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PubMed1979

Polyps of the urethra in children.

The authors present two cases of polyps of the urethra occurring exclusively in boys: one in a 12-month-old infant, the other in a 15-year-old boy. In both patients the polyp caused dysuria or urinary retention. Diagnosis was based on mictional cystography. This examination usually gives a picture of a filling defect spotted in the area of the bladder neck. During miction the defect may move deeper into the urethra. An endoscopic examination may be also helpful. The authors believe that treatment should consist in total excision of the polyp together with its base through the open urinary bladder. Polyps of the urethra have to be differentiated from a valve of the posterior urethra or a shadowless calculus. After total excision of the polyp prognosis is good.

Adolescent↗
PubMed1991

Peutz-Jeghers syndrome associated with adenocarcinoma of the cecum and focal carcinomas in hamartomatous polyps of the colon: a case report.

We report herein a case of Peutz-Jeghers syndrome associated with an adenocarcinoma of the cecum and four focal cancers arising in hamartomatous polyps of the colon. There were a total 27 polyps in the intestine; 4 in the small intestine and the rest in the large intestine. The hamartomatous polyps in which the 4 focal cancers were found showed no component of adenoma, and the other polyps removed from the colon and small intestine at the same time were all hamartomas with no evidence of dysplasia or malignancy. This case was rare in that multiple focal cancers may have arisen directly from the hamartomous polyps of the colon.

Adenocarcinoma↗
PubMed1988

Risk factors and screening techniques in 500 patients with benign and malignant colon polyps. An urban community experience.

The authors have reviewed 13 years of experience with 500 patients who had 1240 polypoid lesions identified at colonoscopy. An analysis of these patients' symptoms, signs, and past histories prior to initial colonoscopy were collated by computer in order to provide useful information to help in early identification of patients with polyps and to define specific risk factors in patients with polypoid cancers (71 patients with 79 cancers). This study shows that the 500 patients with colon polyps, with and without cancer, are similar in all parameters measured. Their symptoms correlated poorly with the pathology or location of the polyp. Frequently unrelated symptoms brought the patient to the attention of their private physician. A significant high-risk group of patients identified were those with prior colon polyps and cancer. A positive family history of colon cancer was not common. Barium enema, the most common examination, was performed in 90 percent of patients and was the first test to diagnose polyps in 54 percent. Flexible sigmoidoscopy, only more recently available and performed in 20 percent of the patients, established a diagnosis of polypoid disease 96 percent of the time. This study supports screening for all adults above 40 years of age with flexible sigmoidoscopy and stool occult blood.

Adult↗
PubMed1988

Juvenile polyps at the site of a ureterosigmoidostomy. Report of five cases.

Five cases of juvenile polyps at the level of a ureterosigmoidostomy are described. One of the juvenile polyps contained an area of adenomatous tissue. The mechanisms that might cause these polyps are discussed. The mechanisms that might cause these polyps are discussed. The presence of adenomatous tissue in one of the patients may be a step of the polyp cancer sequence at the level of ureteral implantation in the colon. The authors make a plea for a call-up and close follow-up of all patients who have a ureterosigmoidostomy.

Adult↗
PubMed1988

Phenotypic markers for a spectrum of colonic polyps and cancers. The malignancy potential ratio.

The purpose of this study was to determine if a panel of monoclonal antibodies could define phenotypic markers that could be used in risk assessment of a spectrum of colonic polyps and colon cancers. Using the ABC immunoperoxidase technique on formalin-fixed sections of surgical specimens, the following results were obtained: 1) Mab B72.3 demonstrated increased reactivity in villous lesions and cancers compared with hyperplastic polyps and tubular adenomas; 2) Mab anti-CAA demonstrated increased reactivity in polyps compared with colon cancers; and 3) using the two antibodies (Mab B72.3 and Mab anti-CAA), a malignancy ratio was obtained that determined malignancy risk for individual polyps. No hyperplastic polyp gave a positive ratio, but about 30 percent of villous lesions were positive. Over 50 percent of villous lesions greater than 2 cm in size had a positive ratio. The malignancy potential ratio may be a valuable marker in assessing risk of malignancy in an individual case.

