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PubMed1993

[Histopathological analysis of gastric polyps: classification and relationship to cancer].

34 cases of gastric polyps were investigated histopathologically. Based on Nakamura's classification, hyperplastic polyps were further classified into the following subtypes: the foveolar epithelial type, fundic glandular hyperplastic type and pyloric glandular hyperplastic type, each being described in detail. It was found that atypical hyperplastic foci usually appear in the foveolar epithelial subtype, indicating a close relationship to cancer. This finding suggests that the subclassification of hyperplastic gastric polyp has a higher practical value in clinical application. The article has also presented a histochemical and CEA immunohistochemical comparative study between hyperplastic polyps, adenoma and atypical hyperplasia of the stomach. The malignant transformation of gastric polyps is discussed and the definition of polyp reconsidered.

Adenoma↗
PubMed1994

Lymphocyte subsets and antigen-specific IgE antibody in nasal polyps.

We tried to elucidate the role of allergic factors in the pathogenesis of nasal polyps. Nasal polyps were obtained from 22 patients with chronic sinusitis which included eight patients proved to have nasal allergy by history, skin test, and serum-specific IgE against houst dust mite. Immunohistochemical studies of lymphocyte subpopulations in the mucosa of nasal polyps were performed with monoclonal antibodies, and the concentrations of antigen-specific IgE in nasal polyps were measured by the fluoroallergosorbent test. In the epithelium, few HLA-DR+ cells were constantly present. In the submucosa, pan T cell marker CD2 was detected more often than CD19 (B cell), and more CD8 (T suppressor/cytotoxic) cells than CD4 (T helper/inducer) cells were found. IgE-producing plasma cells were rarely present. The lymphocyte subpopulations and the levels of antigen-specific IgE in nasal polyps were not different between the allergic and nonallergic groups. This suggests that allergy may not be the cause, and cellular immunity of antigen presenting cells and T lymphocytes, which consecutively induce infiltration and degranulation of mast cells by the production of cytokines, may be involved in the formation of nasal polyps with sinusitis.

Adolescent↗
PubMed1993

The high frequency of upper gastrointestinal pathology in patients with fecal occult blood and colon polyps.

Colon polyps are commonly detected in the workup of fecal occult blood (FOB). It is, however, unclear whether colon polyps can adequately explain FOB. Our aim was to determine the frequency of upper gastrointestinal (UGI) pathology in patients with and without UGI symptoms and with and without risk factors for UGI pathology (such as smoking, drinking alcohol, taking nonsteroidal anti-inflammatory medications, or the presence of associated chronic diseases) who have colon polyps and FOB. Among our 67 study patients with colon polyps and FOB, 79% had associated UGI lesions. Presence or absence of UGI symptoms, risk factors associated with UGI lesions, and polyp characteristics such as size, location, number, and histology, did not appreciably affect this high frequency. Ulcers were the most common lesions in both symptomatic and asymptomatic patients. We conclude that patients with colon polyps found in the evaluation of FOB are likely to have concomitant UGI pathology, and UGI workup should be considered in both symptomatic and asymptomatic patients.

Colonic Polyps↗
PubMed1996

Histology of nasal polyps in various conditions.

At the Salata ENT Department in Zagreb, 28 patients with nasal polyps were examined in the 1992-1993 period. Results of histologic analysis of these nasal polyps are presented. In 10 cases, nasal polyps were histologically examined at three horizontal levels, and the rest by vertical section. The method of hemalaun eoisin and histochemical methods (PAS, Alcian, Mallory, Giemsa and orcein) were used to analyze the following parameters: epithelium, stroma, basement membrane, cell infiltrate and glands. Patients were grouped according to the presence or absence of allergy, relapse of polyps and age group ( < 40 and > 40 years of age). The lateral nasal wall mucosa served as control. Histologic picture of the polyps showed some differences related to allergy and other groups of polyposis. In conclusion, histologic study of polyps should not be taken as the only indicator of the etiology of polyposis but, supplemented with other examinations, as an evidence supporting the diagnosis.

Adolescent↗
PubMed1995

[Study on relationship between nail-fold microcirculation and histopathology of patients with vocal cord polyp and blood stasis syndrome].

