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PubMed1986

The spectrum of urinary tract fibroepithelial polyps in children.

A fibroepithelial polyp is a benign neoplasm that occurs throughout the urinary tract. In children less than 18 years old only 12 cases of upper tract polyps have been reported. We report 2 additional pediatric cases of upper tract fibroepithelial polyps and a rare case of a fibroepithelial polyp in the bladder. At 2 to 7-year followup there has been no recurrence or further development of the polyps. A benign natural history and conservative therapy should be emphasized when fibroepithelial polyps of the upper or lower urinary tracts are encountered in children.

Adolescent↗
PubMed1986

Colorectal polyps and the risk of subsequent carcinoma.

Of 323 patients with colorectal polyps that either were larger than 1 cm in diameter or were 1 cm or smaller but had been subjected to biopsy or excision, 20 (6%) had subsequent development of a colorectal carcinoma, an incidence rate of 4.6 per 1,000 person-years of follow-up. These 20 cases of cancer compared with 7.38 cases expected; thus, the risk of colorectal carcinoma in these patients was 2.7 times that in the general population (P less than 0.001). Although risks were greater for certain subgroups of patients, the differences detected were usually modest. We conclude that patients with large colorectal polyps (more than 1 cm in diameter) should be closely followed up after treatment of the initial polyp, regardless of the size, site, or histologic type of the polyp, the age or sex of the patient, or the type of initial treatment (excision or fulguration). Those patients with more than one polyp, especially if more than one segment of the colon is involved, need special attention. Examination of the entire colon is important because the site of development of carcinoma may be distant from the site of the initial polyp.

Actuarial Analysis↗
PubMed1979

Epithelial polyps of the large bowel: a pathological and colonoscopic study.

Ninety patients who had epithelial polyps or carcinoma of the large bowel and underwent at least 2 colonscopic examinations were studied. The cases were divided into three groups: patients who ;ad only one polyp; those in whom more than one epithelial polyp were found and those who had adenocarcinoma of the large bowel and underwent follow-up colonoscopic examinations. The distribution of the polpys was plotted as to type and distribution in the colon. There seemed to be a trend for the polyp found in follow-up examinations to be located proximal to the splenic flexure. In this regard it was noted that the subsequently found polyps in group II were smaller than those removed on the initial colonoscopic examination. No relationship could be found between any histologic type of epithelial polyp and the presence of carcinoma.

Adenocarcinoma↗
PubMed2000

Intractable pediatric chronic sinusitis with antrochoanal polyp.

It has been reported that pediatric chronic sinusitis with antrochoanal polyp is difficult to cure because it tends to recur easily even with surgery. Therefore, in order to improve its cure rate, aggressive treatment combining polypectomy, intra-maxillary intubation through the inferior meatus, macrolide administration, etc., was attempted. Thirty-seven sides of pediatric chronic sinusitis with antrochoanal polyp and 44 sides of chronic sinusitis without polyp were evaluated after the same treatments. The mean age of patients was 9.7 years, and the mean intubation period was 20 months. Since subjective improvements in children are questionable, the efficacy was evaluated strictly on the basis of X-ray alone focusing on the maxillary sinus. Twenty-four percent of the group with antrochoanal polyp showed 'excellent' effect, i.e. almost complete resolution of the sinus findings, while 45% of the group without polyp showed 'excellent' effect, with a mean follow-up period of 3 years and 6 months. This difference was significant (P<0. 01, chi(2)-test). These results further document the intractableness of chronic sinusitis with choanal polyp in children.

Adolescent↗
PubMed2003

Expression of inducible nitric oxide synthase in antrochoanal polyps.