Adenomatous Polyposis Coli↗
PubMed1987

The pathogenesis of inflammatory polyps.

Eighty-six consecutive colonic resection specimens for inflammatory bowel disease were studied to determine the modes of inflammatory polyp formation. The two major groups of inflammatory polyps were polypoid mucosal tags due to undermining ulceration and mature inflammatory polyps composed of mucosa, muscularis mucosae, and a submucosal core. Mature inflammatory polyps were derived from polypoid mucosal tags after regeneration and the adjacent mucosa showed regenerative changes and submucosal scarring. The study confirms that ulceration which undermines the muscularis mucosae is the major precursor of inflammatory polyps.

Colitis, Ulcerative↗
PubMedDate not supplied

Adenomatous polyps of the ileocecal valve: report of three cases.

Lesions of the ileocecal valve are uncommon and include various inflammatory diseases, submucosal fatty infiltration, edema, and neoplasia. Of the neoplastic lesions, adenomatous polyps are distinctly rare, despite their frequency in the remainder of the colon. Three patients with adenomatous polyps of the ileocecal valve are added to the seven previously reported cases. One had a large pedunculated polyp, another had polyps resulting from familial polyposis, and the third had circumferential adenomatous polypoid hyperplasia and the ileocecal-valve syndrome. Although many lesions of the valve produce the characteristic symptoms, the diagnosis of the ileocecal-valve syndrome is seldom made. Most ileocecal-valve lesions are incidental findings on barium-enema studies and may be carefully followed. The indications for operative intervention are suspicion of malignancy and the presence of troublesome symptoms. If malignancy is likely, a right colectomy should be done. Segmental resection is the procedure of choice for the ileocecal-valve syndrome. Adenomatous polyps may require simple polypectomy, segmental resection, or even subtotal colectomy. Following recognition of these unusual disorders the exact management is individualized.

Adult↗
PubMedDate not supplied

Management of focally malignant pedunculated adenomatous colorectal polyps.

A hospital record review identified 59 patients whose sole colorectal pathology was a pedunculated, adenomatous polyp with a focus of malignancy confined to the head of the tumor. Thirty-one patients had polyps with in-situ carcinoma, and 28 patients had foci of invasive carcinoma. Sixteen patients who had lesions in situ underwent laparotomy, and not a single instance of metastasis was found. Twenty patients who had carcinoma in situ received only local treatment, and 15 are alive and well. None of the patients treated locally has developed subsequent colorectal cancer, and 12 have survived at least five years following treatment. Of the 28 patients who had invasive carcinoma confined to the head of an adenoma, 19 are alive and well, and 17 have lived five years or more following treatment. There was one instance of lymph-node metastasis, which occurred in a patient who had a malignant lesion extending to the neck of the tumor and tumor cells in the lymphatics in the head of the polyp. All of the eight patients treated locally are alive and well, and five have lived at least five years following treatment. The results of this study, coupled with the rarity of reported metastasis from focally malignant, pedunculated, adenomatous colorectal polyps, strongly suggest that local treatment is sufficient for the vast majority of these lesions. Evidence from the literature suggests that resective therapy should be considered when 1) lymphatics within the head of the polyp contain tumor cells; 2) the cancer is highly undifferentiated; 3) the pedicle is extremely short and malignant changes extend to the neck of the adenoma.

Adult↗
PubMed1982

Clinical accuracy in the diagnosis of small polyps using the flexible fiberoptic sigmoidoscope.

