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Hyperplastic polyps following treatment of acute gastric ulcers.

Although hyperplastic polyps are the most common polyps of the stomach, the etiology of these polyps is not completely understood. We report a 61-year-old woman who developed gastric hyperplastic polyps following acute gastric lesions. She was admitted for endoscopic injection sclerotherapy of esophageal varices. After the end of sclerotherapy, acute gastric lesions developed. For treatment of the lesions, omeprazole was used for 8 weeks followed by famotidine for 8 weeks. At the end of the treatment, she developed multiple gastric hyperplastic polyps, suggesting that acute gastric lesions and/or treatment of the gastric lesions are related to the development of hyperplastic polyps in the stomach.

Esophageal and Gastric Varices↗

Positive predictive value and posttest probability of diagnosis of colonic polyp on single- and double-contrast barium enema.

The positive predictive value for a radiographic diagnosis of colonic polyp, the prevalence of polypoid disease, and posttest probability relative to patient age were studied. The positive predictive value for colonic polyp on single- and double-contrast barium enema was determined for 191 polyps found radiographically in 136 patients who also underwent colonoscopy for confirmation. Of 72 polyps seen in 54 patients on single-contrast examination, 59 were confirmed endoscopically; 110 of 119 polyps seen in 82 patients on double-contrast examination were confirmed similarly, giving positive predictive values of 82% and 92%, respectively. Positive predictive values per patient, disregarding the number of polyps present, were 87% (47/54) and 90% (74/82) for the single- and double-contrast examinations, respectively. False-positive errors were due to stool, air bubbles, haustration, and misinterpretation of an appendiceal stump. By using specificities derived from our prevalence of polypoid disease and previously reported sensitivities, we drew posttest probability curves showing that predictive values depend both on the chance of disease before the test is done and on the efficacy of the test used.

Aged↗

Role of mast and goblet cells in the pathogenesis of nasal polyps.

In this study, the role of mast and goblet cells and eosinophils in the pathogenesis of nasal polyposis was investigated. The study group consisted of 28 adult patients (15 males, 13 females) with nasal polyposis who underwent functional endoscopic sinus surgery (FESS). All patients in the study group were examined with a questionnaire, an otolaryngologic examination, an endoscopic examination with 0 degrees and 30 degrees endoscopes, Waters' graphy, and axial and coronal computed tomography of the paranasal sinuses. The control group consisted of 10 adult patients without nasal polyp (7 males and 3 females) who underwent septoplasty. They gave written approval to enter the study. The polyp specimens from the study group were excised from four regions: the maxillary sinus, ethmoid sinus, sphenoid sinus, and nasal cavity. They were examined at x400 magnification by light microscopy, and only the slides with polypoid tissue were included in the study. Slides including a chronic inflammatory process without polypoid tissue were excluded from the study. The control group was composed of the slides of specimens from the inferior turbinate. Forty slides (10 in each group) in the study group and 10 slides in the control group were included in the study. The surgical specimens from the study and control groups were examined with a histochemical staining technique. In every surgical specimen, the type of epithelium and the numbers of goblet and mast cells and eosinophils were calculated in x400 high-magnification field in 10 areas on light microscopy, as well as the mean number of these cells, and for mast cells separately, cell count in the epithelium and the stromal layer of polyp tissue and total mast cell count, including both epithelial and stromal mast cells, were identified. Goblet cells, mast cells, and inflammation with eosinophils were observed in all sinonasal mucosa. The common epithelial type in the polyp tissue was pseudostratified ciliated cylindric epithelium, which contains goblet cells. Goblet cell numbers in the maxillary, ethmoid, and sphenoid sinuses and nasal cavity were found to be significantly higher than in the control group (p < .05). For total mast cell and eosinophil count, no statistically significant difference was found between all five groups. In each group, there was no statistically significant difference between goblet and mast cells. Increased goblet cells in sinonasal polyps indicated that systemic factors also affect nasal polyposis as much as local factors, such as airflow and mucosal contact. Surgical treatment of sinonasal polyps by FESS causes more sufficient air ventilation in the nasal cavity and paranasal sinuses. Therefore, the goblet cell density will decrease because of the exposure of the mucosal surfaces to the air. In particular, FESS and then the appropriate medical treatment may decrease the recurrence rates and increase the patient's comfort. The significantly increased goblet cell count in the sinonasal mucosa demonstrated the importance of these cells in the pathogenesis of nasal polyposis. Also, mast cells and eosinophils may have a role in the inflammatory processes, leading to nasal polyposis formation.