Nail-fold microcirculation of 50 vocal cord polyp patients was observed and compared with hoarseness patients without vocal cord polyp. The results showed that peripheral microcirculation was disturbed in the vocal cord polyp patients. Histopathologic observation of 200 vocal cord polyp patients was made. It was found that principal pathologic change concentrated on the lamina propria mucosae of vocal cord and the most prominent manifestation was disturbance of topical microcirculation of Reinke's layer. In microcirculation aspect, the relationship between polyp of vocal cord and the Blood Stasis Syndrome was confirmed, and pathogenic mechanism of vocal cord polyp was discussed.

Adult↗
PubMed1977

Value of a single forceps biopsy of colonic polyps.

The accuracy of colonoscopic biopsies in predicting the histological diagnosis of colonic polyps removed at colonoscopy or at laparotomy was studied. Forty-two patients were colonoscoped before the removal of 50 polyps. A single fractional biopsy was obtained from each lesion with the standard endoscopic biopsy forceps and was compared to the final histological diagnosis of each excised lesion. Thirteen (26%) of the singular fractional biopsies did not demonstrate the significant histological features of the excised polyps. These tiny biopsies do not adequately represent the entire polyp. Moreover, the 2- to 3-mm size of the biopsy does not permit the study of the central submucosal area of the polyp stalk, the critical area for assessing invasive malignancy. Histological examination of a completely excised polyp is essential for accurate diagnosis and appropriate therapy.

Biopsy↗
PubMed1997

Gastrointestinal lymphonodular hyperplasia and lymphoid polyps of the rectum--a rare coincidence.

Lymphoid polyps of the rectum are rare lesions. We report on an 8 1/2-year-old boy, who presented with hematochezia and abdominal pain. Flexible endoscopy revealed large sessile polyps of the rectum and lymphonodular hyperplasia of the duodenum, terminal ileum und descending colon. One rectal polyp was excised in toto, microscopically it revealed the typical features of a lymphoid polyp. Based on the distinct follicular architecture, the cytomorphology and the immunohistochemical findings of the lymphatic infiltrate we were able to distinguish this lesion from malignant lymphoma. The coincidence of lymphoid polyps and gastrointestinal lymphonodular hyperplasia gives evidence that both entities are different variations of the same benign lymphoproliferative process. Lymphoid polyps of the rectum should be treated by local excision for diagnostic purposes. Immunohistochemical staining of fresh, nonfixed tissue is a useful ancillary technique in distinguishing these benign lesions from lymphoma of mucosa associated lymphoid tissue (MALT-lymphoma).

Biopsy↗
PubMedDate not supplied

Endoscopic resection of large sessile colorectal polyps using a submucosal saline injection technique.

BACKGROUND/AIMS: Endoscopic removal of sessile colorectal polyps 2 cm or greater in diameter is very difficult. We evaluated the safety and usefulness of submucosal saline injection in endoscopic resection of these polyps. MATERIALS AND METHODS: Under colonoscopic observation, 0.9% NaCl was injected submucosally through needle forceps to elevate polyps, which were then resected by electrocoagulation. Before 1989, the depth and healing status of ulcers produced by endoscopic resection with (N = 12) and without (N = 16) submucosal saline injection were examined in specimens obtained at subsequent colectomies. Between 1990 and 1993, patients were assigned by weighted randomization to undergo colonoscopic polypectomy with (N = 24) or without (N = 5) submucosal saline injection. RESULTS: All 12 ulcers after submucosal saline injection were confined to the submucosal layer while 7 (44%) of 16 ulcers without submucosal saline injection reached the muscle layer or deeper. Seventeen of 24 (71%) polyps were completely removed (14 piecemeal and 3 en bloc) without serious complications after saline injection. Resection without submucosal saline injection was complete, but piecemeal, for two of five polyps; postresection bleeding occurred in one case. CONCLUSIONS: Endoscopic resection after submucosal saline injection is a safe and effective treatment for large, sessile colorectal polyps.

Colectomy↗
PubMed1997

Fundic gland polyps developing during omeprazole therapy.

