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PubMed1992

Clonal 6p21 rearrangement is restricted to the mesenchymal component of an endometrial polyp.

Previous cytogenetic analyses revealed t(6;20)(p21;q13) in two endometrial polyps. We karyotyped a large endometrial polyp in which 19 of 25 metaphase cells contained a t(1;6;4)(q21;p21;q13). Subsequent combined immunohistochemical/cytogenetic analysis showed all aberrant metaphase cells to be of mesenchymal derivation, whereas epithelial cells from the polyp were diploid. These studies indicate that rearrangement of chromosome band 6p21 is a characteristic cytogenetic aberration in the stromal component of endometrial polyps.

Aged↗
PubMed2004

National Polyp Study data: evidence for regression of adenomas.

The data of the National Polyp Study, a large longitudinal study on surveillance of adenoma patients, is used for testing assumptions on the adenoma-carcinoma sequence. The observed adenoma and colorectal cancer incidence in the National Polyp Study were compared with the simulated outcomes of the MISCAN-COLON model of epidemiology and control of colorectal cancer for the U.S. population based on expert opinion. Variants of this model were explored in order to identify assumptions on the adenoma-carcinoma sequence that are consistent with the study observations. The high observed adenoma detection rates at surveillance and low observed colorectal cancer incidence in the National Polyp Study could only be explained by assuming a high incidence rate of adenomas accompanied by regression of adenomas. The National Polyp Study data suggest that adenoma prevalence results from a dynamic process of both formation as well as regression of adenomas. This lowers the expectations for the effects of colorectal cancer screening strategies that focus on adenoma detection.

Adenoma↗
PubMed1986

Adenomatous polyps and atherosclerosis: an autopsy study of Japanese men in Hawaii.

It is generally accepted that most colorectal cancers arise from adenomatous polyps and most coronary heart disease is caused by severe atherosclerosis. In order to compare the frequency of these disease precursors in men of Japanese ancestry in Hawaii, the degree of atherosclerosis of the aorta and coronary arteries was estimated by the panel method in 288 male autopsy subjects. The extent of atherosclerosis was then compared in men who did or did not have adenomatous polyps as determined at autopsy. The degree of atherosclerosis of the coronary arteries and aorta was positively and significantly related not only to the presence of adenomatous polyps, but to their size, multiplicity, and degree of atypia as well. This study suggests that shared environmental events could account for the development of severe atherosclerosis and adenomatous polyps. At the same time, it has been observed that hawaii Japanese men experience colon and rectal cancer rates higher than those of US Whites, but their coronary heart disease (CHD) rates are intermediate between the low rates of Japan and the high rates of the US white population. These differences in disease trends and differences in the serum cholesterol and fat intake of Hawaii Japanese men with CHD and colon cancer have suggested that men with these diseases represent different subsets of the westernized Japanese population. If CHD and colon cancer occur in different subsets of this population, they must stem from the accumulation of other risk factors superimposed upon the initiators of their precursor lesions.

Aged↗
PubMed2006

Expression of 5-lipoxygenase and cyclooxygenase pathway enzymes in nasal polyps of patients with aspirin-intolerant asthma.

In aspirin-intolerant subjects, adverse bronchial and nasal reactions to cyclooxygenase (COX) inhibitors are associated with over-production of cysteinyl-leukotrienes (cys-LTs) generated by the 5-lipoxygenase (5-LO) pathway. In the bronchi of patients with aspirin-intolerant asthma, we previously linked cys-LT over-production and aspirin hyper-reactivity with elevated immunoexpression in eosinophils of the terminal enzyme for cys-LT production, LTC4 synthase. We investigated whether this anomaly also occurs in the nasal airways of these patients. Immunohistochemical expression of 5-LO and COX pathway proteins was quantified in nasal polyps from 12 patients with aspirin-intolerant asthma and 13 with aspirin-tolerant asthma. In the mucosa of polyps from aspirin-intolerant asthmatic patients, cells immunopositive for LTC4 synthase were four-fold more numerous than in aspirin-tolerant asthmatic patients (p=0.04). There were also three-fold more cells expressing 5-LO (p=0.037), with no differences in 5-LO activating protein (FLAP), COX-1 or COX-2. LTC4 synthase-positive cell counts correlated exclusively with mucosal eosinophils (r=0.94, p<0.001, n=25). Co-localisation confirmed that five-fold higher eosinophil counts (p=0.007) accounted for the increased LTC4 synthase expression in polyps from aspirin-intolerant asthmatic patients, with no alterations in mast cells or macrophages. Within the epithelium, increased counts of eosinophils (p=0.006), macrophages (p=0.097), and mast cells (p=0.034) in aspirin-intolerant asthmatic polyps were associated only with 2.5-fold increased 5-LO-positive cells (p<0.05), while the other enzymes were not different. Our results indicate that a marked over-representation of LTC4 synthase in mucosal eosinophils is closely linked to aspirin intolerance in the nasal airway, as in the bronchial airways.

