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PubMed1988

Frequency of isolated proximal colonic polyps among patients referred for colonoscopy.

The American Cancer Society now advocates screening asymptomatic populations over the age of 40 to 50 years for colonic malignancy. It is possible, however, that fecal occult blood testing and sigmoidoscopy to 60 cm would fail to identify patients with adenomatous polyps located only in the proximal colon. The purpose of this study was to determine how many patients without polyps in the distal 60 cm of the colon would have more proximal lesions. Ninety-eight consecutive patients with positive fecal blood test results or suspicious barium enema results were studied, using the assumption that if they had been seen six months earlier, when asymptomatic, they would have been candidates for screening examination. Forty-one (42%) of 98 patients had adenomatous polyps or cancer, and 15 (37%) of these patients had isolated proximal lesions. The polyp detection rate from 0 to 60 cm was significantly less than the detection rate for a full colonoscopy (27% vs 42%). We conclude that isolated proximal colonic polyps may be common.

Adenocarcinoma↗
PubMed1988

[Endoscopic and surgical therapy of malignant colorectal polyps].

87 malignant colorectal polyps were removed in 81 patients by endoscopic polypectomy from 1972 until 1987. Thereafter 34 of these patients had a surgical resection of the colon. Surgical resection was performed for incomplete excision of the polyp (20 x), for tumor invasion of the lymphics in the polyp stalk and for moderately/poor differentiated carcinoma. In 6 patients a residual carcinoma was detected in the removed colon specimen, but lymph-node metastasis only in one with moderate-differentiated carcinoma. Our results demonstrate that colorectal polyps with invasive well-differentiated carcinoma and tumor free base do not need a surgical resection. Patients of the high-risk-group (moderately/poor-differentiated carcinoma, invasion of blood vessels and lymphatics, incomplete excision), should be referred to further surgical resection. With regard to the low rate of metastatic spread even in patients with high-risk-polyps accurate differentiation seems to be necessary. In 19 out of 52 (36.5%) patients endoscopic control examinations after surgical or endoscopic resection revealed recurrent pathological findings. On the base of the presented data we conclude that there is a need for short-term endoscopic controls over a period of five years.

Adenocarcinoma↗
PubMed1986

A possible role of aerodynamic factors in nasal polyp formation.

Nasal polyps are apparently the result of multiple deleterious influences acting together. For the establishment of nasal polyps, not only are specific inflammatory changes in the nasal mucosa required but also accessory factors that render the inflamed mucosa susceptible to polyp formation. In this study, it was demonstrated that the unilateral polyposis in patients with deviated septum occurred much more frequently on the concave side (33:14). Inflammatory factors affect both sides equally but the deviated septum influences the air flow through the nasal cavities separately. The air flow rate on the concave side is greater than on the convex side. Since the upper part of the lateral wall of the nasal cavity where polyps occur is the most constricted, the air currents are most rapid and then the air pressure is decreased, tending to form an area of negative pressure. It appears that the negative pressure induces the inflamed mucosa to project into the nasal cavity resulting in polyp formation.

Adult↗
PubMed1986

Mixed hyperplastic and adenomatous polyp arising from ectopic gastric mucosa of the duodenum.

We report an unusual case of a polyp arising from ectopic gastric mucosa in the duodenum. The polyp demonstrated both hyperplastic and adenomatous proliferation. Adenomatous proliferation in a duodenal polyp arising from ectopic gastric mucosa is, to our knowledge, unique. The areas of adenomatous change were morphologically indistinguishable from those of adenomatous polyps arising in the stomach; hence, the adenomatous change observed in this polyp was regarded as a neoplastic process.

Aged↗
PubMed1987

Fecal neutral steroids in normal conditions and in patients with polyps or cancer of the large bowel.