OBJECTIVE: Antrochoanal polyp (ACP) is a polypoid lesion originating from the maxillary sinus, emerging from the ostium and extending to the choana. Although the etiologic causes of ACP are not known completely, it presents a fairly uniform clinical appearance. Nitric oxide (NO) has an important role in non-specific immunoreactions and inflammation in various tissues and has a main regulatory role in airway function and seems to involve in pathomechanism of several respiratory system diseases. NO is synthesized by the effect of three isoforms of nitric oxide synthase i.e. inducible NOS (iNOS). Some studies revealed that ACP has some different characteristics from the ordinary nasal polyps. In the present study, in order to compare ACP with allergic and non-allergic nasal polyps (NANP), we detected and localized the iNOS expression and also evaluate some histological parameters. METHODS: Twenty-six cases were chosen from the files and four controls were used. The cases were separated as follows: normal inferior turbinate mucosa as control (n=4) ACPs (n=8), allergic nasal polyps (ANP) (n=9), and NANP (n=9). Five-micrometer thick sections were prepared from the paraffin sections of polyps and normal nasal mucosa to quantify the iNOS expression. iNOS protein was observed in the cytoplasm of epithelial and stromal inflammatory cells. iNOS protein expression in the groups was assessed according to the intensity of staining and histomorphological parameters, oedema, lymphocytic and eosinophilic cell infiltration were detected semi quantitatively. RESULTS: iNOS expressions, either stromal or epithelial, were not different from each other among the four groups. Although it is not statistically significant, we noted that ANP and ACP frequently showed moderate and severe iNOS protein expression in epithelial and stromal parts when compared with NANPs and controls. Also, iNOS expression was significantly higher in the stroma of the ANPs than NANPs (P=0.012). CONCLUSIONS: ACPs and ANPs have frequently showed moderate and significant epithelial and stromal iNOS expression. Further studies are needed in large groups to elucidate differences between ACP and the other nasal polyps.

Epithelium↗
PubMed2001

[Fibroepithelial polyp of the urethra in a young woman].

OBJECTIVE: We present the case of a fibroepithelial polyp from the uretra of a young female, analysing the factors that make this an interesting case. MATERIAL AND METHODS: A case-report of a fibrous polyp from the urethra of a young female, an analysis of its differential diagnosis and a review of the literature. RESULTS AND CONCLUSIONS: The fibrous polyp of the urethra (fibroepithelual polyp, simple polyp, pedunculated polyp) is a rare benign epithelial tumour, more frequently encountered in males and in the posterior urethra. When it appears in females it is usually located in the external meatus and normally asymptomatic, although it can also present with a mictional syndrome, terminal hematuria or urethral hemorrhage. The differential diagnosis includes other benign epithelial tumours of the urethra, such as the caruncula, mainly the granulomatous, very difficult to differentiate, the squamous papilloma and the acuminated chondiloma. A clinical examination and histological study are necessary for a correct diagnosis, and treatment consists of surgical resection.

Adult↗
PubMed2003

Uterine cavity matrix metalloproteinases and cytokines in patients with leiomyoma, adenomyosis or endometrial polyp.

OBJECTIVE: To determine whether leiomyoma, adenomyosis and endometrial polyps are associated with changes in uterine cavity matrix metalloproteinases (MMP-2 and MMP-9) and cytokines. STUDY DESIGN: Uterine cavity irrigation was performed in women with leiomyoma, adenomyosis and endometrial polyps, and in women with a normal uterus. MMP-2 and MMP-9 were assayed in the uterine washings by gelatin zymography. For individual subjects, the total MMP level was obtained by adding the semi-quantitative scores of band densities related to gelatinases in the zymograms. Interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma) and transforming growth factor-beta1 (TGF-beta1) were measured using enzyme-linked immunosorbant assay (ELISA) kits. RESULTS: The uterine cavity of patients with leiomyoma, adenomyosis and endometrial polyps had significantly higher MMP scores than controls. Although the mean IL-1beta levels were elevated in uteri harboring a pathology compared with the normal uteri, the cytokine was significantly elevated only in the adenomyotic group. Significantly elevated levels of IFN-gamma were found in uteri with leiomyoma and endometrial polyps. Uterine washings from leiomyoma and adenomyosis contained significantly elevated mean levels of TGF-beta1 compared with controls, while TNF-alpha was significantly higher only in leiomyoma. When uterine cytokine levels were compared in relation to individual MMP levels a significant relationship was found between TGF-beta1 and elevated levels of MMP-9 and total MMPs in leiomyoma. A significant relationship was also found between IL-1beta and elevated levels of MMP-2, MMP-9 and total MMPs in the endometrial polyp group. CONCLUSION: The uterine cavity in leiomyoma, adenomyosis and endometrial polyps contains elevated levels of MMPs and cytokines compared with the normal uterus. In some pathologies elevated cytokines are associated with elevated MMPs.

