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PubMed1986

Results of the removal of malignant colonic polyps.

Two-hundred-and-twenty-six patients, aged 26 to 80, had 238 malignant polyps removed. According to the WHO classification, only those lesions in which invasive growth is detected, are termed malignant polyps. Immediately after receiving the histological report, eight patients were operated on. Later, over periods of up to 18 months following the removal of polyps, eight more patients were operated upon for recurrences. The results of follow-up over periods of up to 10 years indicate the efficiency of endoscopic removal of malignant polyps irrespective of the grade of the invasive growth. Taking their experience as a basis, the authors suggest that the plan of approach to further stages of treatment should be based not on the pathological findings in the removed polyps, but on the results of regular follow-up of the patients.

Adult↗
PubMed1990

[The association of skin fibromas and intestinal polyps: an age-related effect].

To test the association between skin tags and colorectal polyps, 157 consecutive patients (60 men and 97 women, mean age 61.2 [17-92] years) who during their hospitalization had a coloscopy for gastro-enterological indications, underwent independently medical and dermatological examinations. 61 patients (38%) had colorectal polyps, 83 (53%) skin tags; 39 had both (24.8%). Thus the probability of having colorectal polyps was significantly higher for a person with than without skin tags (P = 0.033). But this relationship was entirely age-dependent. Discriminant analysis indicated that in addition to age (F = 15.1) the presence of skin tags (F = 1.2) was only a small additional factor in the recognition of those with colorectal polyps. Skin tags are thus of little help in the diagnosis of polyps in elderly patients.

Adenocarcinoma↗
PubMed2000

A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group.

BACKGROUND: After patients have undergone colonoscopic polypectomy, it is uncertain whether colonoscopic examination or a barium enema is the better method of surveillance. METHODS: As part of the National Polyp Study, we offered colonoscopic examination and double-contrast barium enema for surveillance to patients with newly diagnosed adenomatous polyps. Although barium enema was performed first, the endoscopist did not know the results. RESULTS: A total of 973 patients underwent one or more colonoscopic examinations for surveillance. In the case of 580 of these patients, we performed 862 paired colonoscopic examinations and barium-enema examinations that met the requirements of the protocol. The findings on barium enema were positive in 222 (26 percent) of the paired examinations, including 139 of the 392 colonoscopic examinations in which one or more polyps were detected (rate of detection, 35 percent; 95 percent confidence interval, 31 to 40 percent). The proportion of examinations in which adenomatous polyps were detected by barium enema colonoscopy was significantly related to the size of the adenomas (P=0.009); the rate was 32 percent for colonoscopic examinations in which the largest adenomas detected were 0.5 cm or less, 53 percent for those in which the largest adenomas detected were 0.6 to 1.0 cm, and 48 percent for those in which the largest adenomas detected exceeded 1.0 cm. Among the 139 paired examinations with positive results on barium enema and negative results on colonoscopic examination in the same location, 19 additional polyps, 12 of which were adenomas, were detected on colonoscopic reexamination. CONCLUSIONS: In patients who have undergone colonoscopic polypectomy, colonoscopic examination is a more effective method of surveillance than double-contrast barium enema.

Adenoma↗
PubMed2000

Endoscopic piecemeal resection with submucosal saline injection of large sessile colorectal polyps.

