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PubMed1981

A cooperative study on the detection of colorectal cancer and polyps in France.

Systematic investigations testing for the presence of polyps and cancers of the large bowel were conducted in a population of 1,369 inpatients and outpatients, aged 45-70 years, in eight university departments of gastroenterology or abdominal surgery (Toulouse, Dijon, Paris, Marseille, and Strasbourg). Double-contrast barium enema and proctosigmoidoscopy examinations were carried out in all cases, whereas total coloscopy was performed only in the case of detected tumors. A questionnaire including 233 parameters (age, sex, family, and personal history and symptoms) was completed for each patient. A total of 414 lesions were detected in 252 patients, including 245 adenomatous or villous polyps, 8 transformed polyps, and 30 carcinomas; 3 of 4 lesions were located in the rectum or sigmoid. Cancer or adenomatous or villous polyps were found in 13% of the patients. The prevalence of these lesions in the population studied was increased in patients with rectorrhagia (19%) or with a personal history of surgery for colorectal cancer or polyp (23%). In the patients without rectorrhagia or a history of intestinal tumor, the incidence was 9.7%. It was significantly increased in males and patients more than 50 year old. The efficacy of proctosigmoidoscopy and double-contrast barium enema was compared in 909 patients. Sensitivity and specificity were, respectively, 35% and 99% for endoscopy, 96% and 94% for radiology.

Aged↗
PubMedDate not supplied

Immunohistochemical characterization of canine intestinal epithelial and mesenchymal tumours with a monoclonal antibody to hepatocyte paraffin 1 (Hep Par 1).

Monoclonal antibody hepatocyte paraffin 1 (Hep Par 1) is reported to be highly specific and sensitive for hepatocellular tumours of humans and dogs. However, in a previous study we observed immunoreactivity for Hep Par 1 in an intestinal adenocarcinoma metastatic to the liver. In this paper, we examined normal intestine and 57 canine intestinal tumours including adenocarcinomas of the small and large intestine, colonorectal polyps, mucinous carcinomas, stromal tumours, leiomyosarcomas, fibrosarcoma, plasmacytomas, and osteosarcoma for immunoreactivity for Hep Par 1. Normal intestinal epithelial cells were strongly labelled, particularly at the base of crypts. However, epithelial cells in small intestinal neoplasms had variable reactivity for Hep Par 1. In contrast, normal colonic epithelium was seldom labelled, but hyperplastic or neoplastic colonic epithelium was usually reactive to Hep Par 1. Five of seven small intestinal adenocarcinomas, two of three large intestinal adenocarcinomas, two of three mucinous adenocarcinomas, and all (29) rectal polyps were positive for Hep Par 1. The staining was diffuse, granular and cytoplasmic. The only non-epithelial tumours positive for Hep Par 1 were two of four leiomyosarcomas. Hep Par 1 can be used to differentiate hepatocellular from biliary neoplasms but its value in differentiating metastatic tumours to the liver is questionable due to the reactivity of Hep Par 1 in many intestinal tumours.

Animals↗
PubMed1989

Ultrastructure of the absorptive cell glycocalyx in hyperplastic colonic polyps after staining with alcian blue and high iron diamine.

The glycocalyx of absorptive cells in large intestinal hyperplastic polyp was characterized histochemically at the electron microscope level by the use of the Alcian Blue pH 2.5 and high iron diamine techniques with the aim of comparing their ability in preserving the fine reticular network of the structure. Both the reagents stained glycocalyx, indicating the presence of sulphated acidic glycoconjugates. However, they showed different degrees of condensation of the reactive sites. Alcian Blue preserved its filamentous appearance better.

Alcian Blue↗
PubMed1992

Relationship between breast cancer and colorectal adenomatous polyps. A case-control study.