Cytokines↗
PubMed2001

Proliferation profile of endometrial polyps in post-menopausal women.

OBJECTIVE: To determine whether or not the presence of c-erbB2 over-expression in endometrial polyps affects the percentage of cells positive for Ki-67 proliferation marker. METHODS: Thirty-five patients with endometrial polyps were submitted to polypectomy by hysteroscopy. Ki-67 and c-erbB2 over-expression were investigated in the polyps by immunohistochemistry. RESULTS: The presence of c-erbB2 over-expression by immunohistochemistry was observed in 80% of endometrial polyps and was associated with higher proliferation rates as determined by the number of positive Ki-67 cell nuclei. In c-erbB2-negative polyps, the proliferation rates were low. CONCLUSION: Ki-67 and c-erbB2 over-expression are frequent in endometrial polyps in post-menopausal women.

Aged↗
PubMed2000

Expression of RANTES by IL-1 beta and TNF-alpha stimulated nasal polyp fibroblasts.

OBJECTIVE: Accumulation of eosinophils (Eo) is one of the most characteristic feature of nasal polyps. However, the question remains why eosinophils accumulate into the nasal polyp tissue. RANTES (regulated upon activation, normal T cell expressed and presumably secreted) is a recently described chemokine that is said to play a role in the recruitment of eosinophils into inflammatory tissue sites. Fibroblasts are a rich source of cytokines and inflammatory mediators. The objective of this study was to demonstrated the expression of the chemokine RANTES in nasal polyp fibroblasts after stimulation with proinflammatory cytokines like TNF-alpha and IL-1 beta. METHODS: Fibroblast lines were established from human nasal polyp biopsy tissues taken from patients with chronic sinusitis who had no other associated diseases. Cultured nasal polyp fibroblasts were stimulated with TNF-alpha or IL-1 beta at various doses (0.1, 1.0, 1 ng/ml) or for various times (l, 6, 12, 24, 48, 72 h). To detect the RANTES gene expression, RT-PCR was performed. The resulting supernatants were assayed with ELISA for the level of RANTES. RESULTS: We demonstrated that TNF-alpha and IL-1 beta induced the gene expression and protein production of RANTES in nasal polyp fibroblasts. This responsiveness to TNF-alpha and IL-1 beta was time and dose-dependent. CONCLUSION: These findings suggest that nasal polypfibroblasts may also play an important role in the recruitment of Eo through the production of RANTES.

Cells, Cultured↗
PubMed1996

Effect of new macrolide roxithromycin upon nasal polyps associated with chronic sinusitis.

We often observe shrinkage of nasal polyps with low-dose long-term macrolide treatment, which was recently developed in Japan for the treatment of intractable chronic sinusitis. In order to assess the efficacy of this treatment for nasal polyps, we administered the new macrolide roxithromycin (RXM) (1 tablet: 150 mg a day) for at least 8 weeks to 20 patients with nasal polyps associated with chronic sinusitis. It was competent in controlling nasal polyp with the overall incidence of improvement being 52%. The combination of RXM with azelastine (1 mg twice/day), an inhibitor of mediator release, was examined in 20 other patients. It augmented the rate of improvement to 68%, but the increase was not significant. The incidence of improvement increased with time after the start of medication in both groups. Smaller polyps were more likely to decrease in size, but some larger polyps also markedly decreased in size. Associated allergic conditions and the extent of eosinophilic infiltration had no relation to the treatment result. We speculate that the mechanism of effectiveness of RXM is through its suppressive potency in cytokine production from inflammatory cells.