BACKGROUND: Because endoscopic en bloc resection of large, sessile colorectal polyps is technically difficult, they are usually resected piecemeal. However, piecemeal resection makes it difficult to evaluate the completeness of the resection histopathologically. In this study the efficacy of endoscopic piecemeal resection of large, sessile colorectal polyps was investigated after follow-up greater than 1 year. METHODS: We removed 56 sessile colorectal polyps 2 cm or greater in diameter in 56 patients by using an endoscopic submucosal saline injection technique. Endoscopic examinations were repeated at 3, 6, and 12 months and longer after initial endoscopic resection. If no residual tumor was found endoscopically and histologically, the patient was considered to be "cured." RESULTS: Of the 56 polyps, 14 (25%) were resected en bloc, and 42 (75%) were resected piecemeal. Of the 42 patients treated with piecemeal resection, 23 (55%) required additional endoscopic or surgical interventions. In patients followed 1 year or longer after initial treatment, the cure rate by en bloc resection was 100% (14 of 14) and that by piecemeal resection was 83% (35 of 42). Arterial bleeding occurred in 4 patients (7%) during or after endoscopic resection. In 3 of them, bleeding was stopped by endoscopic clipping, but 1 patient required emergent laparotomy. CONCLUSIONS: Endoscopic piecemeal resection after submucosal saline injection with an intensive follow-up program is a safe and effective treatment for large, sessile colorectal polyps.

Adult↗
PubMed1995

Loss of Apc heterozygosity and abnormal tissue building in nascent intestinal polyps in mice carrying a truncated Apc gene.

Mutations in the APC (adenomatous polyposis coli) gene appear to be responsible for not only familial adenomatous polyposis but also many sporadic cases of gastrointestinal cancers. Using homologous recombination in mouse embryonic stem cells, we constructed mice that contained a mutant gene encoding a product truncated at a 716 (Apc delta 716). Mendelian transmission of the gene caused most homozygous mice to die in utero before day 8 of gestation. The heterozygotes developed multiple polyps throughout the intestinal tract, mostly in the small intestine. The earliest polyps arose multifocally during the third week after birth, and new polyps continued to appear thereafter. Surprisingly, every nascent polyp consisted of a microadenoma covered with a layer of the normal villous epithelium. These microadenomas originated from single crypts by forming abnormal outpockets into the inner (lacteal) side of the neighboring villi. We carefully dissected such microadenomas from nascent polyps by peeling off the normal epithelium and determined their genotype by PCR: all microadenomas had already lost the wild-type Apc allele, whereas the mutant allele remained unchanged. These results indicate that loss of heterozygosity followed by formation of intravillous microadenomas is responsible for polyposis in Apc delta 716 intestinal mucosa. It is therefore unlikely that the truncated product interacts directly with the wild-type protein and causes the microadenomas by a dominant negative mechanism.

Adenoma↗
PubMed2000

Vascular permeability factor/vascular endothelial growth factor in nasal polyps.

Although the aetiology of polyps is still, for the most part, unknown, the disease is known to involve tissue oedema. Vascular permeability/vascular endothelial growth factor (VPF/VEGF) is a major inducer of angiogenesis and capillary permeability. This study investigated VPF/VEGF expression in biopsies of nasal polyps from 39 patients and in healthy nasal mucosa from 10 patients by immunohistochemical staining. Staining for VPF/VEGF in the mucosal surface and in the glandular epithelium of nasal polyps was weaker than in normal controls. In two patients, strong staining for VPF/VEGF was found in a granular pattern in mast cells, while the mast cells in other polyposis patients appeared to be largely degranulated. VPF/VEGF was not seen in the mast cells of control patients. Although expression of VPF/VEGF was not increased in the epithelium of the nasal polyps, VPF/VEGF secreted from mast cells may take part in nasal polyp formation.

Adolescent↗
PubMed2001

Analysis of proteoglycan gene messages in human nasal mucosa and nasal polyp using dot blot hybridization.