Adolescent↗

Macrolide treatment decreased the size of nasal polyps and IL-8 levels in nasal lavage.

Recently, epidemiologic and experimental studies have been reported that long-term macrolides are effective for the treatment of chronic airway inflammatory diseases including diffuse panbronchiolitis, chronic rhinosinusitis, and cystic fibrosis (Jaffe A, Francis J, Rosenthal M, et al. Long-term azithromycin may improve lung function in children with cystic fibrosis. Lancet 351:420, 1998), and that macrolides can directly reduce the production of IL-8 by nasal epithelial cells (Suzuki H, Shimomura A, Ikeda K, et al. Inhibitory effect of macrolides on interleukin-8 secretion from cultured human nasal epithelial cells. Laryngoscope 107:1661-1666, 1997). In this study we administered macrolides with 14-membered rings to patients with nasal polyps due to chronic rhinosinusitis for at least 3 months and measured the IL-8 level in nasal lavage from those patients. The IL-8 levels in nasal lavage from patients with nasal polyps were reduced during macrolide treatment. There was significant correlation between decreased IL-8 levels in nasal lavage and the clinical effect of macrolides on the size of the nasal polyps. In the group whose polyps were reduced in size, the IL-8 levels dramatically decreased from 231.2 pg/mL to 44.0 pg/mL (p < 0.05), and were significantly higher before macrolide treatment than those in the group whose polyps showed no change (p < 0.005). This reduction in IL-8 may be an important aspect of the effect of macrolide treatment on nasal polyps in chronic rhinosinusitis.

Anti-Bacterial Agents↗

Superantigens and chronic rhinosinusitis II: analysis of T-cell receptor V beta domains in nasal polyps.

BACKGROUND: The superantigen (SAg) hypothesis of chronic rhinosinusitis (CRS) suggests that toxins within the nose stimulate massive oligoclonal expansion of T-cell populations with subsequent eosinophil recruitment and tissue inflammation. SAgs are capable of activating 1 x 10(4) more lymphocytes than conventional antigens by binding specific Vbeta-domains of the T-cell receptor (TCR). The net effect is skewing from the normal Vbeta-profile by oligoclonal expansion of specific domains. This study will assess polyp tissue for evidence of an SAg response in CRS with nasal polyps (CRSwNP). METHODS: This study consists of a prospective analysis of 18 CRSwNP subjects undergoing sinus surgery. Flow cytometry was used to analyze the distribution of 24 specific TCR V beta-domains in lymphocytes from polyp tissue and blood. Evidence of oligoclonal expansion was tabulated for each specimen and defined as mean normative percentage + 2 SD. RESULTS: Eighteen of 18 CRSwNP subjects showed expansion of polyp lymphocytes expressing TCRs with specific V beta-domains. The average number of V beta-clones per CRSwNP subject was seven in polyp lymphocytes but only two in blood lymphocytes. CONCLUSION: The current results indicate that polyp lymphocytes exhibit significant oligoclonal expansion of specific V beta-domains. These data are considered diagnostic of a SAg effect. The corresponding blood profile is much less, suggesting that the nose is the primary source of stimulus. Although the trigger(s) for this expansion are unknown, these data are consistent with the hypothesis that staphylococcal toxins are central to the development of CRSwNP.

Chronic Disease↗

Hyperplasia or neoplasia. Macroscopic versus microscopic appearance of colorectal polyps.