There is evidence suggesting that the excretion and conversion of neutral sterols in the human large bowel might be somewhat related to the development of colorectal cancer. Therefore, our objectives were: to characterize the excretion and the major pattern of sterol degradation in normal conditions, both in children and in adults; and to investigate if abnormalities of these parameters are frequent in patients with colorectal cancer or polyps. The study has been carried out in: 38 adult volunteers; 29 children divided into 4 age groups; 22 patients with colorectal cancer; 16 members of 6 families with adenomatosis coli; 15 members of 2 families with a high prevalence of multiple polyps or cancer of the large bowel; 12 subjects with colorectal polyps without familiality. With the subjects kept under metabolic control, fecal samples were collected for at least 3 days and analyzed by thin layer chromatography and gas-liquid chromatography. Total neutral steroid excretion was lower in children than in adult volunteers; in contrast, there was no significant difference between the latter and the other investigated group of patients with cancer or polyps, with values ranging between 230 and 680 mg/day. All the adult volunteers were "high converters" of cholesterol to its intestinal metabolites coprostanol and coprostanone [89 +/- 10% (SE) of degradation]. Children less than 1 year old degraded little or no cholesterol (10.4 +/- 6% of total neutral sterols), whereas with increasing age the fraction of conversion became more similar to that of adults. In patients with colorectal tumors 2 populations could be defined, one characterized by a large degradation of cholesterol and the other by little or no conversion. Low degradation of cholesterol was found in 3 of 6 families with adenomatosis coli. In conclusion, we did not find any significant difference in total neutral sterol excretion among controls, colorectal cancer patients, or subjects at risk. In adult volunteers the normal pattern of cholesterol degradation is characterized by a large conversion of cholesterol to its intestinal metabolites. In children this process changes with increasing age from an absolute "nonconverter" state (after birth) to the pattern typical of adults. Finally, in a minority of patients with either polyps or cancer of the large bowel and of their first-degree relatives, cholesterol is poorly degraded and represents the most abundant fecal sterol.

Adolescent↗
PubMed1985

Increase of the mitotic activity of colonic mucosa in patients with multiple non-familial adenomatous polyps.

A histological study of colonic mucosa, including the measurement of the mitotic index, was performed in routinely processed specimens from control subjects and patients with multiple non-familial adenomatous polyps, to ascertain whether the onset of adenomatous polyps was accompanied by an increase in mucosal mitotic activity as compared with controls. The mitotic index of both the polyps and the mucosa 20 cm from the anal orifice of the same patients was significantly (P less than 0.01) higher than that of control 20 cm from the anal orifice and a shift of the mitotic activity from the lower two-thirds to the upper third of glands was observed in the polyps. These data suggest that an increase of mitotic activity in the superficial third of the glands as compared with controls plays a pathogenetic role in the onset of adenomatous polyps and that this phenomenon is accompanied by a diffuse increase of mitotic activity in the deeper two-thirds of the glands.

Aged↗
PubMed1985

[Polyp of the posterior urethra. Apropos of 6 cases].

Polyp of posterior urethra is a rare cause of urinary obstruction. Attached by a pedicle to the superior part of the veru montanum, such a polyp is mobile and can move in the bulbar urethra, causing urinary retention. If can also bleed provoking either hematuria or urethrorrhagia. Urinary infection can be present. Vesico-urethral ultrasound examination can show the polyp. But the diagnosis is made on a voiding cystourethrogram either at the end of an intravenous pyelogram or after suprapubic puncture of the bladder. Cystourethroscopy can also diagnose the lesion, and can treat it by electrocoagulation of the pedicle. Surgery by suprapubic incision and cystostomy is another method of treatment. It is perhaps less dangerous that the endoscopic treatment because the pedicle is very close to the ejaculatory ducts. Pathology of polyp of posterior urethra is variable but benign. The most frequent lesion is a fibrous polyp specially in children. Recurrency of such a lesion is very exceptional.

Child, Preschool↗
PubMed1985

Innervation of human nasal polyps.

Nasal polyps from 12 patients were studied by means of transmission electron microscopy. Nerve fibers in the polyp could be recognized in 4 out of the 12 polyps. Both myelinated and nonmyelinated nerve fibers were observed. The endings of the nonmyelinated nerve were adrenergic and observed in the area close to the smooth muscle cells of the artery. The secretory cells in the form of acini did not accompany nerve endings although these acini contained myoepithelial cells. Some nerves had normal features but others had a degenerated form in the pedicle of the nasal polyp. No cholinergic fibers were observed in these polyps.