It has been suggested that the formation and growth of nasal polyp require the remodeling of extracellular matrix. Proteoglycans (PGs) are major components of the extracellular matrix that maintain the integrity of structural tissue. The leucine-rich repeat PGs include lumican, decorin and biglycan and have many important biologic activities in various pathologic conditions, including the remodeling of the extracellular matrix. Therefore, these small-PG families may be involved in the formation and growth of nasal polyp. In the present study, surgical specimens of nasal polyps and nasal mucosa were assessed for expression of mRNA coding for lumican, decorin and biglycan using reverse transcriptase-polymerase chain reaction followed by dot blot hybridization. Lumican, decorin and biglycan mRNA were expressed in all tissue samples examined. Semiquantitative dot blot hybridization revealed that the levels of the lumican and biglycan messages are lower in nasal polyp tissues than in nasal mucosa. The decorin messages in nasal polyp were expressed at levels similar to those in nasal mucosa. These results suggest that lumican, decorin and biglycan may be important components of the extracellular matrix in nasal mucosa. Considering the function of these PGs, normal levels of decorin associated with low levels of biglycan and lumican may play a role in the pathogenesis of nasal polyposis.

Adult↗
PubMed2004

Effects of topical amphotericin B on expression of cytokines in nasal polyps.

OBJECTIVE: Although chronic rhinosinusitis (CRS) is one of the most frequently reported chronic diseases its etiology is not well understood. Recently, fungi have been proposed to influence the chronicity of rhinosinusitis. If fungi do play an important role then topical antifungal treatment may improve the inflammatory process of CRS. Therefore, in this study we measured inflammatory cytokine levels in nasal polyps after intranasal antifungal irrigation. MATERIAL AND METHODS: Nasal polyps were collected before and 4 weeks after treatment with 100 mg/l topical amphotericin B (n = 16), 50 mg/l topical amphotericin B (n = 14) or normal saline (n = 11). The cytokine--IL-5, IL-8, interferon-gamma, RANTES--protein content of polyp homogenates were determined by means of ELISA. RESULTS: Nasal polyps were found to contain large amounts of cytokines (IL-5, IL-8 and RANTES) compared with normal inferior turbinates. After 4 weeks of treatment with topical agents, IL-5 levels tended to decrease in comparison with those of the other cytokines, but this difference was not statistically significant. CONCLUSIONS: Topical amphotericin B treatment and nasal saline irrigation both influence the expression of nasal polyp cytokines. Topical nasal irrigation may influence the inflammatory process of CRS.

Administration, Intranasal↗
PubMed2005

Distributional characteristics of sulfated glycosaminoglycans in normal human nasal mucosa and nasal polyp.

The results of this study suggest that an altered expression pattern of sulfated glycosaminoglycans (GAGs) in nasal polyp may not function as a charge restriction barrier for vascular permeability, contributing to the leakage of protein and fluid. Sulfated GAGs are found on the vascular endothelial surface and in the extracellular matrix in various tissues and organs, suggesting that these materials constitute a negatively charged screen restricting the movement of circulating plasma molecules. This study was designed to elucidate the distributional characteristics of sulfated GAGs in normal human nasal mucosa and nasal polyp in order to understand their roles in the formation of nasal polyp. The expression and localization of sulfated GAGs in normal human nasal mucosa and nasal polyp were detected light microscopically with the histochemical method using poly-L-lysine-conjugated colloidal gold followed by silver enhancement. Sulfated GAGs in normal human nasal mucosa were distributed in the epithelial layer, vascular endothelial surface, submucosal gland and extracellular matrix. In nasal polyp, intense staining was also seen in the glandular structure and epithelial layer. However, the vascular endothelium and extracellular matrix exhibited either a weak reaction or no reaction.

Adult↗
PubMed2005

Cyclooxygenase-2 expression in endometrial polyps during menopause.

OBJECTIVE: To determine whether cyclooxygenase-2 (COX-2) is expressed in endometrial polyps during menopause and how previous hormone use may affect this expression. PATIENTS AND METHODS: Fifty-two postmenopausal patients with endometrial polyps were enrolled for this study. Eighteen patients had no history of previous hormone use, while the remaining patients had used vaginal conjugated estrogens for short periods of time (n = 25) or were long-term users of tibolone (n = 5) or tamoxifen (n = 4). The endometrial polyps were removed by hysteroscopy, and COX-2 and Ki-67 expression were measured in tissue samples by immunohistochemistry. RESULTS: Endometrial polyps expressed COX-2 in the glandular epithelium and this expression was not significantly greater in patients who had previously used tibolone, tamoxifen or vaginal estrogens. However, Ki-67 expression was greater in the group using vaginal estrogens compared with the group of non-users; while in the other two treatment groups Ki-67 expression was less than in hormone never-users. CONCLUSION: COX-2 expression is present in endometrial polyps during menopause and may play a role in their growth regulation.