Adolescent↗
PubMed1993

Solitary hamartomatous duodenal polyp; a different entity: report of a case and review of the literature.

Solitary hamartomatous duodenal polyps are a clinical entity considered until now to express an incomplete or initial form of Peutz-Jeghers syndrome (PJ syndrome). Following our experience of 1 case, we analyzed the clinical characteristics of the 12 previously reported cases of solitary hamartomatous duodenal polyps. In none of these cases did we find any documentation of mucocutaneous pigmentation, a family or personal history of intestinal polyps, or local neoplastic degeneration of the disease, and all cases presented during the fifth or sixth decade of life. Thus, we conclude that solitary hamartomatous duodenal polyps constitute a different entity to PJ syndrome, the most appropriate elective treatment for which is endoscopic electrosurgical polypectomy.

Adult↗
PubMed1982

A solitary juvenile polyp with hyperplastic and adenomatous glands.

This report describes a 21-year-old man with chronic rectal bleeding, who was found to have a solitary juvenile polyp containing hyperplastic and adenomatous glands. This admixture of glandular elements has not been clearly recognized previously. The significance of this finding is uncertain at this time. Since adenomatous polyps are considered premalignant lesions, and juvenile polyps have been associated with colon cancer, we recommend that juvenile polyps with adenomatous glands also be regarded as premalignant lesions.

Adenoma↗
PubMed1994

Obstructive jaundice caused by a cholesterol polyp of the gallbladder: report of a case.

We present herein the case of a 34-year-old man in whom obstructive jaundice was found to be caused by an impacted detached cholesterol polyp. A cholecystectomy with exploration of the common bile duct was performed after ultrasonography showed cholesterol polyps and stones in the gallbladder. Intraoperative cholangioscopy demonstrated an impacted cholesterol polyp at the distal end of the common bile duct which appeared to be detached from the gallbladder. To our knowledge, this is the first report of an impacted detached cholesterol polyp causing obstructive jaundice.

Adult↗
PubMed1983

Large hyperplastic polyps of the stomach.

Epithelial polyps of the stomach can be divided into 2 types: adenomatous and hyperplastic or regenerative. Imprecisions in terminology and histologic classification of the reported cases make it difficult to establish the true incidence of each type. The size of gastric polyps has been among the criteria for predicting malignant potential of the lesion. We present 4 patients in whom large, sometimes multiple, gastric masses represented benign hyperplastic polyps. The radiographic and pathologic features of these large gastric polyps which were not associated with carcinoma are reviewed.

Aged↗
PubMed1997

Long-term survival after treatment of malignant colonic polyps.

PURPOSE: This study was designed to evaluate the long-term outcome and survival of patients treated for malignant colonic polyps. METHODS: A retrospective review of 15,975 cases of colonoscopies with 8,685 endoscopic polypectomies performed between 1972 and 1990 was undertaken. In 65 patients, the polypectomy specimens contained invasive carcinoma. Six patients were excluded (follow-up, <6 months). Polyp data, operative findings, and follow-up on the remaining 59 patients were recorded. RESULTS: Malignant polyps were found in 35 males and 24 females who had an average age of 64 (range, 39-81) years. Follow-up ranged from 12 to 202 (mean, 90) months. Tumor differentiation was poor in one and well or moderately differentiated in 58 patients. Positive or indeterminate margins were found in 13 patients. Thirty-seven (63 percent) patients were managed with polypectomy and surveillance. Four of these (with rectal tumors) also had an additional local excision for questionable margins. One recurrence was noted in a patient who refused surgery, which was recommended because of indeterminate margins. Twenty-two patients (37 percent) underwent colectomy. Indications included Haggitt Level 3 or 4 invasion (19), inadequate margins (7), patient preference (1), and poor differentiation (1). Residual disease was found in colectomy specimens of three patients (14 percent). There were no cancer-related deaths in either treatment group. Life table analysis demonstrated a five-year survival of 82 percent for the colectomy group and 95 percent for the polypectomy group (P = 0.15). CONCLUSION: Treatment of patients with malignant polyps must be individualized based on evolving criteria. Patients in whom polypectomy margins are inadequate should undergo colectomy. With appropriate selection criteria, patients selected for colectomy had a five-year survival rate similar to the rate of those treated by polypectomy alone.

Adult↗
PubMed1990

Giant inflammatory polyps associated with idiopathic inflammatory bowel disease. An ultrastructural study of five cases.