Although there is a known reciprocal association between breast and colorectal cancer in women, few studies have investigated whether a similar association exists between breast cancer and colorectal adenomatous polyps, known to be precursor lesions for colon cancer. A case-control study was conducted on patients in three colonoscopy practices in New York to determine possible risk factors for adenomatous polyps. Among women studied, there were 128 patients with incident adenomatous polyps and 284 control subjects who underwent colonoscopy and had no colorectal neoplasia. No significant association between the incidence of an adenomatous polyp in the colon or rectum and a history of breast cancer was found (odds ratio, 0.71; 95% confidence interval, 0.34 to 1.64). If shared risk factors for breast and colorectal cancer are the reasons for the concurrence of these two malignant lesions, these results suggest that these factors act at the level of promoting adenomatous polyps of the colon and rectum into colorectal cancer.

Adult↗
PubMedDate not supplied

Adenomas and hyperplastic polyps in screening studies.

A survey is given of colorectal polyps detected in a prospective randomized screening study with the fecal occult blood test. It is demonstrated that colonoscopy in persons with positive Hemoccult-II tests results in detection of and removal of a higher number of adenomas than among controls. The strategy may, therefore, possibly be followed by a reduction of the incidence of colorectal cancer. Screen-detected adenomas were most often in males and were larger than among controls; they were most often in the sigmoid colon, whereas the rectum was the most frequent location for adenomas in controls. Eight percent of persons with screen-detected adenomas had some symptoms, which could be referred to adenomas, in contrast to 50% among controls. Hyperplastic polyps served as markers for adenomas in persons with positive Hemoccult-II as well as in controls with adenomas detected by colonoscopy; however, most persons with adenomas had no hyperplastic polyps. Endoscopic polypectomy did not result in any severe complications, but surgical removal in 2 of 22 patients proved fatal. The results presented are compared with those of other prospective randomized trials. The optimistic view--that the incidence of cancer may be reduced by polypectomy in persons with positive Hemoccult-II tests--stresses the importance of securing optimal colonoscopy service.

Adenoma↗
PubMed1993

Small rectosigmoid polyps as markers of proximal neoplasms.

PURPOSE: The aim of this study was to determine the spatial distribution and histotype of small colorectal polyps and to determine the validity of distal-small colorectal polyps as markers of proximal neoplasms. METHODS: In 366 patients who underwent total colonoscopy and removal of all polyps, the presence and features of polyps were recorded. The relationship between proximal neoplasms and distal polyps was investigated in 216 of 366 subjects who had no personal or familial history of colorectal neoplasia. RESULTS: Of 366 patients, 96 were free from polyps. A total of 733 small colorectal neoplasms was removed from the remainder: 79.9 percent neoplastic and 20.1 percent hyperplastic, inflammatory, or hamartomatous. High-grade dysplasia was noted in 2.7 percent of the neoplastic polyps. One adenoma containing invasive carcinoma was observed. In the subset of 216 patients, proximal neoplasms were found in 11.4 percent of those with no distal polyps, 33.8 percent of those with distal-small colorectal polyps only (P < 0.01), and 58.8 percent of those with at least one polyp > 5 mm in diameter (P = 0.001). The proximal neoplasm percentage was the same in patients with at least one adenomatous-small polyp and those with only hyperplastic-small polyps. CONCLUSIONS: A distal-small colorectal polyp, whether adenomatous or hyperplastic, may be a proximal neoplasm marker. Total colonoscopy is thus justified in all patients with distal polyps, regardless of their size and histotype.

Adult↗
PubMed1992

Prevalence of colorectal polyps in Filipinos. An autopsy study.

From May 1988 to May 1990, a prospective autopsy study was performed in patients who died at the Philippine General Hospital in Manila, Philippines. Patients younger than 10 years of age, patients with a history of large bowel resection, and patients whose deaths were related to trauma were excluded. There were 416 patients; 246 were males, and 170 were females. The mean age was 47 years (range, 11-95 years). Six of the 416 patients (1.4 percent) were found to have polyps. One patient had an inflammatory polyp, one was diagnosed with familial adenomatous polyposis, and one had an associated cecal carcinoma. Five "sporadic" adenomatous polyps were found in the remaining three patients (prevalence rate, 0.7 percent). All of the adenomatous polyps were located distal to the hepatic flexure and exhibited only mild atypia. The mean size was 6.4 mm (range, 2-20 mm). The incidence of colorectal adenomas in Filipinos is low compared with that in age-adjusted Western populations. This finding coincides with a low incidence of colorectal carcinoma. The documentation of a low risk for adenomatous polyps and colorectal cancer indicates that it would be difficult for massive screening programs to demonstrate a significant positive impact on the early detection of colorectal neoplasias in the Filipino general population.