OBJECTIVE: Side effects of omeprazole therapy include reversible hypergastrinemia, entero chromaffin-like hyperplasia, and possibly acceleration of atrophic gastritis in the gastric corpus in patients with Helicobacter pylori infection. The objective of this report is to describe six cases of fundic gland polyps that developed while omeprazole was being used for Barrett's esophagus. METHODS: Three women and three men developed fundic gland polyps after 1-5 yr of omeprazole therapy, 20 mg/day. In the index case, fundal polyps developed after 2 yr of continuous omeprazole therapy. Omeprazole was stopped, but because of poor clinical efficacy with H2-blockers, it was reinstated. RESULTS: After 4 yr of therapy, multiple large fundal polyps were present. Histology of all lesions revealed characteristic fundal gland polyps with multiple cystic dilations. None of the patients had H. pylori infection. Serum gastrin was normal in four and slightly increased in two. CONCLUSION: These cases support the possible causal relation between the use of omeprazole and the development of fundic gland polyps in patients without H. pylori gastritis.

Adult↗
PubMed1996

[Estradiol receptors expression in nasal polyps and its significance].

Nasal polyps are generally considered as a result of extreme nasal mucosal edema induced by long-term recurrent inflammation of the respiratory mucosa. The estradiol (E2) has been demonstrated to play a facilitating role in nasal inflammation. To evaluate the effect of estradiol on the pathogenesis of nasal polyps, the expression of E2 receptors in paraffin section from patients with nasal polyps (84 cases), chronic hypertrophic rhinitis (6 cases) and healthy control subjects were investigated by means of immunohistochemistry for E2 receptors and toluidine blue staining for mast cells. It was shown that there was high expression of E2 receptors in 61 out of 84 cases (male 40, female 44) of nasal polyps and the expression distributed equally among both sexes. Low expression of E2 receptors presents in 2 out of 6 cases of chronic rhinitis and 1 out of 4 healthy subjects. Noteworthily, the E2 receptor expressing cells are similar with the mast cells in shape and distribution. The authors speculate that they may be identical cells. E2 receptor expression in nasal polyps suggests that estradiol plays certain role in the development of nasal polyps.

Adult↗
PubMed1963

COLON AND RECTAL POLYPS. RELATIONSHIP TO CARCINOMA.

A review of certain significant contributions to the literature was undertaken to evaluate evidence for and against the proposition that there is positive relationship of adenomatous polyps to carcinoma of the colon and rectum. The overwhelming evidence would seem to indicate that some adenomatous polyps are disposed to develop into invasive carcinomas. Since there is no way of determining which polyp has this tendency, it would seem prudent to remove all polyps that can be removed safely with a sigmoidoscope and remove any in the colon that are more than 1 to 1.5 cm in diameter, the criterion as to size depending upon other factors in each case. It is established that colon and rectal carcinomas may also arise from the mucosa without first appearing in a polyp. Such lesions may clinically appear as shallow ulcerations.

Adenoma↗
PubMed1982

Adenomatous and carcinomatous changes in hamartomatous polyps of the small intestine (Peutz-Jeghers syndrome): report of a case and review of the literature.

The authors report the unique case of a patient with the Peutz-Jeghers (P-J) syndrome who had multiple small bowel hamartomatous polyps, some of which also showed adenomatous and carcinomatous changes. Over the course of 30 years, over 100 small bowel and colonic polyps were resected; all histologically demonstrated the typical features seen in hamartomatous polyps. Several jejunoileal polyps excised during the last few months of the patient's life showed not only hamartomatous features but also adenomatous epithelium. As far as the authors can determine, this is the first documented case of adenomatous changes found within a small bowel hamartomatous polyp. In addition, at least one duodenal polyp demonstrated areas of hamartoma, adenoma, and in situ carcinoma. The literature on the occurrence of gastrointestinal adenomas and carcinomas in patients with the P-J syndrome is reviewed, and the relationship of hamartomas, adenomas, and carcinomas of the gastrointestinal tract is discussed.

Adenoma↗
PubMed1991

DNA ploidy of colorectal cancer and synchronous polyps in polyposis coli.