Adrenergic Fibers↗
PubMed1979

Differential pathology of nasal polyps in cystic fibrosis and atopy.

Nineteen nasal polyps from 13 patients were examined histologically. Nine polyps from seven cystic fibrosis (CF) patients could be positively identified by a triad of observations: delicate, barely visible basement membrane of surface epithelium without submucosal hyalinization, lack of extensive infiltration of eosinophils (Giemsa stains), and a preponderance of acid mucin in glands and cysts of the polyp and in its surface mucous blanket (Alcian Blue-periodic acid-Schiff stains). Two polyps from two patients with CF and atopy showed the characteristic findings of CF without modification. Eight polyps from four atopic patients without CF were identified by the reverse triad of changes: extensive thickening of the epithelial basement membrane and its extension into the submucosa as an irregular hyaline membrane, high stromal eosinophil count, and mainly neutral mucin in mucous glands, cysts, and mucous blanket. Hyperplastic mucous glands, mucous cysts of variable sizes, focal metaplasia of surface epithelium, and acid mucin in goblet cells were considered nonspecific lesions.

Adolescent↗
PubMed1979

Colorectal polyps of the dog: a clinicopathologic study of 17 cases.

Seventeen cases of colorectal polyps in the dog were seen at the Ontario Veterinary College over a 12-year period. The mean age of occurrence was 6.9 years, and males and females were almost equally affected. The Collie was the most frequently affected breed (4/17). The clinical signs were typically dyschezia, periodic intermittent diarrhea and melena, and rectal prolapse of the polyp. The histopatholic classifcation were hyperplastic polyp (1), papillary adenoma (1), tubular adenoma (4), papillotubular adenoma (10), and unclassified (1). Severe epithelial atypia, likely carcinoma in situ, was apparent in 5 of the papillotubular adenomas. Retrospective analysis of survival data after polypectomy suggested a good prognosis, but the results were inconclusive and it is possible that some of the polyps represented premalignant lesions. Large polyps (greater than 1 cm in diameter) frequently had marked epithelial atypia and were considered more likely to recur or to become malignant.

Animals↗
PubMed1979

[Clinical pathology of colonic mucosal polyps].

Of 636 polyps removed during endoscopy between 1973 and 1975 at the University Hospital, Zurich, 36 (5.5%) were of the hyperplastic and 18 (2.8%) of the juvenile type. One polyp was seen in a female patient with Peutz-Jeghers syndrome. The vast majority of the polyps (581, 91.5%) were neoplastic in origin; 70% were tubular adenomas, 16% villous adenomas, and 14% intermediate forms or tubulo-villous adenomas. On the basis of a continuous spectrum in histologic structure and similar cellular dedifferentiation, these three types of adenoma may be viewed as different forms in the development of the same neoplastic process. Hyperplastic and hamartomatous polyps are innocuous, whereas the neoplastic forms may well turn aggressive. Malignant change was observed in 5.1% of our material, particularly in villous adenomas and in polyps exceeding 1 cm in diameter. The presence or absence of invasive growth through the muscularis mucosae is of prime importance for therapy. In accordance with WHO nomenclature, the term carcinoma is used only in the presence of such infiltration. If, in addition, the tumor tissue is not well differentiated, additional segmental resection may be required. The term "focal carcinoma" is no longer in use and has been replaced by "severe focal atypia". In these cases, primary polypectomy for diagnostic purposes is also the optimal therapy, and is as effective here as in cases of benign adenoma.

Adenoma↗
PubMed1979

Antral-choanal polyps.

The series involves 38 patients who had antral-choanal polyps removed at the Mayo Clinic during the 10 year period between 1965 and 1974. In contrast to common nasal polyps, antral-choanal polyps often are solitary and unilateral and usually are not associated with an allergic diathesis. These polyps recur frequently if they are simply avulsed; permanent ablation of the polyps requires thorough curettage of the antrum.

Adolescent↗
PubMed1982

'Endometrial' adenocarcinoma of the prostatic urethra arising in a villous polyp. A light microscopic and immunoperoxidase study.

