generalized juvenile polyposis coli. Clinical management based on long-term observations.

Generalized juvenile polyposis occurred in five patients (age range, 18 months to 16 years). Clinical findings included abdominal pain, weakness, rectal bleeding, diarrhea, rectal prolapse, intussusception, clubbing, and failure to thrive. Laboratory findings included anemia, hypoalbuminemia, hypokalemia, and skin test anergy. Diagnosis is achieved by double contrast enema, endoscopy, and biopsy. Unlike patients with solitary juvenile polyps, patients with generalized involvement require surgical intervention. Subtotal colectomy and ileoproctostomy are the procedures of choice, and we performed them in four cases. An ileoanal-endorectal pull-through procedure was required in one patient with continued rectal disease. All five patients are currently alive and well. Long-term follow-up is important as polyps may persist into adult life. Family members are at risk for developing gastrointestinal tract tumors and should be screened.

Adolescent↗
PubMed1985

Tissue CEA detection by immunoperoxidase (PAP) test in colorectal polyps: correlations with the degree of dysplasia.

We study the presence of Carcinoembryonic antigen (CEA) on 39 colorectal polyps by the immunoperoxidase technique. The histological examination demonstrated 15 tubular adenomas, one villous adenoma, two tubulo-villous adenomas, six tubular adenomas with slight dysplasia, one tubular adenoma with moderate dysplasia, four tubular adenomas with severe dysplasia, three tubulo-villous adenomas with severe dysplasia, five tubular adenomas with neoplastic degeneration, and two tubulo-villous adenomas with neoplastic degeneration. Twenty-eight of thirty-nine polyps (71.79%) showed a positive staining reaction for CEA. Regarding the intensity of the reaction (classified as absent or negative [-], slightly positive [+], and markedly positive [+ +]), 11/39 polyps presented a negative reaction (28.21%), 19/39 (48.71%) presented a slight reaction, and 10/39 polyps (25.64%) presented a marked reaction. Results demonstrated a higher intensity of the staining reaction in severely dysplastic polyps and in neoplastic degeneration. In conclusion, it is possible that the presence of CEA can be useful to show an initial cellular restlessness of certain polyps.

Adenoma↗
PubMed1993

Clinical significance of diminutive polyps of the rectum and sigmoid colon.

A retrospective review of 637 consecutive colonoscopies with polypectomy in 526 patients was performed to determine the association of small polyps of the rectum and sigmoid colon with more proximal colonic neoplasms. All colonic polyps were proximal to the sigmoid colon in 117 procedures. Proximal neoplasms were found in 32 percent of patients with a single polyp in the rectum or sigmoid colon. The incidence increased to 83 percent for those with three or more polyps. The occurrence of proximal colonic neoplasms was not affected by the size or histologic type of the rectosigmoid polyps. These findings would suggest that total colonic evaluation be considered in all patients with a polyp in the rectum or sigmoid colon regardless of the size or histologic type of the polyp.

Adenoma↗
PubMed1994

Simple method for polyp retrieval during colonoscopy.

Retrieval of small polyps can often be frustrating for the skilled endoscopist. We introduce a technique of polyp retrieval that is simple and effective in yielding intact specimens for accurate pathologic examination.

Biopsy↗