Cyclooxygenase 2↗
PubMed2003

Localization and quantitation of eotaxin mRNA in human nasal polyps.

Nasal Polyps (NPs) are the most common mass lesions found in the nose. NPs cause airway obstruction, prevent normal sinus function, and can lead to infection of the eye, facial bones and central nervous system. The predominant cell type inhabiting NPs is the eosinophil, and the chemokine eotaxin is believed to play an important role in NP eosinophilia. The objective of this study was to localize and quantitate expression of eotaxin mRNA in human NPs. Total RNA was isolated from NPs that were collected from 5 patients who had undergone polypectomy. Portions of these polyps were also fixed in formalin, embedded in paraffin, and sectioned onto slides for use in in situ hybridization. Total RNA from one patient was used in a reverse transcriptase polymerase chain reaction using eotaxin specific primers to generate a human eotaxin cDNA. The eotaxin cDNA was cloned and used to generate probes for Northern blot analyses and for use in in situ hybridization (ISH). Eotaxin mRNA was detected by Northern analyses in all patient samples, though the relative expression level in each patient varied. ISH localized the expression of eotaxin mRNA specifically in eosinophils in 2 of the 3 patients in the study for whom the embedded polyp tissue appeared sufficiently well preserved for mRNA localization. Our findings suggest that eosinophilia in NPs is likely a self-amplification process whereby increasing numbers of eosinophils are recruited to enter the polyp as a result of production of eotaxin by eosinophils already within the polyp.

Blotting, Northern↗
PubMed1990

Alcoholic beverages and adenomatous polyps of the sigmoid colon: a study of male self-defence officials in Japan.

The drinking habits of 86 men with adenomatous polyps of the sigmoid colon were compared to those of 1184 men with normal colonoscopy among middle-aged male self-defence officials. After adjustment for rank, smoking history and rice consumption, total ethanol intake was positively associated with the risk of adenomatous polyps. The odds ratio (OR) was 2.4 (95% confidence interval (CI) 1.0-5.5) for men consuming at least 60 ml of ethanol per day. Among five alcoholic beverages (shochu, beer, sake, whiskey and wine), both sake and beer showed a dose-response relationship with the risk of adenomatous polyps although the association with beer was less striking. Shochu was the largest source of ethanol intake in the study population, but there was virtually no association between shochu consumption and adenomatous polyps. Men drinking wine had a significantly increased risk, but these men were too few to examine the relation in detail. The findings suggest that the consumption of specific alcoholic beverages rather than ethanol itself is associated with an increased risk of adenomatous polyps of the sigmoid colon.

Adenoma↗
PubMed1993

Atheroemboli-associated polyps of the sigmoid colon.

Atheroemboli-associated inflammatory type polyps localized to a portion of the sigmoid colon occurred in a 68-year-old diabetic man presenting with a 2-year history of bloody diarrhea and abdominal pain. The patient underwent segmental resection of the sigmoid colon. The specimen contained 15 polyps ranging from 0.3 to 1.9 cm in greatest dimension, localized to an 8-cm length of sigmoid colon. The polyps had an edematous submucosa with a superficially ulcerated mucosa. Microscopically, arterioles within the submucosa of the polyps contained organized atheroemboli. The overlying mucosa was largely replaced by granulation tissue, with foci of coagulation necrosis present in residual mucosa. The remainder of the bowel was unremarkable. The histologic diagnosis of atheroembolization to the gastrointestinal tract is difficult, requiring the inclusion of submucosa with atheroemboli in the biopsy tissue. Ischemic ulcers and erosions as well as inflammatory polyps related to atheroemboli may require deeper biopsy for etiologic diagnosis.