Small light-red sessile colorectal polyps, 1-5 mm in diameter, are generally believed to be hyperplastic (non-neoplastic), whereas polyps that are dark-red in contrast to the surrounding mucosa are thought to be adenomas. This hypothesis was tested prospectively in a series of 209 polyps removed by one endoscopist in a 6-month period. A 'blinded' pathologist provided the histopathological diagnosis. Twenty-two per cent of polyps described as hyperplastic by the endoscopist were adenomas, whereas 40% of those believed to be adenomas, 1-5 mm in diameter, were hyperplastic. The diagnostic effectivity of the endoscopist increased with increasing size of the polyps. In conclusion, all colorectal polyps must be removed to prevent possible precancerous lesions from being left behind and to define a group of patients with increased risk of new adenomas, in whom follow-up examinations should be considered.

Adenoma↗

Systematic review of endoscopic sinus surgery for nasal polyps.

OBJECTIVES: To provide a systematic review of the clinical effectiveness of endoscopic sinus surgery (ESS) for the removal of nasal polyps. DATA SOURCES: Searches of electronic databases, websites and reference lists were made to identify relevant studies. REVIEW METHODS: An extensive search was performed to identify all articles where FESS is used for the excision of nasal polyps. Two reviewers independently screened articles for inclusion according to predefined criteria. Comparative studies were included if they were primary research, focused on FESS for the removal of nasal polyps, reported patient relevant outcomes and were published in English. In addition, case series studies were included if they met the above criteria and enrolled more than 50 patients with polyps. Data were then extracted by one reviewer and checked by a second. A structured form was used to assess the internal and external validity of included studies. Comparative data were reported where available. Excluded case series and case reports were grouped and described. A group of nine ear, nose and throat (ENT) experts were selected, then using the literature and their own experience, they generated a list of priority research questions. Existing economic evaluations were sought and described. RESULTS: Of the 33 studies included, the randomised controlled trials and controlled trials reported overall symptomatic improvement that ranged from 78 to 88% for FESS compared with 43 to 84% for similar techniques (including polypectomy, Caldwell-Luc and intranasal ethmoidectomy). Disease recurrence was 8% for FESS compared with 14% for Caldwell-Luc and polyp recurrence was 28% for endoscopic ethmoidectomy compared with 35% for polypectomy. Revision surgery was reported in one study only and was the same for FESS and Caldwell-Luc procedures. Percentage of overall complications was reported in only one comparative study and was 1.4% for FESS compared with 0.8% for conventional procedures. The case series studies reported overall symptomatic improvement for patients with nasal polyps ranging from 37 to 99% (median 89%). For the mixed patient groups (with and without polypoid disease) overall symptomatic improvement ranged from 40 to 98% (median 88%). Total complications in the case series studies ranged from 22.4 to 0.3% (median 6%). CONCLUSIONS: The majority of studies report that symptoms improve following FESS with relatively few complications; however, only a small proportion of evidence is comparative. Results from non-comparative studies do not inform the choices that need to be made by ENT surgeons and commissioners. Health economics data are also lacking and therefore cannot inform these decisions. FESS may offer some advantages in effectiveness over comparative techniques, but there is enormous variation in the range of results reported and there are severe methodological limitations. There is a clear need for quality-controlled trials in order to answer questions regarding the effectiveness of FESS. A number of priority research questions from a selection of ENT surgeons within the UK are identified and presented.

Endoscopy↗

Association of serum lipids and glucose with the risk of colorectal adenomatous polyp in men: a case-control study in Korea.

Previous studies on life style for colorectal cancer risk suggest that serum lipids and glucose might be related to adenomatous polyps as well as to colorectal carcinogenesis. This case-control study was conducted to investigate the associations between serum lipids, blood glucose, and other factors and the risk of colorectal adenomatous polyp. Male cases with colorectal adenomatous polyp, histologically confirmed by colonoscopy (n=134), and the same number of male controls matched by age for men were selected in hospitals in Seoul, Korea between January 1997 and October 1998. Serum lipids and glucose levels were tested after the subjects had fasted for at least 12 hr. Conditional logistic regression showed that there was a significant trend of increasing adenomatous polyp risk with the rise in serum cholesterol level (Ptrend=0.07). Increasing trend for the risk with triglyceride was also seen (Ptrend=0.01). HDL-cholesterol and LDL-cholesterol had increasing trends for the risk, which were not significant. In particular, it was noted that higher fasting blood glucose level reduced the adenomatous polyp risk for men (Ptrend=0.001). This study concluded that both serum cholesterol and triglyceride were positively related to the increased risk for colorectal adenomatous polyp in Korea. Findings on an inverse relationship between serum glucose and the risk should be pursued in further studies.