Adult↗
PubMed1996

Noradrenergic innervation of nasal polyps and polypoid mucosae.

In order to study the sympathetic innervation of nasal polyps and polypoid mucosae, the glyoxylic catecholaminergic histofluorescence method was employed in the examination of specimens taken from patients who had nasal disorders with polyps or polypoid mucosae. One percent neutral red was used as a counterstain. Abundant sympathetic fibers were present around the vessels of the pedicle of nasal polyps. However, no sympathetic innervation was found in the body and apex of the polyps. In the microscopical views of polypoid formations, there were no obvious differences between non-diseased nasal mucosa and polypoid mucosa in the distribution of sympathetic innervation. Based on these results, the following conclusions were drawn: (1) The loss of the sympathetic innervation was suggested to an important role in the pathogenesis of nasal polyps. (2) During polypectomy, the polyp had better be removed along with the pedicle for there is abundant sympathetic innervation and it will result in reduced bleeding.

Humans↗
PubMed2003

Interobserver agreement in the histologic diagnosis of colorectal polyps. the experience of the multicenter adenoma colorectal study (SMAC).

Current clinical practice guidelines for patients with colorectal polyps are mainly based on the histologic characteristics of their lesions. However, interobserver variability in the assessment of specific polyp characteristics was evaluated in very few studies. The purpose of this study was to evaluate the interobserver agreement of four pathologists in the diagnosis of histologic type of colorectal polyps and in the degree of dysplasia and of infiltrating carcinoma in adenomas. A stratified random sample of 100 polyps was obtained from the 4,889 polyps resected within the Multicentre Adenoma Colorectal Study (SMAC), and the slides were blindly reviewed by the four pathologists. Agreement was analyzed using kappa statistics. A median kappa of 0.89 (range 0.79-1.0) was estimated for the interobserver agreement for the diagnosis of hyperplastic polyp vs. adenoma. The agreement in the diagnosis of tubular, tubulovillous, and villous type, was given by median kappa values of 0.50, 0.15, and 0.36, respectively. The median kappa for the diagnosis of infiltrating carcinoma was 0.78 (range 0.73-0.84). Agreement on diagnosis of adenoma histologic subtypes, degrees of dysplasia, or infiltrating carcinoma in adenoma was moderate. A simpler classifications might help to better identify patients at different risk of colorectal cancer.

Adenocarcinoma↗
PubMed1999

Which endometrial polyps should be resected?

STUDY OBJECTIVE: To evaluate the efficacy of color Doppler exploration after diagnostic hysteroscopy in choosing which endometrial polyps can be safely left in situ. DESIGN: Prospective, long-term follow-up study (Canadian Task Force classification II-1). SETTING: University hospital. PATIENTS: Two hundred twenty women with hysteroscopically confirmed endometrial polyps. INTERVENTIONS: Transvaginal ultrasonographic surveillance with color Doppler mapping and hysteroscopic resection. MEASUREMENTS AND MAIN RESULTS: We removed 126 (57.2%) polyps because of positive color Doppler map, and 29 (13.1%) with a negative color Doppler map because of symptoms. Sixty-five (29.5%) polyps were not removed because they did not cause symptoms and no Doppler map was found. At follow-up, six were removed because of hemorrhagic episodes. At 3 years, 59 patients with endometrial polyps remained asymptomatic by clinical and ultrasonographic follow-up. CONCLUSION: In this series, 59 patients (26.8%) avoided surgical removal of polyps. (J Am Assoc Gynecol Laparosc 6(1):71-74, 1999)

Endometrial Neoplasms↗
PubMed1988

The release of histamine from nasal polyp tissue and peripheral blood when challenged with antihuman IgE, house dust mite extract and mixed grass pollen extract and compared with positive skin tests.