Aged↗
PubMed2004

Hyperplastic (serrated) polyps of the colorectum: relationship of CpG island methylator phenotype and K-ras mutation to location and histologic subtype.

We investigated the frequency of promoter region CpG island methylation (CIM) of hMLH1, MGMT, MINT1, MINT2, and p16 and K-ras mutations in a total of 79 hyperplastic (serrated) polyps (HPs) from 75 patients and correlated the molecular profiles to polyp location in the colorectum, histologic variation, and other factors. Methylation-specific PCR (MS-PCR) was used to assay CIM status. HPs that showed CIM of one or more or two or more of the genes assayed were classified as CpG island methylator phenotype (CIMP) and CIMP-high (CIMP-H), respectively. PCR restriction fragment length polymorphism was used to assay K-ras codon 12 and 13 mutations. Logistic regression indicated a statistically significant trend for increasing odds for CIMP (P = 0.002) and CIMP-H (P < 0.001) according to proximity to the cecum or distance from the rectum. Conversely, K-ras codon 12 mutation was present in 13 of 40 (32.5%) distally located HPs compared with 2 of 39 (5.1%) proximal HPs (P = 0.006). Histologic subtype distribution varied by proximal and distal locations. Frequency of CIMP in serrated polyps with abnormal proliferation (SPAPs), differed significantly from goblet cell serrated polyps (GCSPs) (24 of 26, 92.3% vs. 6 of 13, 46.2%) (P = 0.003) and microvesicular serrated polyps (MVSPs) (26 of 38, 68.4%) (P = 0.03). Frequency of K-ras mutation in GCSPs (7 of 13, 54%) differed from that of MVSPs (6 of 38, 16%) (P = 0.01) and SPAPs (2 of 26, 8%) (P = 0.003). Location in the colorectum and histologic subtype were major determinants of the molecular profile of HPs. The molecular findings of CIMP and K-ras mutations appear to encompass most if not all HPs; CIMP profiles suggest that SPAP is the most advanced morphologic variant. We postulate that MVSP and GCSP may be precursor lesions that, if proximally located or larger, can progress to SPAP. Frequent K-ras mutations and infrequent CIMP distinguish the distal GCSP variant.

Adult↗
PubMed1996

Association of diet and colorectal adenomatous polyps: dietary fiber, calcium, and total fat.

We conducted a case-control study to investigate the relation between dietary fiber, calcium, and total fat and the risk of colorectal adenomatous polyps. We used a food frequency questionnaire to assess the usual diet for 157 cases and 480 controls. In multivariate analyses, dietary fiber was inversely associated with risk of adenomatous polyps. The odds ratio (OR) for individuals in the highest vs the lowest quartile was 0.5 [95% confidence interval (CI) = 0.3-0.9]. We found an inverse association between dietary calcium and risk of adenomatous polyps, but the protective effect was present only for individuals in the fourth vs the first quartile (OR = 0.7; 95% CI = 0.3-1.3). Intake of total fat was positively associated with risk of adenomatous polyps, but we saw no consistent trend. Calcium intake appeared to modify the effect of total fat intake on the risk of adenomatous polyps.

Adenomatous Polyps↗
PubMed2004

Dark lumen magnetic resonance colonography in a rodent polyp model: initial experience and demonstration of feasibility.

