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Cyclooxygenase-2 expression in fibroblasts and endothelial cells of intestinal polyps.

Cyclooxygenase-2 (COX-2), the inducible COX isozyme, plays a key role in intestinal tumorigenesis. We have demonstrated recently that COX-2 protein is induced in the polyp stroma near the intestinal luminal surface in the Apc(Delta716) mouse, a model for human familial adenomatous polyposis, and stimulate tumor angiogenesis. However, the precise cell types that express COX-2 are still to be determined. By immunohistochemical analysis, here we show that the majority of COX-2-expressing cells in the intestinal polyps of Apc(Delta716) mice are fibroblasts and endothelial cells. Furthermore, the COX-2-expressing cells in human familial adenomatous polyposis polyps are also fibroblasts and endothelial cells. In contrast, bone marrow-derived cells such as macrophages and leukocytes express little COX-2 protein in the intestinal polyps. These results clearly indicate that fibroblasts and endothelial cells play important roles in polyp expansion by expressing COX-2, resulting in tumor angiogenesis.

Actins↗

Clinical factors influencing the eosinophil infiltration of nasal polyps.

AIMS AND METHODS: Our study, based on a retrospective chart analysis, was aimed 1) to describe the varying degree of eosinophil infiltration in a series of 263 adult patients operated on diffuse and bilateral nasal polyposis (NPS) after failure of medical treatment, in 15 cystic fibrosis patients with bilateral nasal polyps, and in 31 patients with chronic sinusitis without polyps (18 bilateral, 13 unilateral) 2) to search for clinical factors that might influence the degree of eosinophil infiltration. Eosinophil infiltration was expressed semi-quantativity as a percentage of inflammatory cells. RESULTS: Our study confirms that eosinophil infiltration is a striking feature of nasal polyposis. All patients with chronic sinusitis showed less than 10% eosinophils (mean +/- SEM = 2 +/- 2%) whereas 88% of patients with NPS showed more than 10% eosinophils (50 +/- 2%). Cystic fibrosis lied in between with 40% of patients showing more than 10% eosinophils. In idiopathic bilateral NPS the number of eosinophils was increased in patients with asthma (58 +/- 3%) and even more in Widal's triad (75 +/- 4%). Atopic patients did not have more eosinophils (52 +/- 5%). Patients treated with systemic steroids within two months before surgery showed decreased eosinophil infiltration (22 +/- 3% vs 50 +/- 2 for treated versus untreated) whereas patients treated with topical steroids did not (47 +/- 2%). CONCLUSIONS: Thus, a link might exist between clinical presentation and eosinophil infiltration. Chronic sinusitis and nasal polyps are probably not the same disease. Eosinophils appear as a link between nasal polyps, asthma and aspirin intolerance. Atopic status does not modify eosinophil infiltration of nasal polyps. Systemic steroids appear significantly more effective to reduce the eosinophil infiltrate than topical steroids in our selected group of operated patients.

Adolescent↗

[The infiltration and activation stage of eosinophils in nasal polyps].

OBJECTIVE: To assess the infiltration and activation of eosinophils in nasal polyps. METHOD: Nasal polyps from sixteen patients were investigated. The samples were stained with Chromotrope 2R histochemical and ABC immunohistochemical methods. RESULT: The majority of eosinophils in nasal polyps were activated, and there were no significant differences in the numbers of total eosinophils (Chromotrope 2R positive cells) and activated eosinophils (EG2 positive cells) between allergic and nonallergic patients. CONCLUSION: Eosinophilia is a prominent histologic feature of nasal polyps which indicates that the activated eosinophils may play vital role in the pathogenesis of nasal polyps.

Adult↗

[Expression of Th1, Th2-typed cytokines and its significance in nasal polyps].