Adolescent↗
PubMed2001

Isolated adenomatous polyposis of the appendix: report of a case.

This case study describes a 61-year-old patient who had previously undergone sigmoid polypectomy. A follow-up colonoscopy revealed a polyp prolapsing into the colonic lumen through the base of the appendix. A laparoscopic-assisted appendectomy was performed, in which the cecum was exteriorized through the trocar hole so that a wide excision of the base could be performed. Fifty-eight polyps were observed in the appendix, but the base was free of polyps. Histologic studies reveal well-differentiated villous adenomatous polyposes. The patient was symptom free four years after surgery.

Adenomatous Polyps↗
PubMed1987

Surgery based on misdiagnosis of adenomatous polyposis. The Canadian Polyposis Registry experience.

The histopathology of 304 patients registered in the Canadian Familial Polyposis Registry (CFPR) with a diagnosis of supposed adenomatous polyposis (AP) was reviewed. The diagnosis was changed in 17 (5.6 percent) of these patients. Group 1 consisted of nine patients who had adenocarcinomas plus multiple tubular adenomas (seven) or metaplastic polyps (two). Eight patients who had no colon cancer comprised Group 2. In these patients, the diagnosis was changed to lymphoid polyposis (2), metaplastic polyps (3), isolated adenomas (2), or juvenile polyposis (1). All 17 patients had had previous colonic resections. Following the change in diagnosis, this treatment was considered inappropriate in 11 patients. Treatment, prognosis, and follow-up of patients and affected family members depend on the type of polyposis syndrome diagnosed. Correct histologic assessment of polyps prior to initial surgery is essential.

Adolescent↗
PubMed2006

A novel method of endoscopic mucosal resection assisted by submucosal injection of autologous blood (blood patch EMR).

PURPOSE: Endoscopic mucosal resection assisted by submucosal injection of saline is a widely used procedure; however, it has three limitations: 1) it often is difficult to maintain a desirable level of tissue elevation after the injection; 2) the saline has no efficacy in preventing hemorrhage; 3) nothing can protect the site of mucosal defect after endoscopic mucosal resection to prevent perforation. Blood, as a new medium for use in submucosal injection, may remedy these drawbacks. This is the first report of this technique. METHODS: From May to October 2004, 28 outpatients (8 females; median, 64 years) with 35 colorectal polyps (median, 5 mm in diameter; range, 1-30 mm) were enrolled in this study. Technique of the blood patch endoscopic mucosal resection: after autologous blood was injected into the submucosa under the lesion using a disposable 23-gauge needle, the lifted mucosa with the lesion was removed using a conventional snaring technique. The outcomes were prospectively studied. RESULTS: Although one lesion was not lifted by the submucosal injection because of the submucosal invasion of carcinoma, 33 of the other 34 lesions (97.1 percent) were successfully completed using the blood patch endoscopic mucosal resection. The clot covered the raw surface after the endoscopic mucosal resection without bleeding. No complications (including hemorrhage and perforation) were observed. The blood patch endoscopic mucosal resection did not disturb pathologic examination. CONCLUSIONS: Endoscopic mucosal resection assisted by submucosal injection of autologous blood can be performed safely, easily, and economically. Autologous blood is a promising medium for submucosal injection on endoscopic mucosal resection.

Aged↗
PubMed1988

Immunohistochemical study of epithelial cell proliferation in hyperplastic polyps, adenomas, and adenocarcinomas of the large bowel.