Adenomatous Polyps↗

Hypertrophied anal papillae and fibrous anal polyps, should they be removed during anal fissure surgery?

AIM: Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice. They are mostly ignored being considered as normal structures. The present study was aimed to demonstrate that hypertrophied anal papillae and fibrous anal polyps could cause symptoms to the patients and that they should be removed in treatment of patients with chronic fissure in anus. METHODS: Two groups of patients were studied. A hundred patients were studied in group A in which the associated fibrous polyp or papillae were removed by radio frequency surgical device after a lateral subcutaneous sphincterotomy for relieving the sphincter spasm. Another group of a hundred patients who also had papillae or fibrous polyps, were treated by lateral sphincterotomy alone. They were followed up for one year. RESULTS: Eighty-nine percent patients from group A expressed their satisfaction with the treatment in comparison to only 64% from group B who underwent sphincterotomy alone with the papillae or anal polyps left untreated. Group A patients showed a marked reduction with regard to pain and irritation during defecation (P = 0.0011), pricking or foreign body sensation in the anus (P = 0.0006) and pruritus or wetness around the anal verge (P = 0.0008). CONCLUSION: Hypertrophied anal papillae and fibrous anal polyps should be removed during treatment of chronic anal fissure. This would add to effectiveness and completeness of the procedure.

Adult↗

[Immunohistological study of eosinophilic infiltration of nasal polyps in aspirin-induced asthma].

It is well known that nasal polyps frequently develop in patients with aspirin-induced asthma, which is thought to be a non-atopic disease. We immunohistochemically examined the eosinophils infiltrating the nasal polyps in patients with aspirin-induced asthma. It has also been established that the monoclonal antibody EG1 reacts with both stored and secretion type ECP (eosinophil cationic protein), and that EG2 reacts only with the secretion type of ECP. EG2 positive cells may thus be considered to be activated eosinophils. Seven cases with nasal polyps associated with aspirin-induced asthma participated in our study. Blood eosinophilia was observed in all 7 cases, but 6 showed normal blood values IgE. Two reacted to house dust antigen, on skin tests and RAST. In the nasal polyps, many EG2 positive cells were observed. On serial sections, the number and distribution of EG1 and EG2 positive cells were almost equal. In the superficial lamina propria, extra-cellular release of ECP was noted. However, epithelial damage did not relate to the number of EG2 positive cells or the degree of extra-cellular EG2 release. In the deep lamina propria, slight extra-cellular ECP release was found. From these results, the eosinophils in nasal polyps accompanying aspirin-induced asthma were thought to be activated. Eosinophils seem to play an important role in the development of nasal polyps. However, tissue injury induced by eosinophils, was not be demonstrated in this study.

Adult↗

Giant fibrovascular polyp of the esophagus. A lesion causing upper airway obstruction and syncope.

Giant fibrovascular polyp of the esophagus is a rare but dramatic entity. These large polyps arise in the proximal esophagus and can cause airway obstruction secondary to mechanical pressure on the larynx, or they can present as a mass that is regurgitated into the oral cavity. We present a 66-year-old man who complained of nausea and vomiting that were associated with a fibrovascular polyp protruding into the mouth. He had also experienced several episodes of syncope resulting from intermittent airway obstruction. He underwent an open resection of an 11.8-cm fibrovascular polyp and an endoscopic resection of a second fibrovascular polyp 2 days later. Histopathologically, both masses were composed of a mixture of mature adipose tissue lobules and fibrovascular tissue, lined by reactive squamous epithelium. Despite their large size, giant fibrovascular polyps should be recognized radiologically and pathologically as benign lesions. However, they can result in significant morbidity.

Aged↗

Malignant polyps: are they sheep in wolves' clothing?