Nasal polyps are a condition of uncertain aetiology but are associated with diseases of the lower respiratory tract, in particular, asthma and cystic fibrosis. Asthma may be mediated by mast cell reactions and the commonest allergen to degranulate mast cells is house dust mite. Mast cells have been shown to be degranulated in nasal polyps. This study looks at thirty-six patients who had nasal polypectomy and of whom fourteen were asthmatic to see if histamine was released from polyp tissue and peripheral blood when they were challenged with antihuman IgE and extracts of house dust mite and mixed grass pollens. These results were compared with skin tests to these allergens. A release of above 15 per cent of the total histamine was considered positive. Eight patients released histamine from polyp tissue but only three patients released histamine with both anti IgE and allergen extracts. The release from blood compared well with positive skin tests (p greater than 0.05 corrected chi square). Although allergy may cause mast cell degranulation in polyp tissue, this study suggests that it is unlikely to be a common cause of nasal polyps.

Animals↗
PubMed2002

Decreased apoptosis and distinct profile of infiltrating cells in the nasal polyps of patients with aspirin hypersensitivity.

BACKGROUND: Patients with aspirin-hypersensitive rhinosinusitis/asthma suffer from a severe form of hyperplastic rhinosinusitis with recurrent polyposis. We aimed to assess the presence of apoptotic cells in nasal polyps from aspirin-hypersensitive (AH) and aspirin-tolerant (AT) patients with rhinosinusitis as related to the characteristics of local inflammation. METHODS: Nasal polyps obtained from 16 AH patients and 36 AT patients (17 atopic and 19 nonatopic) were stained for eosinophils and metachromatic cells, and in parallel immunocytochemistry was performed to detect CD45RO+, HLA-DR+, CD8+ and CD68+ positive cells. Apoptotic cells were detected by a nick-end labelling technique, TUNEL. RESULTS: The density of apoptotic cells in AH polyps (5.5 + 1.5 cells/mm2) was significantly lower as compared to both atopic (18.7 + 3.8 cells/mm2; P < 0.02;) and nonatopic (21.3 + 5.2 cells/mm2; P < 0.01) AT polyps. The number of eosinophils, mast cells, and CD45RO+ cells were significantly increased in AH compared to AT polyps (P < 0.001), and the density of HLA-DR+ cells in AH patients was higher than in nonatopic (P < 0.02), but not in atopic AT patients. While in AH patients the duration of rhinosinusitis correlated inversely with the number of apoptotic cells (r = - 0.67; P < 0.04), in contrast, in AT atopic patients the duration of rhinosinusitis showed positive correlation with apoptosis (r = 0.89; P < 0.003). CONCLUSIONS: We conclude, that decreased apoptosis of inflammatory cells in nasal polyps from ASA-hypersensitive patients, reflects a distinct mechanisms of local inflammation and may be related to persistence and severity of the disease in these patients.

Adult↗
PubMed2003

Nuclear factor-kappaB activity is down-regulated in nasal polyps from aspirin-sensitive asthmatics.