A monoclonal antibody to bromodeoxyuridine was used in tissue specimens previously incubated with bromodeoxyuridine to show S-phase cells by immunohistochemical technique. Biopsy specimens of normal mucosa (n = 10), hyperplastic polyps (n = 10), adenomas with low-grade dysplasia (n = 20), adenomas with high-grade dysplasia (n = 10), and invasive adenocarcinomas (n = 10) of the large bowel were studied. Labeling index and cell proliferative patterns were analyzed. No statistically significant difference was found in labeling index between normal mucosa and hyperplastic polyps or between adenomas with high-grade dysplasia and adenocarcinomas. The labeling index was significantly lower in normal mucosa and in hyperplastic polyps than in adenomas and adenocarcinomas (p less than 0.001). The difference in labeling index between adenomas with high-grade dysplasia and low-grade dysplasia was also statistically significant (0.01 less than p less than 0.05). In normal mucosa and in hyperplastic polyps the proliferative zone was confined to the lower two-thirds of the crypt; no kinetic activity was found in the upper portions of the crypt or in surface epithelium. In adenomas the labeled cells were either present in the upper third or scattered along the whole axis of the crypt and in the surface epithelium. Labeling patterns in invasive carcinomas were similar to those observed in adenomas with high-grade dysplasia. The difference in proliferative patterns between hyperplastic polyps and adenomas supports a different significance of the two polypoid lesions in the histogenesis of large bowel cancer; our results confirm the subsequent steps of the adenoma-carcinoma sequence. Immunohistochemical labeling patterns observed with monoclonal antibody to bromodeoxyuridine in polypoid and cancer lesions of the large bowel are similar to those described by autoradiographic studies.

Adenocarcinoma↗
PubMed1995

Endoscopically removed malignant colorectal polyps: clinicopathologic correlations.

BACKGROUND/AIMS: Treatment options for patients with endoscopically removed malignant colorectal polyps are polypectomy alone vs. polypectomy followed by surgery. The aim of this study was to define histopathologic parameters that can be used for clinically relevant treatment decisions. METHODS: Five pathologists evaluated 140 polyps for the presence or absence of unfavorable histology. Unfavorable histology was tumor at or near (< or = 1.0 mm) the margin and/or grade III and/or lymphatic and/or venous invasion. Adverse outcome was recurrent and/or local cancer and/or lymph node metastasis. RESULTS: Adverse outcome was 19.7% (14 of 71), 8.6% (2 of 23), and 0% (0 of 46) when unfavorable histology was present, indefinite (lack of agreement), and absent, respectively (P < 0.0005, present vs. absent). Four patients with cancer > 1.0 mm from the margin had an adverse outcome (2 with lymphatic invasion and 2 indefinite for lymphatic invasion). Four patients with negative resections later developed distant metastases. Eight patients (6.3%) died of disease, and 2 of 69 without unfavorable histology (both indefinite for lymphatic invasion) had an adverse outcome. Interobserver strength of agreement was substantial to almost perfect for margin, grade, and venous invasion and fair to substantial for lymphatic invasion. CONCLUSIONS: This system is usable clinically. Patients with unfavorable histology are probably best managed by resection postpolypectomy, whereas in the absence of unfavorable histology, they probably can be treated by polypectomy only.

Colonic Polyps↗
PubMed1985

Constitutional C-band pattern in patients with adenomatosis of the colon and rectum.

The pattern of polymorphism in the C-band-positive constitutive heterochromatin of chromosomes #1, #9, and #16 was studied in fibroblasts from 23 unrelated patients with adenomatosis of the colon and rectum and in peripheral lymphocytes from 78 control persons. The parameters of the heterochromatic regions analyzed were relative size, symmetry-asymmetry within homologous chromosome pairs, and frequency of inversions. The polyposis coli patients had a significantly higher frequency (p less than 0.05) of partial and total heterochromatin inversion on chromosome #9 than the control group (37.0% compared with 21.8%). In the other parameters studied, no significant differences were found between patients and controls.

Chromosome Banding↗