One of the arguments supporting the concept that benign adenomatous polyps of the colon degenerate into cancer is the observation of malignancy in polypoid growths known to have been present for years. Although a latent phase--the duration of time between the initial development of a malignancy and the subsequent occurrence of a clinical problem--must exist, this argument implies that this time span is not many years. If both the prevalence of malignant polyps and the incidence of consequent symptomatic colon cancer were known, the average latent phase could be calculated. In order to estimate this prevalence, I used autopsy data; the estimate was validated using independent data fro three colonoscopic screening studies. The annual incidence of all colon cancer in the United States is approximately 150,000 cases. I estimate that 725,000 people in the United States harbor at least one malignant polyp. Even if all 150,000 cases of colon cancer were associated with symptoms and began as malignant polyps, the average latent phase is 4.8 years. Because some colon cancers are removed while the patient is still asymptomatic (discovered on screening examination) and because at least some colon cancers arise de novo from the mucosa, the average latent phase must be even longer. These estimates suggest that it cannot be assumed that the histologic finding of cancer in a polyp that has been observed for many years represents "malignant degeneration" of a previously benign neoplasm; such a malignancy may have had that histologic characteristic from the start. Further, histologically ominous lesions (malignant polyps) may often have prolonged benign clinical courses.

Adult↗

Colonic polyps in patients with acromegaly.

Seventeen patients with acromegaly were prospectively studied with barium enemas and colonoscopy to investigate the possibility that acromegaly is associated with an increased frequency of colonic polyps and colon cancer. Polyps were identified in nine patients and were removed and examined in eight. In five patients the polyps were adenomatous, and in four of the five there were multiple polyps. The presence of polyps closely correlated with the presence of skin tags (p = 0.041) and also with the age of the patient (p less than 0.01). No new cases of colonic cancer were discovered; however, reviewing the records of 44 patients with acromegaly, four cases were previously diagnosed with colon carcinoma. This study identifies a unique group of patients that are at risk for the development of colonic polyps and perhaps colon cancer.

Acromegaly↗

Skin tags: a cutaneous marker for colonic polyps.

The relation between adenomatous colonic polyps and the development of adenocarcinoma of the colon is well established. An association between skin tags and colonic polyps in patients with acromegaly has also been reported. To ascertain if skin tags are a cutaneous marker for colonic polyps independent of the presence of acromegaly, 100 men referred for colonoscopy were studied. Forty-six patients had colonic polyps and 37 also had skin tags; the correlation was highly significant (p less than 0.005). The sensitivity and specificity of the presence of skin tags serving as a cutaneous marker for adenomatous colonic polyps were both greater than 75%. Thus, at least in this population, skin tags may serve as a means for identifying patients at increased risk for having colonic polyps.

Colonic Neoplasms↗

Transvaginal color Doppler sonography versus sonohysterography in the diagnosis of endometrial polyps.

OBJECTIVE: To compare the diagnostic performance of transvaginal color Doppler sonography (TVCD) and sonohysterography (SHG) in the diagnosis of endometrial polyps. METHODS: Fifty-one women (mean age, 51 years; range, 27-75 years) with clinical or B-mode sonographic suspicion of endometrial polyps were included in this prospective study. Transvaginal color Doppler sonography first and then SHG were performed in all patients. On TVCD, a polyp was suspected when a vascular pedicle penetrating the endometrium from the myometrium was identified. On SHG, a polyp was suspected when a focal polypoid lesion was seen within the endometrial cavity. All patients underwent hysteroscopy and endometrial biopsy, the findings of which were used as the criterion standard. Sensitivity and specificity for TVCD and SHG were calculated and compared by the McNemar test. RESULTS: Hysteroscopy and endometrial biopsy findings were as follows: endometrial polyps, 41; endometrial hyperplasia, 3; cystic atrophy, 4; proliferative endometrium, 2; and endometritis, 1. Sensitivity and specificity for TVCD and SHG were 95% and 80% and 100% and 80%, respectively (McNemar test, P = .5) CONCLUSIONS: Transvaginal color Doppler sonography and SHG had similar performance for diagnosing endometrial polyps.

Adult↗

[Colonic polyps in children. Experience with polypectomy].