Seventy-eight patients referred to a specialist clinic for investigation of large-bowel symptoms were examined with the flexible fiberoptic sigmoidoscope. One hundred twenty polyps were treated, including 84 adenomatous and 32 hyperplastic polyps. Sixty-nine per cent of polyps were situated beyond 18 cm from the anal verge. Endoscopic diagnosis was correct in 82 per cent of cases. The size of the polyp assessed endoscopically strongly influenced the clinical diagnosis but proved unreliable as a means of making an accurate diagnosis. Results indicate that whenever possible all polyps of all sizes should be removed for microscopic examination.

Adenoma↗
PubMed1982

Endoscopic polypectomy for the removal of polyps of the small intestine.

Since intussusception is a common complication of the Peutz-Jeghers polyps, laparotomy should be recommended to remove them. However, all of them will not be palpable or discernible during laparotomy. Operative endoscopy was employed for removing polyps of the small intestine of a 22-year-old female who was previously diagnosed as Peutz-Jeghers syndrome. Using a newly designed enteroscope with two channels (SIF-2C, Olympus), four large polyps over 1 cm in size were removed from the ileum and jejunum with safety. Endoscopic polypectomy is one of the rapidly advancing fields and widely spread methods in gastrointestinal endoscopy since the introduction of electrosurgical techniques. Although the endoscopic removal of polyps arising from the esophagus, stomach, duodenum, colon and rectum can be performed with ease and safety, polypectomy for the polyps of the small intestine has never been performed because of the technical difficulties to handle the scope in the small intestine. Two channel enteroscope resolved this problem. Therefore, it is emphasized that double channel enteroscope makes the polypectomy in the small intestine possible and the indication of enteroscopy will be more extended.

Adult↗
PubMed1994

Role of laparoscopic cholecystectomy in treating gallbladder polyps.

Since the application of laparoscopic cholecystectomy (Lap C) to gallbladder polyps has not yet been fully evaluated, we performed Lap C on 26 patients with gallbladder polyps. Pathological examinations showed adenocarcinoma in three patients, adenoma in two, and cholesterol polyp in 21. Preoperative diagnoses of the cases with adenocarcinoma were a cholesterol polyp in one patient and an adenoma in two. Adenocarcinoma was confirmed to reside in the mucosa without any invasion of lymphatic ducts or small vessels in the three patients. This procedure was considered to be sufficient for this grade of cancer, and, therefore, no additional operations were performed. At present, our policy is to resect by Lap C a gallbladder polyp having a maximum size larger than 10 mm and a tendency to grow or presenting with suspicion of adenoma. When cancer is suspected by preoperative examinations, however, traditional surgery may be recommended.

Adenocarcinoma↗
PubMed2002

Comparison of cyclo-oxygenase 2 expression in colorectal serrated adenomas to expression in tubular adenomas and hyperplastic polyps.

BACKGROUND AND AIMS: Serrated adenoma (SA) is a newly defined category of colorectal neoplasia that contains features of both adenoma and hyperplastic polyp, and has two patterns, hyperplastic and cerebriform patterns. Since cyclooxygenase 2 (COX-2) has been found upregulated in colorectal cancers and adenomas, we examined whether either the hyperplastic or cerebriform pattern of SA has the potential for tumor progression and should be a target for clinical treatment. PATIENTS AND METHODS: An immunohistochemical scoring system was used to compare COX-2 expression in colorectal SAs (n=79), tubular adenomas (n=66), and hyperplastic polyps (n=21). RESULTS: COX-2 scores were significantly higher in SA of the cerebriform pattern (n=44) than in SA of the hyperplastic pattern (n=35). There was no difference in COX-2 scores between SA of the cerebriform pattern and tubular adenoma. In SA accompanied by hyperplastic polyp (n=26) the hyperplastic components expressed little COX-2, the same as traditional hyperplastic polyps. COX-2 expression in the SA component was similar to that in pure SA. CONCLUSION: SA of the cerebriform pattern should be treated similarly as traditional tubular adenomas. COX-2 induction may additionally be involved in progression from hyperplastic polyp to SA.

Adenoma↗
PubMed2002

Immunohistochemical expression of VEGF and VEGF receptors in nasal polyps as compared to normal turbinate mucosa.