Five cases of giant inflammatory polyps associated with idiopathic inflammatory bowel disease are reported. Polyps produced intestinal obstruction in three cases; consequently, surgery was performed. In a further two cases, intestinal bleeding was improved by endoscopic polypectomy. Electron microscopy showed fibroblasts, myofibroblasts, mast cells, lymphocytes, collagen fibers, capillaries, and venules. Remnants of the original mucosal epithelial cells, smooth muscle cells, and hypertrophic autonomous nerve plexuses were noted. Nerve fibers were interwoven with the matrix of the polyps. Mast cells were closely linked with vessels, nerves, and collagen fibers. They may have an important role in the excessive granulation, angiogenesis, and fibrotic process in giant inflammatory polyps.

Adult↗
PubMed1999

CD44 expression in benign and malignant colorectal polyps.

PURPOSE: This retrospective study was undertaken to evaluate immunohistochemically the expression of CD44 standard protein and CD44v5 and CD44v6 isoforms in colorectal adenomas and early invasive cancers developing within adenomas as possible markers characterizing colorectal polyps with a more aggressive biologic potential. METHODS: Archival tissues of 81 consecutive locally resected colorectal polyps, comprising 57 colorectal adenomas and 24 carcinomas-in-adenomas, were stained immunohistochemically with the use of commercially available mouse monoclonal antibodies: SFF-2 for CD44 standard protein, VFF-8 for CD44v5, and VFF-7 for CD44v6. RESULTS: Sixty-three percent of the colorectal polyps were positive for CD44 standard protein, 59 percent were positive for CD44v5, and 27 percent were positive for CD44v6. Ninety-three percent of the low-grade adenomas were CD44 standard protein-positive, in contrast to 50 percent of the high-grade adenomas and only 42 percent of the carcinomas-in-adenomas (Kendall's Tau = -0.42; P < 0.0001). CD44v6 expression was more frequently found in early invasive cancers (54 percent) than in high-grade adenomas (25 percent) and low-grade adenomas (7 percent). This difference also was statistically significant (Kendall's Tau-b = 0.39; P = 0.00003). Surprisingly, a downregulation of CD44 standard protein expression was observed in the adenoma tissue adjacent to carcinomas (62 percent) and areas with high-grade atypia (71 percent), compared with low-grade adenomas (93 percent; Kendall's Tau-b = -0.28; P = 0.004). CONCLUSIONS: Our data suggest that CD44 standard protein and CD44 isoform v6 expression differs considerably in benign and malignant colorectal polyps. Clinical studies with larger patient groups could clarify the prognostic potential of CD44 further.

Adenoma↗
PubMed2000

Hyperplastic polyps: "more than meets the eye"? Report of sixteen cases.

The vast majority of hyperplastic polyps are small, left-sided, and inconsequential in nature. However, hyperplastic polyps that are large, right-sided, mixed, and found in association with a family history of carcinoma may represent an "atypical" group, and their clinical significance is uncertain. We believe that these atypical lesions should not be lumped together with the common variety of diminutive hyperplastic polyps. Rather, when such hyperplastic polyps are encountered, they should be excised and the patient should be placed on regular colonoscopic surveillance.

Cell Transformation, Neoplastic↗
PubMed1997

Abnormal vaginal bleeding from endometrial polyps in a woman receiving tamoxifen therapy for breast cancer: report of a case.

We report herein the case of a women receiving tamoxifen therapy for breast cancer who developed vaginal bleeding, subsequently found to be caused by unusual endometrial polyps. Upon presentation, ultrasonography and magnetic resonance imaging (MRI) demonstrated a tumor within the uterus. A hysterectomy was performed, and macroscopic examination showed polyp-like lesions of the uterus. Histologically, these polyps demonstrated cystically dilated glands and stromal proliferation, and were diagnosed as endometrial polyps. Although tamoxifen has few side effects, any signs or symptoms of gynecological abnormalities should be carefully evaluated in patients on long-term tamoxifen therapy.

Antineoplastic Agents, Hormonal↗
PubMed1997

A long-term follow-up study of nasal polyp patients after simple polypectomies.