Sixteen patients with polyposis coli and cancer were studied retrospectively to determine the incidence of DNA ploidy abnormalities in the tumors and synchronous polyps. Six patients (37 percent) had nondiploid tumors. Nondiploid tumors were more likely to be advanced and had a significantly worse prognosis (17 percent vs. 76 percent 5-year survival; P less than 0.01). Only 4 of 20 polyps studied were nondiploid. There was no association between tumor and polyp ploidy. All nondiploid polyps were found in patients with synchronous diploid cancers. Patients with nondiploid polyps were more likely to be older and have more advanced tumors than those with diploid polyps. DNA ploidy abnormalities seem to occur with the same frequency in polyposis coli as in the nonpolyposis population, and tumor ploidy correlates with prognosis.

Adenomatous Polyposis Coli↗
PubMed2002

Alcohol, cigarette smoking, dietary factors and the risk of colorectal adenomas and hyperplastic polyps--a case control study.

BACKGROUND & AIMS: Epidemiological studies on the association between lifestyle factors and the risk of colorectal polyps have led to conflicting results. The aim of the present study was to assess the relationship between alcohol consumption, dietary risk factors, cigarette smoking and colorectal adenomas or hyperplastic polyps, respectively. METHODS: In formation on alcohol consumption, a detailed dietary history, cigarette smoking and intake of non-steroidal anti-inflammatory drugs was collected among 502 Caucasian subjects undergoing complete colonoscopy, 207 with colorectal adenomas, 71 with hyperplastic polyps and 224 controls with no polyps. RESULTS: Using univariate analysis significant risk factors for adenomas were age above 55 years, male sex, BMI > 24 (OR 1.91 [1.26-2.88]), an intake of ham + sausage > 15 g/day (OR 1.87 [1.12-3.11]) and smoking (OR 1.71 [1.17-2.5]). The association with alcohol intake > 7 g/day was not significant (OR 1.42 [0.97-2.07], p = 0.071). In the multiple logistic regression only age > 55 years (OR 2.97 [1.94-4.52]), male sex (OR 2.12 [1.54-3.6]) and smoking (OR 1.56 [1.01-2.39]) were significant risk factors for adenomas. Unexpectedly the mean consumption of alcohol, wine and beer, was significantly lower in subjects in whom adenomas were localized only in the rectum compared to those having adenomas in the sigmoid or in the proximal colon. Significant risk factors in subjects with hyperplastic polyps on univariate analysis were intake of > 15 g of ham and sausage/day (OR 3.70 [1.49-9.19]), smoking (OR 1.79 [1.04-3.06]) and male sex. In the multiple logistic regression only intake of > 15 g/day of ham + sausage and male sex were significant risk factors (OR 3.24 [1.23-140.8] and 1.83 [1.05-318], respectively). CONCLUSION: When controlling for other potential risk factors, smoking was the only significant lifestyle risk factor for colorectal adenomas and the intake of ham and sausage > 15 g/day for hyperplastic polyps. The intake of alcohol, wine and beer were markedly higher in subjects with adenomas of the colon compared to those with adenomas in the rectum.

Adenoma↗
PubMedDate not supplied

Bannayan-Riley-Ruvalcaba syndrome: spectrum of intestinal pathology including juvenile polyps.

Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a disorder that includes juvenile polyposis as part of its pathologic spectrum, and it recently has been shown to share phenotypic and genotypic features with Cowden's disease. In existing literature, descriptions of intestinal pathology in patients with BRRS are relatively sparse and occasionally erroneous. We describe the intestinal pathology in multiple specimens from three children with BRRS. Examination of gastrointestinal biopsies from these children revealed predominantly colonic and rectal polyps with the histology of juvenile polyps. Additionally, two cases with clusters of ectopic ganglion cells within the lamina propria, one in a colonic polyp and one in a duodenal biopsy, and an atypical polyp were observed. Bannayan-Riley-Ruvalcaba syndrome should be included in the list of differential diagnostic considerations when a child or young adult presents with a juvenile polyp, particularly if unusual histologic features such as atypical polyps or ectopic ganglion cells are encountered.

Adenomatous Polyposis Coli↗
PubMed1991

Sulindac causes regression of rectal polyps in familial adenomatous polyposis.