The factors involved in the development of chronic inflammation and edema in nasal polyps remain to be clarified. The expression of vascular endothelial growth factor (VEGF) has been described in plasma cells, suggesting that plasma cells may play a major role in the development of edema in nasal polyps through the production of VEGF. We performed immunohistochemical analysis using specific antibodies to VEGF and to the known VEGF receptors, VEGFR-1 and VEGFR-2, on paraffin sections of human nasal polyps ( n=11) and controls of human mucosa of the normal middle turbinates ( n=6). In normal turbinate mucosa, sporadic immunostaining for VEGF was observed throughout the endothelial cells of the small veins and arteries. VEGFR-1 and VEGFR-2 expression was faint in the healthy turbinates. In nasal polyp tissues, strong immunostaining for VEGF was found in the endothelium of blood vessels and in the infiltrating perivascular inflammatory cells. Fibroblasts also stained for VEGF. Strong immunolabeling to VEGFR-1 was evident in the vascular endothelium, whereas weak to moderate VEGFR-1-staining was generally confined to scattered mononuclear round cells. Mononuclear round cells and the endothelium of capillaries revealed immunoreactivity to VEGFR-2. These findings support a role for VEGF and its receptors, VEGFR-1 and VEGFR-2, in the development and perpetuation of edema and angiogenesis in nasal polyps.

Endothelial Growth Factors↗
PubMed2002

Localization of ZO-1 and E-cadherin in the nasal polyp epithelium.

The tight junction and adherens junction complex of epithelial cells, which show disturbed localization in some inflammatory conditions, serve as an important paracellular barrier in polarized epithelial cells. However, very little information is available about the expression of the tight-junction protein, ZO-1, and the adherens-junction protein, E-cadherin, in nasal polyp epithelium. The aim of this study was to investigate the localization of ZO-1 and E-cadherin in nasal polyp epithelia by means of immunohistochemistry. We classified nasal polyp epithelia from 20 patients into pseudostratified ciliated columnar epithelia, basal and mucous cell hyperplasia and squamous metaplasia according to their dominant cell type. The expression of ZO-1 and E-cadherin in each epithelial cell type was analyzed and compared with normal ethmoidal mucosa, which was taken as a control. In pseudostratified ciliated columnar epithelia, as in the normal control epithelia, ZO-1 showed a spot-like distribution on the apicolateral junction of the adjoining cells. E-cadherin labeling was seen as a distinct basolateral staining on the mid-portion of the lateral walls. In basal and mucosal cell hyperplasia-dominant epithelia, the localization of ZO-1 positivity was similar to that in the normal mucosa, whereas the E-cadherin on the lateral walls showed a more intense distribution along the lateral cell-to-cell junction. In the nasal polyp epithelia showing squamous metaplasia, ZO-1 was rarely expressed; by contrast, E-cadherin exhibited stronger expression on the periphery of the cells in a circumferential fashion. In conclusion, in nasal polyp epithelia, ZO-1 showed down-regulation as in the worsening of epithelial dedifferentiation, whereas E-cadherin exhibited up-regulation with the increasing severity of epithelial remodeling.

Adult↗
PubMed2004

Infarcted angiomatous nasal polyps.

Angiomatous nasal polyps are a rarely reported subtype of inflammatory sinonasal polyps that are characterized by extensive vascular proliferation and ectasia. Compromise of their vascular supply may occasionally lead to infarction, resulting in clinical, radiological and pathological features that simulate a neoplastic process. In the present paper, the salient characteristics of this unusual entity are described. The clinical, radiological and pathological features of two patients with infarcted angiomatous nasal polyps are presented. Grossly, the polyps had an unusual inhomogenous appearance and texture and were associated with a foul odor. CT findings included bony expansion and destruction. MRI findings included markedly inhomogenous contrast enhancement on T1-weighted images. Histopathologically, both cases showed abundant vascular ectasia, with widespread intraluminal thrombosis and necrosis. Recanalization and reparative changes were also present. Angiomatous nasal polyps are poorly documented in the literature. Although entirely benign, they may simulate neoplastic processes, thus awareness of their existence is of considerable importance.