A 77-year-old man had a papillary neoplasm of the prostatic urethra removed by transurethral resection. Light microscopically, much of the tissue consisted of a benign villous polyp lined by prostatic epithelium. An adenocarcinoma with cells that resembled those of uterine endometrial carcinoma was also present within the villous polyp. Using immunoperoxidase techniques, prostatic acid phosphatase and prostatic-specific antigen were localized in the epithelial cells of both the villous polyp and the adenocarcinoma. To our knowledge, this is the first reported case of adenocarcinoma arising in a urethral polyp. The immunohistochemical findings and the close association of the adenocarcinoma with the prostatic epithelium of the villous polyp provided evidence that so-called endometrial carcinoma of the prostatic utricle is of prostatic epithelial origin rather than müllerian derivation.

Acid Phosphatase↗
PubMed1978

[Cervical polyps and diagnostic curettages (author's transl)].

The early detection of carcinoma of the cervix is successful due to the systematic cytologic and colposcopic examination of the largest number of women possible. In cases with endocervical polyps a diagnostic curettage is customarily done along with removal of the polyp. The curettage which requires admission to hospital and carrie a risk of operative complications is an extensive procedure for the diagnosis of a cervical polyp. Because of the high accuracy of cytologic and colposcopic diagnosis it is suggested to omit the curettage in the management of non-bleeding polyps in the premenopausal woman. The asymptomatic polyp should be followed by cytology or office removal with obligatory histologic examination. Follow-up cytology of the cervical canal is necessary.

Adult↗
PubMed1983

[Microspectrophotometric study of the DNA content of the nucleus of cells from premalignant polyps and cancer of the rectum].

38 adenomatous polyps, 42 villous polyps with varying degree of proliferation and epithelial dysplasia, 34 polyps with preinvasive cancer components and 44 polyps containing invasive cancer elements were examined microspectrophotometrically. The analysis established an increased level of epithelial cells with ploidy varying 3c-5c to be a characteristic feature of the initial stages of malignant transformation of rectal polyps. The invasive cancer had similar peculiarities.

Adult↗
PubMed1980

[Assessment of endoscopic, cytological and histological diagnostic methods in stomach polyps].

The results of endoscopic and morphological diagnostic methods for gastric polyps in 91 patients are analysed in detail. It is concluded that endoscopic examination makes it possible to reveal gastric polyps of any localization. However, to solve the problem of therapeutic policy it is necessary to examine the biopsy material from polyps, prior to their removal, both cytologically and histologically. This is due to the fact that small size polyps after endoscopic polypectomy are no longer suitable for morphological assay, whereas cytograms obtained from the transverse sections and surface of large polyps are equivalent diagnostically to cytograms of the biopsy specimens.

Adolescent↗
PubMed1982

Fecal blood loss in patients with colonic polyps: a comparison of measurements with 51chromium-labeled erythrocytes and with the Haemoccult test.

The quantitative determinations of fecal daily blood loss after intravenous administration of 51Cr-labeled erythrocytes in 44 patients with colonic polyps and in 11 controls were compared with the results of the daily performed Haemoccult test without dietary restrictions. A total of 642 stool specimens was analyzed for 51Cr loss and the Haemoccult test. The mean fecal daily blood loss in the 34 patients with adenomatous polyps of the descending colon and rectosigmoid was 1.36 +/- 0.14 ml/day (mean +/- SEM), in the 10 patients with polyps of the ascending and transverse colon it was 1.28 +/- 0.31 ml/day, and in the 11 controls 0.62 +/- 0.07 ml/day. There was no positive Haemoccult test in the controls. In fecal specimens from patients with polyps in the descending colon and rectosigmoid containing 2.0-3.99 ml blood/day, the Haemoccult-test was positive in 86%. Fecal specimens from patients with polyps in the ascending colon and transverse colon containing equal blood loss yielded a positive Haemoccult test result in 26%. Thus, the positivity of the Haemoccult test is determined by the fecal daily blood loss and the anatomic location of colonic bleeding sites.

Chromium Radioisotopes↗
PubMed1981

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

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

Aged↗