OBJECTIVE: To evaluate the possible role of cytokines in pathophysiology and treatment of nasal polyps. METHOD: The expressions of Th1-typed cytokines IFN-gamma, IL-2, IL-12 and Th2-typed cytokines IL-4, IL-5, IL-8, IL-10, IL-13 were investigated with enzyme-linked immune sorbent assay(ELISA) in 25 patients with nasal polyps. RESULT: There was a significant upregulation of Th2-typed cytokines IL-4, IL-5, IL-8, IL-10, IL-13 in nasal polyps compared with normal nasal mucosa, especially IL-4 and IL-5 (3.9 times and 8.8 times higher than normal mucous respectively) while the expression of Th1-typed cytokines IFN-gamma, IL-2, IL-12 decreased after treated with local glucocorticoid. The levels of Th2-typed cytokines decreased significantly and Th1-typed cytokines had no obvious change. CONCLUSION: The upregulation of Th2-typed cytokines such as IL-4, IL-5, IL-8, IL-10, IL-12 may play an important role in the pathophysiology of nasal polyps and Th2-typed cytokines can be viewed as a target of treatment to nasal polyps.

Adolescent↗

Presence of platelet-activating factor in nasal polyps and eosinophils.

Platelet-activating factor (PAF) has been reported to play a role in allergy and inflammatory reactions but its role in the pathogenesis of nasal polyps remains unclear. In this study, we examined both PAF and peptide leukotrienes (peptLTs) in individual preparations from nasal polyps. The amounts of PAF were much greater than those of peptLTs in all preparations. Nasal polyps were divided into two groups according to the severity of eosinophil infiltration: a severe group (eosinophil count > or = 50/mm2) and a mild group (eosinophil count < 50/mm2). The amounts of PAF in the nasal polyps were significantly higher in the severe group than in the mild group (p < 0.01). PAF activity correlated with tissue eosinophilia and polyps obtained from patients with aspirin-sensitive asthma contained relatively large amounts of PAF, with enriched infiltration of eosinophils.

Aspirin↗

[Significance and detection of interleukin-8 in human nasal polyps].

OBJECTIVE: To investigate the distribution and content of immunoreaction interleukin-8(IL-8) antigen in the human nasal polyps. METHODS: Twenty-two cases of nasal polyp and 10 cases of normal inferior turbinate were studied with immunohistochemical SABC method and ELISA method. RESULTS: Immunohistochemical results demonstrated that IL-8 antigen staining occurred predominantly within inflammatory and epithelium cell plasm. The level of IL-8 in nasal polyp tissue was higher than in normal control specimens. The value in nasal polyp tissue was in 322.06-2091.41 pg/ml, but in normal with a range of 29.31-332.19 pg/ml. The results demonstrated a remarkable difference between the two groups (P < 0.001). CONCLUSION: These data demonstrated the presence of IL-8 antigen in nasal polyps. Thus IL-8 likely plays a significant role in the pathogenesis of this disease process. There is an important significance of finding a potential treatment method.

Adolescent↗

[Cytologic diagnosis of stomach polyps].

Cytological and cytochemical studies of smears, taken during gastrofibroscopy in 36 patients with polyps of the stomach, with the aim to ascertain cytological and cytochemical characteristics of gastric polyps depending upon their histological structure were carried out. It was established that in the case of simple glandular polyps, because of nonspecificity of morphological changes in the stomachal epithelium, a cytological investigation in establishing clinical diagnosis plays a secondary role; the presence of goblet cells in smears makes it possible to verify polyps by means of enterolysis; identification in smears of cells of the proliferating epithelium, possessing a set of pathognomic signs, enables one to diagnose cytologically a corresponding form of polyps.

Cytodiagnosis↗

[Effects of taking the pingzhi tablets on cellular infiltration in tissues of nasal polyps].