BACKGROUND: Colonic polyp, the most common gastrointestinal tumor in children, is considered a cause of rectal bleeding in the pediatric population. Colonoscopy is the "gold standard" procedure in diagnosis and therapeutic. OBJECTIVE: To know the incidence and symptomatology of colonic polyps in children to remark on the usefulness of the endoscopic examination. PATIENTS-METHODS AND RESULTS: Between 1985 and 1996, over 1,000 colonoscopies were performed on 50 children between 8 months and 14 years old. The patients had colonic polyps and lower gastrointestinal bleeding. In 40 cases polyps were solitary, 82% were located in rectum sigmoid, and 80% of polyps were found to be juvenile (retention). There were no complications associated with diagnostic and therapeutic endoscopy. CONCLUSIONS: The endoscopic method was shown to be very useful for diagnosis as well as treatment of the colonic polyps in children.

Adolescent↗

Transvaginal sonographic evaluation of endometrial polyps: a comparison with two dimensional and three dimensional contrast sonography.

Endometrial polyps are a frequent cause of menorrhagia and are often associated with infertility. Routine transvaginal (TV) ultrasound evaluation may detect intrauterine anomalies. Sonographic evaluation of the endometrium after uterine cavity distention, called hystero-sono-salpingography (HSSG), improves the resolutive effectiveness of TV sonography. Recently the development of three-dimensional (3D) scanning of the uterine cavity has provided accurate images. The purpose of this study was to compare conventional 2D and 3D scanning of the uterine cavity with or without saline contrast medium in the detection and evaluation of focal endometrial polyps. Twenty-three patients out of 642 women suggestive for intrauterine anomalies at routine TV sonogram were examined by 2D and 3D sonography before and after intrauterine saline contrast medium. Sonographic appearance was verified by hysteroscopic and histologic evaluation. Two-dimensional TV sonography diagnosed 23 polyps versus 16 confirmed at hysteroscopic and histologic examinations, revealing a specificity of 69.5%; 2D TV HSSG diagnosed 17 polyps, with a specificity of 94.1%; 3D TV sonography diagnosed 18 polyps, with a specificity of 88.8%; 3D HSSG diagnosed 16 polyps according to hysteroscopic and histologic findings, with a specificity of 100%. HSSG has been demonstrated to be an effective and suitable method in the detection of intrauterine anomalies, particularly with 3D sonography.

Adult↗

Lack of association between the C677T MTHFR polymorphism and colorectal hyperplastic polyps.

Colorectal hyperplastic polyps are benign lesions that share many risk factors with colorectal adenomas and cancers. Low folate intakes are associated with an increased risk of colon cancer. The enzyme 5,10-methylene-tetrahydrofolate reductase (MTHFR) may be linked to DNA methylation and nucleotide synthesis and thus play a role in the etiology of colorectal neoplasia. We investigated an association between the common MTHFR polymorphism (C677T) and colorectal hyperplastic polyps within the Minnesota Cancer Prevention Research Unit case-control study. Cases (n = 200) were diagnosed with colonoscopically confirmed hyperplastic polyps; controls (n = 645) were derived from the same gastroenterology practice and were polyp-free at colonoscopy. Dietary intakes were estimated from a self-administered food-frequency questionnaire prior to colonoscopy. Multivariate adjusted odds ratios (ORs) and 95% confidence intervals for MTHFR status were 0.8 (0.6-1.2; CT versus CC wild-type) and 0.9 (0.5-1.6; TT versus CC). In subgroup analyses stratified on dietary intakes of folate, vitamin B12, vitamin B6, or methionine, those with the TT genotype and either low intakes of folate or vitamin B6 were at increased risk relative to those with normal or high vitamin intake. However, most 95% confidence intervals included 1.0, and no consistent trends were observed. In contrast to our findings on colorectal adenomas, increasing alcohol consumption was associated with an elevated risk of colorectal hyperplastic polyps, regardless of genotype. The MTHFR (C677T) variant genotype does not appear to be related to risk of colorectal hyperplastic polyps, and there is no convincing evidence that MTHFR shows a different relation to risk, dependent on dietary intakes of nutrients related to its pathway.

Adenoma↗