BACKGROUND: We examined whether a decreased activity of nuclear factor(NF)-kappaB), a transcriptional regulator of cyclooxygenase-2 (COX-2), could account for down-regulation of COX-2 in nasal polyps of aspirin-sensitive asthmatics. METHODS: Nasal polyps were obtained from 17 aspirin-intolerant asthma/rhinitis patients (AIAR; 7 men, mean age 48 +/- 12 years) and 23 aspirin-tolerant asthma/rhinitis patients (ATAR; 12 men, mean age 65 +/- 11 years). COX-2 mRNA expression was measured using semiquantitative reverse transcriptase competitive polymerase chain reaction (RT-PCR), and the results were expressed as mean +/- standard error of 106 molecules of mRNA/ micro g of total RNA. NF-kappaB binding was measured with 32P-labeled oligonucleotides and electrophoretic mobility shift assay (EMSA), and the results were expressed as a percentage with respect to the mean EMSA obtained in 19 healthy nasal mucosa. RESULTS: The mean levels of COX-2 mRNA expression (0.25 +/- 0.06) and NF-kappaB activity (89 +/- 13) in nasal polyps from AIAR were significantly lower than in polyps from ATAR (COX-2 = 1.58 +/- 0.50, and NF-kappaB = 143 +/- 12, P < 0.01 and P < 0.05, respectively). Levels of COX-2 mRNA and NF-kappaB activity in polyps from patients on corticosteroid therapy did not differ statistically from those who were not on this therapy before polypectomy. CONCLUSION: This study shows that the low expression of COX-2 mRNA in nasal polyps from aspirin-sensitive patients is associated with a down-regulation of NF-kappaB activity.

Adrenal Cortex Hormones↗
PubMed2002

Endoscopic resection of large sessile colonic polyps by specialist and non-specialist endoscopists.

BACKGROUND: Patients with large sessile colonic polyps for which endoscopic resection might be feasible are often referred directly for operation. The aim of this study was to determine the outcome of patients with such polyps diagnosed by specialist and non-specialist colonoscopists. METHODS: Patients with large (greater than 2 cm) sessile polyps detected at colonoscopy from January 1995 to July 2000 were identified. Resection technique and clinical and endoscopic outcomes were recorded. Two of the colonoscopists (B.P.S., C.B.W.) are recognized as specialists. RESULTS: Some 130 polyps were identified, 100 detected by either of two specialist endoscopists (including 14 cancers) and 30 by 14 non-specialist endoscopists (including ten cancers). Endoscopic resection of benign polyps was attempted by experts in 80 (93 per cent) of 86 cases and by non-experts in 15 of 20 cases (P = 0.03), with successful management by endoscopy alone in 61 (76 per cent) of 80 and in six of 15 cases respectively (P = 0.01). Complications occurred following three polypectomies performed by an expert (bleeding, two; pain, one) and one by a non-expert (bleeding). The estimated end-cost of management by specialists was less than half of that by non-specialists. CONCLUSION: Endoscopic resection of large sessile colonic polyps is feasible in the majority of patients and should be considered as first-line therapy. Prompt referral to a specialist endoscopist may improve outcomes by avoiding operation or enabling complete excision at a single endoscopy session.

Adult↗
PubMed2002

CD34+ stromal cells and hyalinized vascular changes in the anal fibroepithelial polyps.

AIMS: To elucidate the pathogenesis of the anal fibroepithelial polyp, we examined surgically resected lesions histopathologically. METHODS AND RESULTS: Twenty-seven surgically resected anal fibroepithelial polyps were investigated histologically with an additional immunohistochemical examination using anti-CD34. For a control study, the surgical specimens of the anal canal showing non-polypoid lesions, obtained from haemorrhoidectomy (18 specimens) and rectectomy (five specimens) due to rectal cancer without anal canal involvement, were also analysed. We demonstrated characteristic spindle or stellate cells immunohistochemically positive for CD34 in the anal fibroepithelial polyps (24/27, 89%). The number of CD34+ cells was statistically related to the size of anal fibroepithelial polyps, although CD34+ stromal cells were recognized in the non-polypoid anal submucosa and haemorrhoids. We also found hyalinized vascular changes in the base of six anal fibroepithelial polyps examined. These features were not detected in the non-polypoid anal canal. CONCLUSIONS: An increase in CD34+ stromal cells may play a role in the enlargement of anal fibroepithelial polyps. CD34+ stromal cells are suggested to be distinctive mesenchymal cells with a capability for tissue repair and overgrowth. The vascular impairment could be secondary change associated with localized tissue damage by abnormal traction.

Adult↗