OBJECTIVE: To assess the effects of taking the "Pingzhi Tablets" on infiltration of inflammatory in tissues of chronic sinusitis and nasal polyps. METHOD: Nasal polyps from taking the "Pingzhi Tablets" treated patients (40 cases) and untreated patients (40 cases) were investigated. The samples were stained by HE and SABC-AP immunohistochemical methods. RESULT: Compared with untreated polyps, the polyps treated by taking the "Pingzhi Tablets" contained significantly lower tissue densities of CD 11b+, CD7+ positive cells. Although the densities of CD 19+ positive cells were lower in treated polyps, the differences were not statistically significant. CONCLUSION: The findings demonstrated tissue effects of treatment with taking "Pingzhi Tablets" and the treatment was effective in suppressing the inflammatory cell infiltration.

Adult↗

[Effects of corticosteroid on eosinophils and expression of transforming growth factor beta 1 in nasal polyps].

OBJECTIVE: To observe the effects of systemic steroids on the infiltration of eosinophils and the expression of TGF beta 1 in nasal polyps. METHOD: The SP immunohistochemical methods were applied to explore the expression of TGF beta 1 in nasal polyps before and after corticosteroids use; the optical density of positive cells in mucosal epithelia, eosinophils, glandular epithelium, vascular endothelial, matrix and mucous membrane was measured by using HPIAS-1,000 image-conduct system. RESULT: The expression of TGF beta 1 was positive in nasal polyps. The number of eosinophils and the expression of TGF beta 1 was significantly reduced in nasal polyps after treated with corticosteroids compared with pre-treated. CONCLUSION: The effects of systemical steroid use on the nasal polyps may depend on decreasing the infiltration of eosinophils and the expression of TGF beta 1.

Adult↗

Large endometrial polyp with sarcomatous stromal components following long-term tamoxifen treatment for breast cancer: a case report and review of the literature.

Tamoxifen is commonly used in the management of patients with breast cancer because of its anti-oestrogenic effects to the breasts. However, tamoxifen acts as an oestrogen agonist on the endometrium increasing the incidence of endometrial polyps, hyperplasia and cancer. In addition, it may be possible that tamoxifen increases the occurrence of uterine body tumours. We describe a rare case of a large endometrial polyp with sarcomatous stromal components in a 73-year-old breast cancer patient treated daily with 20 mg of tamoxifen for four years. The glands of the polyp were lined by benign appearing epithelium. The polyp was twisted and protruded from a dilated cervix at the entrance of the vagina. The patient was treated by removal of the polyp and dilatation and curretage. A postoperative computed tomography scan showed many focal hypodense lesions in the hepatic lobes with a well-defined profile suggestive of metastatic disease and the patient was referred for combined chemotherapy. In conclusion, a case of a mesenchymal malignant neoplasm arising in the uterus of a breast cancer patient treated with tamoxifen is reported and its clinical, histological and immunohistochemical features are discussed. Also, the international literature is reviewed.

Aged↗

[Laparoscopic surgery for endoscopically irretrievable colonic polyps].

AIM: The vast majority of benign colorectal neoplasms can be safely removed by colonoscopic polypectomy; while peduncolated polyps can be easily endoscopically excised, the removal of sessile polyps may be more difficult. METHODS: Between January 1997 and December 1998, 12 patients underwent laparoscopic or laparoscopic-assisted colonic resection for treatment of endoscopically irretrievable colonic polyps; this group was compared to 12 patients who underwent a laparotomic approach for polyps in the same period of time and to 23 patients who previously underwent similar laparoscopic resections. RESULTS: There were no significant differences between laparoscopic and laparotomic groups. CONCLUSION: Laparoscopic or laparoscopic-assisted colonic resection for treatment of endoscopically irretrievable colonic polyps remains our preferred method of treating these lesions.

Aged↗

[Clinical study of hysteroscopic surgery for endometrial polyps].