In familial adenomatous polyposis, sulindac-induced polyp regression has been reported by several authors. In this study, the goal was to confirm these results by a randomized, placebo-controlled, double-blind crossover study in 10 patients with rectal polyps that had been previously treated by colectomy and ileorectal anastomosis. Patients received sulindac, 300 mg/day, or placebo during two 4-month periods separated by a 1-month wash-out phase. One patient was not compliant and was excluded. With sulindac, the authors observed a complete (6 patients) or almost complete (3 patients) regression of the polyps. With placebo, the authors observed an increase (5 patients), no change (2 patients), and a relative decrease (2 patients) in the number of polyps. The difference between sulindac and placebo was statistically significant (P less than 0.01). In biopsy specimens of polyps and normal rectal mucosa of 6 patients, the authors conducted an immunohistochemical study of the cellular proliferation index using the Ki 67 monoclonal antibody (Ki 67 index), at the beginning and at the end of each treatment period. They were not able to show a sulindac-induced modification of the Ki 67 index. The authors conclude that sulindac is effective in inducing the regression of rectal polyps in familial adenomatous polyposis.

Adenomatous Polyposis Coli↗
PubMed1996

Fertility Outcome after Outpatient Hysteroscopic Removal of Endometrial Polyps and Submucous Fibroids

We assessed the value of hysteroscopic removal of polyps and submucous fibroids from women requesting fertility treatment. Between December 1991 and June 1995 we recruited 146 women (age 28-44 yrs) with such lesions who were undergoing investigations for in vitro fertilization (IVF). In most of them, intrauterine pathology was not the sole cause of subfertility. In all women the lesions were diagnosed by hysterosalpingography or vaginal ultrasound examination with fluid instillation and subsequent hysteroscopy. In 122 patients the lesion was removed hysteroscopically with the resectoscope under light sedation in an outpatient setting. No complications occurred during or after surgery. The remaining 24 patients with polyps smaller than 2 cm underwent IVF treatment directly. In the 122 women who proceeded to treatment, further diagnostic office hysteroscopy was also performed. Group A consisted of 82 women with up to three polyps (65 <2 cm, 17 >2 cm); group B, 40 women with up to five fibroids smaller than 4 cm; and group C, 24 women with ultrasound diagnosis of polyps smaller than 2 cm for whom no treatment was carried out. In groups A and B the diagnosis was confirmed histologically. All these women subsequently underwent IVF. In group A (<2 cm polyps) the pregnancy rate was 28% per embryo transfer, and in the rest of group A (>2 cm) it was 40%. In group B the pregnancy rate was 46% and in group C 35%. We think that polyps less than 2 cm diameter do not require removal before IVF and do not affect the outcome of the subsequent pregnancy.

Journal Article↗
PubMed1998

Alleles of APC modulate the frequency and classes of mutations that lead to colon polyps.

Most inherited mutant alleles of the adenomatosis polyposis coli gene (APC) cause the appearance of large numbers of colon polyps, the familial polyposis syndrome. (These mutant alleles are designated APCp alleles.) A subset of APC mutations, the attenuated or APC(AP) alleles, predispose to only a few colon polyps. This leads to the hypothesis that if mutation of the inherited normal allele is rate limiting in polyp development, the increased number of polyps associated with the APCp allele indicates that the frequency of mutations that can lead to polyp formation is higher among APCp carriers than among APC(AP) carriers. We have previously suggested that the APC protein might modulate the frequency of mutations, such as loss of heterozygosity (LOH), necessary for colon polyp formation. We thus reasoned that tumours from patients who carry an APC(AP) allele might show a reduced frequency of LOH compared with tumours from patients who carry an APCp allele. Loss of AAPC mutant alleles is designated as LOH(AP). Screening of tumours from APC(AP) carriers revealed a reduction of LOH compared with that of an unselected group of polyposis patients. In fact, no loss of the inherited APC(N) allele was observed, although sequencing showed that the inherited APC(N) allele had frequently undergone point mutations and small deletions in the tumours. A low frequency loss of the inherited APC(AP) allele was seen. These findings support the suggestion that the APC(AP) allele has residual gene activity and that this activity modulates the spectrum and frequency of mutations that lead to adenoma formation.

Adenomatous Polyposis Coli↗