PURPOSE: We sought to assess dark lumen magnetic resonance (MR) colonography for the detection of colon polyps in a rodent model with histology as the gold standard. MATERIAL AND METHODS: Fourteen male Wistar rats were subjected to carcinogenic N-methyl-N'-nitro-N-nitrosoguanidine at the age of 4 months to induce colon neoplasms. MR imaging was performed after a time interval of 1 year. Preparation and data acquisition was performed with the animals under full anesthesia. After a body-warm saline enema images were acquired on a clinical 1.5-T whole-body MR system using a standard extremity coil. Plain and contrast-enhanced (0.3 mmol/kg; Gd-DOTA; Dotarem, Guerbet, France) 3-dimensional T1-weighted gradient recall echo images were acquired. Two radiologists analyzed the MR data sets in consensus for lesion depiction. Contrast uptake in colonic wall and polyps was quantitatively assessed by signal-to-noise ratio and contrast-to-noise ratio measurements and compared using a Wilcoxon-Mann-Whitney U test with statistical significance at a P value < 0.05. Finally, all animals were killed, and the MR imaging results were compared with pathologic findings. Sensitivity and specificity were calculated. RESULTS: By pathology, a total of 15 polyps were found in 9 of 14 rats. MR colonography detected 13 of 15 polyps measuring between 4 and 11 mm (mean 7 +/- 0.6 mm) in 8 of 9 animals, resulting in a sensitivity and specificity of 0.87 and 1.0, respectively. Compared with the precontrast data, all polyps showed a statistically significant increase in signal-to-noise ratio (78.2 +/- 6.3 to 167.4 +/- 17.7) and contrast-to-noise ratio (45.4 +/- 5.2 to 124.6 +/- 11.2). CONCLUSION: MR colonography with a dark colon lumen and a bright, contrast-enhanced colon wall appears well suited for the detection of colonic lesions in a rodent model.

Animals↗
PubMedDate not supplied

MRI of placental polyps.

OBJECTIVE: Placental polyp is intrauterine polypoid placental tissue retained after delivery or abortion and may cause life-threatening bleeding. We studied the value of MRI in diagnosing placental polyps. MATERIAL AND METHODS: Two women, 26 and 32 years old, with histologically proven placental polyp were included in this study. These patients were treated with local injections of methotrexate or transcatheter arterial embolization. The MR images before and after these treatments were studied retrospectively. RESULTS: High intensity pedunculated masses of 3-4 cm in size were observed in the expanded uterine cavity on T2-weighted and contrast-enhanced T1-weighted SE images. Bloody contents were observed around the masses. Placental polyps were more intensely enhanced than the myometrium by the contrast media, and the enhanced T1-weighted images indicated the retained placental tissues with an adherent part to the myometrium. Magnetic resonance imaging was also useful in following up the reduction in the size of the lesions and in the blood flow after the treatments. CONCLUSIONS: Magnetic resonance imaging may be useful in diagnosing and following up placental polyps.

Adult↗
PubMedDate not supplied

Positive predictive value of endoscopic features deemed typical of gastric fundic gland polyps.

BACKGROUND: Fundic gland polyps (FGPs) are now the most common gastric polyp encountered by endoscopists. However, they have minimal clinical significance. If they could be reliably predicted by endoscopic features, it might prevent the need for and cost of biopsy. GOALS: To determine the positive predictive value of endoscopic criteria deemed characteristic of FGPs. STUDY: We prospectively identified 56 consecutive patients with one or more gastric polyps deemed typical of FGPs by endoscopic criteria and submitted them for histologic analysis. Patients with familial adenomatous polyposis were excluded. RESULTS: Histologic examination confirmed that 50 (89.3%) of the 56 polyps were FGPs. Of the six polyps incorrectly predicted to be FGPs, three were determined to be of normal gastric body-type mucosa, one was uninterpretable secondary to squeeze artifact, one was a lymphoid aggregate with mucosal edema, and one was polypoid regenerative mucosa in the setting of chronic active gastritis and Helicobacter pylori infection. CONCLUSIONS: As sporadic FGPs are common and can be predicted with a high degree of accuracy based on endoscopic evaluation, it may not be necessary to submit them for pathologic examination. This practice would result in cost savings.

Adult↗