OBJECTIVE: To investigate the methods of different types of hysteroscopic surgery for endometrial polyps. METHODS: A total of 109 cases by different ways by hysteroscopic surgery for endometrial polyp from October 2000 to May 2002 were followed up. The mean age was 45 +/- 9 (26 - 73) years. The mean follow-up was 12 +/- 5 (3 - 22) months. The patients of menstrual disorder were asked for filling in pictorial blood loss assessment chart (PBAC) before and after the surgery. RESULTS: By the PBAC there was significant difference between before and after the surgery (P = 0.001). After the surgery, among 84 polyps with menstrual disorder, 14 cases (16.7%) were amenorrhea, 26 cases (31.0%) spotting, other 24 cases reducing the amount. Thirty-four cases that had had anemia recovered in one month after the surgery. In 16 cases dysmenorrhea, 7 cases were recovered, 7 got better, and the other 2 got worse. Of 5 cases of infertility (3 were primary and 2 were secondary), 4 cases got pregnancy after the surgery. CONCLUSIONS: The polyp patient who had menstrual disorder without desire of fertility should undergo polypectomy with endometrial resection in order to avoid recurrence. The patient who has desire of fertility should undergo polypectomy merely. If she had polyp with polypoid hyperplasia she should undergo polypectomy with endometrial resection of superficial layer. The postmenopausal patient should perform polypectomy merely or polypectomy with endometrial ablation.

Adult↗

[Expression of NO and NOS in nasal polyps].

OBJECTIVE: To investigate the expression of nitric oxide synthase(NOS) in nasal polyps tissue and also to study the function of nitric oxide in the pathology of nasal polyps. METHOD: Investigating the expression of iNOS, eNOS with immunohistochemical staining, and the expression of iNOS mRNA with hybridization in situ. Analysing the production of nitric oxide in the nasal polyps through nitrate reductase technique. RESULT: In the polyps group, eNOS located in gland cells, epithelial and vascular endothelial cells, the staining of which was a little stronger than those of controls. The staining of iNOS was fairly strong in the epithelial cells, and it expressed mostly in the inflammatory cells inside the tissue. CONCLUSION: eNOS may play a role in glandular secretion and vascular dilatation. The increase of eNOS might respond to the enhanced nasal secretion and edema of nasal mocusa. Large amount of NO produced by iNOS may deteriorate the inflammation process of nasal polyps.

Adult↗

[Effect of erythromycin on the expression of apoptotic gene on eosinophils in nasal polyps in vitro].

OBJECTIVE: To study the expression of apoptotic gene in nasal polyps and the possible effect of erythromycin on it. METHODS: Total 40 nasal polyps biopsies were detected the expression of Bcl-2, Bax, Bcl-xL as well as Fas protein on eosinophils by immunohistochemistry. The expression of Bax, Bcl-xL, Fas on eosinophils in 15 nasal polyps explants which cultured with or without erythromycin were detected also. RESULTS: In nasal polyps, the expression of Bcl-2, Bax, Bcl-xL and Fas protein on eosinophils are 5% (2/10), 65% (26/40), 40% (16/40) and 90% (36/40) respectively. As compared with inferior turbinate, there were significant difference in expression of Bax and Fas protein between two tissues (P < 0.05). After cultured with erythromycin, the expression of Bax protein increased (P < 0.05), but the expression of Bcl-xL and Fas protein had not changed. CONCLUSION: Bax may be the most significant gene which control the apoptosis of eosinophils in nasal polyps. And a possible mechaism which erythromycin promote the apoptosis of eosinophils is increase the expression of Bax.

Adolescent↗

An evaluation of left sided colonic polyps as a marker for right sided cancers.

The detection of a left-sided polyp on flexible sigmoidoscopy has been suggested as providing a heralding sign for right-sided tumours. We assessed our own experience with right-sided colonic cancers with reference to detection modality, surgical intervention and their association with left-sided polyps. We performed a retrospective review of a prospectively collected colorectal cancer database, with endoscopic and radiological records. Patients were subcategorised on the basis of the presence or absence of left-side polyps. Ninety-one consecutive patients who underwent curative surgery for right-sided colonic cancers were studied. Endoscopy was used to detect right-sided carcinomas in 10 (83%) of the 12 cases with synchronous left-sided polyps and radiological imaging utilised in 2 cases. In patients without evidence of left sided disease endoscopy was used in 40 (51%) of the 79 patients. In our experience most right sided cancers do not have a synchronous polyp evident on the left side 79 (87%).