A long-term follow-up study was performed on randomly selected patients after simple snare polypectomies. There were 243 patients, of whom 211 underwent endoscopic examination. There were 154 males and 57 females and median age was 57.7 years. Median period of follow-up was 8 years (range, 38-145 months). The median number of polypectomies was 1.6 (range, 1-15). Polyp eosinophilia was recorded in 97% of the cases. From life-table analysis the 5-year rate for two or less polypectomies was 80% (95% confidence intervals, 75-86%). Symptoms and findings were recorded at a median time of 56 months from the last polypectomy. At this time 70% of the patients denied blocked nose or excessive secretions. Seventeen per cent of the group claimed loss of sense of smell, while 28% stated that it was poor. At follow-up, large polyps were found in 3% of the patients, moderately sized ones in 30% and small in 42%. No polyps were visible in 25%. Patients with asthma (26%) had more polypectomies than those without (median, 2.4 versus 1.4). Patients with a history of non-steroidal antiinflammatory drug intolerance (7%) had the highest number of polypectomies. Previous troublesome sinusitis and allergy seemed not to exert major influence on the number of polypectomies needed. In the primary care of nasal polyp patients, the majority only need minor or limited surgery or only medical treatment.

Adult↗
PubMed1997

Fibroepithelial polyp of the ureter associated with an adjacent ureteral calculus.

Ureteral fibroepithelial polyps are rare benign tumours. Sometimes an ureteric calculus may be seen, proximal to the polyp. We describe a case of fibroepithelial polyp (FEP) associated with a calculus in the distal part of the right ureter. To our knowledge this is the first ureteral FEP reported in the literature associated with a ureteral calculus distal to it. Aetiology, clinical features, diagnosis and therapy of fibroepithelial polyps are discussed in the light of the literature.

Adult↗
PubMed1986

Colonoscopic excision of large and giant colorectal polyps. Technical implications and results over eight years.

Large polyps are sessile or pedunculated lesions that are larger than or equal to 3 cm in size. Sixty-six colonoscopic piecemeal excisions of large pedunculated and sessile polyps (75 percent of 88 recognized large polyps) were performed over eight years. The macroscopic feature of the lesions and the result of an extensive snare biopsy were the deciding factors for endoscopic as opposed to surgical removal. Only three complications (4.5 percent) were recorded (two hemorrhages and one colonic wall burn syndrome), none of which required surgery. Fifty patients with 52 adenomatous lesions had colonoscopic follow-up (range, 3 to 85 months). Of 36 sessile adenomas, two cases of residual (5.5 percent) and four of recurrent disease (11 percent) were observed. Colonoscopic removal is an alternative to local surgical excision of large benign colorectal polyps, and often can be an alternative method to elective colectomy in elderly and high-risk patients.

Adenocarcinoma↗
PubMedDate not supplied

Inflammatory fibroid polyp of sigmoid colon.

A case of inflammatory fibroid polyp of the sigmoid colon is presented. This is the eight case of this type of polyp in the colon and, to the best of our knowledge, the first one involving the sigmoid and producing intussusception. Symptomatology of the inflamed fibroid polyp in this part of the gut closely simulates gastrointestinal malignancy. The treatment is surgical excision of the polyp, or colonoscopic resection when it is possible. Intraoperative colonoscopy helps the surgeon to localize the lesion and to role out the existence of other lesions.

Colon, Sigmoid↗
PubMed1993

Is there a valid association between skin tags and colonic polyps: insights from a quantitative and methodologic analysis of the literature.

OBJECTIVE: To assess the reported association between skin tags and colonic polyps and to evaluate the methodologic rigor of the studies. DESIGN AND DATA IDENTIFICATION: English-language literature search using MEDLINE, Index Medicus, and bibliographic reviews of texts and all pertinent articles to perform a quantitative and methodologic analysis of all studies from 1983 (the original publication) assessing the association under study. Eligible studies were independently assessed using explicit methodologic guidelines for validity and generalizability of observational research. Two appraisers independently performed tests for heterogeneity and used meta-analytic methods in an attempt to provide summary estimates of the overall strength of association. MEASUREMENTS AND MAIN RESULTS: Significant statistical heterogeneity across studies indicated sharp differences in the direction and magnitude of the odds ratios for the association between skin tags and colonic polyps (chi-square test of homogeneity = 37.42, 9 degrees of freedom; p < 0.005). This marked disparity prevented meaningful pooling of the individual data. The degree of statistical heterogeneity was not significantly reduced after an analysis of specific subgroups of studies. Limitations potentially responsible for the varying outcomes included lack of blinded ascertainment of clinical information, noncomparability of subjects, differing diagnostic evaluations of the colon, and uncontrolled confounding. In addition, all but one study were performed in a tertiary care setting, seriously limiting the results to the "average" subject seen in primary care settings. CONCLUSION: Methodologic limitations and inconsistencies in study outcomes preclude the aggregation of data necessary to compute a valid and meaningful summary estimate of association. Sufficient variability prevents any consensus regarding the association between skin tags and colonic polyps. In addition, the applicability of the results is limited primarily to subjects seen in tertiary care centers, limiting the overall clinical usefulness of skin tags as "biomarkers" of colonic polyps. Recommendations for further research are provided.

Adult↗