Adult↗
PubMed2005

Cholesterol granulomas in antrochoanal polyps: a clinicopathologic study.

The purpose of this study was to investigate antrochoanal polyps with cholesterol granuloma (CG), which is a granulomatous reaction to cholesterol crystals that has been precipitated in the tissue. It is usually associated with chronic middle ear disease, common in the mastoid air cells, less common in the orbit and rarely found in the paranasal sinuses. The aim of this study was to analyze the etiology and pathological findings of antrochoanal polyps associated with cholesterol granuloma. This is a retrospective study of five cases of antrochoanal polyp with cholesterol granuloma, (four males and one female between 15 and 77 years of age) who presented with nasal obstruction, rhinorhea and snoring. The cases were clinically and histologically reviewed. Four patients were treated endoscopically and one by intranasal polypectomy without endoscope. There was no recurrence during the follow-up between 24 to 36 months (mean 31.2 months). Five uncommon cases with antrochoanal polyp with cholesterol granuloma are presented. The cholesterol granulomas consist of fibrous granulation tissue containing cholesterol crystals with surrounding foreign body giant cells. The pathogenesis of antrochoanal polyp with cholesterol granuloma is unclear, and further investigations are needed.

Adolescent↗
PubMed2005

Why is the hyperplastic polyp a marker for the precancerous condition of the gastric mucosa?

It is well known from the older literature that gastric carcinomas are more likely to develop in a stomach containing hyperplastic polyps. The reason why such a stomach should represent a precancerous condition is, however, largely unexplained. The aim of this study was to determine the disorders of the gastric mucosa in which hyperplastic polyps occur. In 244 patients with hyperplastic polyp, in whom at least two additional biopsies each from the antrum and corpus were available, gastritis was classified on the basis of the updated Sydney System. In none of the 244 patients was the gastric mucosa found to be normal. The most common disorder, at 51.3%, was autoimmune gastritis of the corpus mucosa, while chronic active Helicobacter pylori (Hp) gastritis was seen in 37.3% of the patients. Of the patients with Hp gastritis, 56.1% had corpus-dominant Hp gastritis. Other forms were relatively rare: when A-gastritis, corpus-dominant Hp gastritis and any other form of Hp gastritis were lumped together as a precancerous condition, these changes were found in 88.6% of the patients with hyperplastic polyps of the stomach. In the presence of hyperplastic polyps of the gastric mucosa, additional biopsies obtained from the antrum and corpus should always be performed to obtain a basis for deciding whether to apply Hp eradication treatment as potential carcinoma prophylaxis.

Adult↗
PubMed2000

Details of hyperplastic polyps of the stomach shrinking after anti-Helicobacter pylori therapy.

The precise etiology of hyperplastic polyps of the stomach is unknown, but recent studies suggest that they arise as a consequence of inflammation occurring in intimate association with Helicobacter pylori infection. The process of polyp regression after anti-H. pylori therapy, however, is unclear. Here we report a patient with large hyperplastic polyps of the stomach that regressed markedly after anti-H. pylori therapy. Histological examination of the regressed polyps revealed a decrease in the height of the hyperplastic foveolar epithelium and a decrease in the amount of inflammatory cell infiltration in the stroma. In addition, the percentage of Ki-67-positive hyperplastic epithelial cells markedly decreased after anti-H. pylori therapy, indicating that the epithelial cell proliferation rate had markedly decreased after treatment. At the same time, the degree of cyclooxygenase-2 expression in epithelial cells in the polyps decreased after treatment. Because cyclooxygenase-2 is expressed at sites of inflammation or neoplasm, these findings are consistent with a decrease in inflammatory cell infiltration, and represent resolving inflammation.

Anti-Bacterial Agents↗