Adult↗

Significance of distal polyps detected with flexible sigmoidoscopy in asymptomatic patients.

BACKGROUND: Colorectal cancer is a frequent cause of death from cancer. To reduce the mortality associated with this disease, regular flexible sigmoidoscopy is recommended. However, the significance of diminutive polyps (adenomatous or hyperplastic) detected during flexible sigmoidoscopy remains controversial, as does the appropriate endoscope length (35 vs 60 cm) for colorectal cancer screening. METHODS: One hundred one consecutive patients with no history of colonic disease, gastrointestinal tract symptoms, or positive results of fecal occult blood testing underwent flexible sigmoidoscopy as part of a colorectal cancer screening program. All patients with distal polyps detected during flexible sigmoidoscopy underwent colonoscopy. RESULTS: More than 25% of these asymptomatic, predominantly male subjects had colonic neoplasms or polyps detected. Fifty percent more lesions could be detected with a 60-cm sigmoidoscope than with a 35-cm sigmoidoscope, and detection of any distal polyp, whether adenomatous or hyperplastic, was associated with at least one proximal colon adenoma in 20% of patients. "Extended flexible sigmoidoscopy" for colorectal cancer screening was well tolerated by patients, as evidenced by insertion to the hepatic flexure in 25% of patients, and provided significantly more information than could be obtained with a 35-cm sigmoidoscope. CONCLUSIONS: Colorectal cancer screening should be performed with a 60-cm flexible sigmoidoscope, and distal colonic polyps or neoplasms will be detected in 25% of asymptomatic patients.

Aged↗

[Polyps of the proximal colon: rightward shift, malignancy potential and symptomatology].

To evaluate the neoplastic risk of polyps of the right hemicolon we assigned 202 polyps larger than 4 mm, consecutively resected, to two groups according to their location, proximal or distal to the splenic flexure. We compared sex and age of the patients and the following characteristics of the polyps: size 10 mm and over, adenomatous and villous component, presence of severe dysplasia and absence of a stalk. We found that polyps in the proximal colon were less frequently dysplastic and smaller; on the other side fewer of them had a stalk. A significant rightward shift was observed in the male patients over 65 years old. Apparently right hemicolon polyps are less prone to overt clinical bleeding.

Age Factors↗

A study of hypertrophied anal papillae and fibrous polyps associated with chronic anal fissures.

BACKGROUND: Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice. However, they do cause a few disturbing symptoms. This study describes the advantages of the removal of such pathologies associated with chronic anal fissure. PATIENTS AND METHODS: Following lateral anal sphincterotomy, the polyps or papillae were removed using a radio frequency device. A comparison before and after removal of the papillae or polyps was carried out for the associated complaints such as like pruritus, pricking sensation, wetness, crawling in the anus etc. In a separated randomized and prospective study, 80 patients were divided into two groups. 40 patients underwent only sphincterotomy, while in the remaining 40 patients, the papillae or polyps were removed after sphincterotomy. Symptom comparison was made before and after the procedure at 6- month follow-up. RESULTS: After one month of the procedure, the associated symptoms were significantly reduced, with a near total decline in the primary complaints of pain and bleeding. There was significant reduction in conditions like pruritus (p=0.0001), discharge per anus (p=0.0001), crawling sensation in the anus (p= 0.0006) and sense of incomplete evacuation (p= 0.0001). The prospective study confirmed the above findings. CONCLUSION: The above study establishes that removal of hypertrophied anal papillae and fibrous polyps should be routinely carried out during surgical treatment of anal fissure to add to effectiveness and completeness of the procedure.

Anal Canal↗