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PubMed2006

Computer-aided detection of colonic polyps using low-dose CT acquisitions.

RATIONALE AND OBJECTIVES: This report proposes an alternative method for the automatic detection of colonic polyps that is robust enough to be directly applicable on low-dose computed tomographic data. MATERIALS AND METHODS: The polyp modeling process takes into account both the gray-level appearance of polyps (intensity profiles) and their geometry (extended Gaussian images). Spherical harmonic decompositions are used for comparison purposes, allowing fast estimation of the similarity between a candidate and a set of previously computed models. Starting from the original raw data (acquired at 55 mA), five patient data sets (prone and supine scans) are reconstructed at different dose levels (to 5 mA) by using different kernel filters, slice overlaps, and increments. Additionally, the efficacy of applying an edge-preserving smoothing filter before detection is assessed. RESULTS: Although image quality decreases when decreasing acquisition milliamperes, all polyps greater than 6 mm are detected successfully, even at 15 mA. Although not important at high doses, smoothing improves detection results for ultra-low-dose (tube current<15 mA) data. CONCLUSION: The advantage of low-dose scans is a significant decrease in effective dose from 4.93 to 1.61 mSv while retaining high detection values, particularly important when thinking of population screening.

Algorithms↗
PubMed2006

Assessment of polyp and mass histopathology by intravenous contrast-enhanced CT colonography.

RATIONALE AND OBJECTIVES: We sought to demonstrate that intravenous contrast-enhanced CT colonography (CTC) can distinguish colonic adenomas from carcinomas. METHODS: Supine intravenous contrast-enhanced CTC with colonoscopic and/or surgical correlation was performed on 25 patients with colonic adenomas or carcinomas. Standard deviation of mean polyp CT attenuation was computed and assessed using ANOVA and receiver-operating characteristic analyses. RESULTS: Colonoscopy confirmed 32 polyps or masses 1 to 8 cm in size. The standard deviations of CT attenuation were carcinomas (n = 13; 36 +/- 6 HU; range 28-48 HU) and adenomas (n = 19; 49 +/- 14 HU; range 31-100 HU) (P = 0.005). At a standard deviation threshold of 42 HU, the sensitivity and specificity for classifying a polyp or mass as a carcinoma were 92% and 79%, respectively. The area under the receiver-operating characteristic curve was 0.89 +/- 0.06 (95% confidence interval 0.73-0.96). CONCLUSIONS: Measurement of the standard deviation of CT attenuation on intravenous contrast-enhanced CTC permits histopathologic classification of polyps 1 cm or larger as carcinomas versus adenomas. The presence of ulceration or absence of muscular invasion in carcinomas creates overlap with adenomas, reducing the specificity of carcinoma classification.

Adenoma↗
PubMed2006

Large pedunculated polyps originating in the esophagus and hypopharynx.

Large pedunculated esophageal and hypopharyngeal polyps are uncommon. Clinical presentation most commonly includes dysphagia and mass regurgitation. If left untreated the patient may develop polyp aspiration complicated by fatal asphyxiation. Diagnosis has depended on endoscopy and barium swallow historically; however, these procedures may fail to provide a diagnosis. In recent years computerized tomographic scan and magnetic resonance imaging have proved reliable methods of diagnosis. These polyps are located predominantly in the upper esophagus and frequently are comprised of a fibrous component. Malignant potential is low. Resection of these lesions is warranted; it may be approached endoscopically if feasible or surgically through a cervical or thoracotomy approach, depending on the location. Recurrence is rare. To our knowledge, this is the largest review of large esophageal polyps, including 110 reported cases in the literature.

Adolescent↗
PubMed2007

CT colonography: automatic measurement of polyp diameter compared with manual assessment - an in-vivo study.

AIM: To investigate whether automated diameter assessment was feasible for CT colonography. MATERIALS AND METHODS: Two experienced observers independently measured the maximum diameter of 50 polyps (colonoscopic reference size range 5-12 mm) from colonography datasets using conventionally placed software callipers and a variety of two-dimensional (2D) computed tomography (CT) window settings (colon, abdominal, bone, lung), and also three-dimensional (3D) perspective rendering. Polyps were also measured using automated polyp-segmentation software. Agreement between observers and with the colonoscopic reference measurement was determined using Bland-Altman, Wilcoxon, and Mann-Whitney U analyses. RESULTS: Inter-observer agreement was similar for all window displays: mean difference in millimetres (SD difference; 95% limits of agreement) ranged from 0 (1.7, -3.3, 3.3) for 2D colon to -1.1mm (1.6, -4.3, 2.0) for 3D, compared with -0.5 (2.09, -4.6, 3.6) for automated measurement. When compared to colonoscopy, the largest discrepancy occurred using the 3D display (mean difference 1.3mm, 2.5mm for each observer). There was also a significant difference between estimates and reference size when using the 2D abdominal and 3D displays (p=0.03, <0.001). CONCLUSION: Automated polyp measurement is possible in vivo. Automated and conventional methods have comparable inter-observer agreement. The greatest measurement error is encountered when using a 3D display for estimates of diameter.

Colon↗
PubMed2005

Serous papillary carcinoma of the endometrium arising from endometrial polyps: a clinical, histological, and immunohistochemical study of 13 cases.

Serous papillary carcinoma is an aggressive tumor. Point mutations in the p53 suppressor gene might explain in part the rapid growth of this malignant tumor and its unfavorable outcome. The aims of this study were to evaluate the behavior of serous papillary carcinoma developing in endometrial polyps and to assess the p53 protein overexpression. Patients included in this study were treated in our institution between 1982 and 2003. All clinical and pathological materials were examined. A p53 protein immunohistochemical analysis was performed on paraffin-embedded tissues. Thirteen serous papillary carcinomas arising from benign polyps of the endometrium were identified. The patients' age averaged 73 years. All patients were treated surgically. After an average follow-up of 22 months, 54% of the patients were dead or alive with disease. Of 10 serous papillary carcinomas, 8 (80%) for which paraffin blocks were available overexpressed the p53 protein. A serous papillary carcinoma arising from benign polyps of the endometrium remains a malignant neoplasia with an unfavorable outcome even if the primary tumor is limited to the polyp. The high rate of protein p53 overexpression suggests that a p53 gene mutation occurs early in the disease and might explain the rapid growth of the tumor.

Aged↗
PubMed2004

Vocal fold nodule vs. vocal fold polyp: answer from surgical pathologist and voice pathologist point of view.

Vocal fold polyps and nodules are caused by inflammation caused by stress or irritation. Our study involved looking retrospectively at 30 patients. A clinical diagnosis was established by an otolaryngologist and voice pathologist through videostroboscopic analysis. Histological sections after removal of the vocal fold lesion were available for microscopic examination. All of these cases have also been previously evaluated and photographed. A clinical diagnosis of either a polyp or a laryngeal nodule have been made and documented. Two pathologists made the histological evaluation separately initially unaware of the clinical diagnosis. Their impression was recorded. After the clinical diagnosis become available and comparison between the clinical and pathological diagnosis were made, a retrospective review of the tissue was attempted to reconcile the differences. In conclusion, after careful histological evaluation, no definitive histological distinction can be made between laryngeal nodules and polyps. Our data showed no distinction between the two entities when compared for the presence of edema, fibrin, inflammation, and amyloid-like material. A statistically significant difference was found in the size of the specimen and the presence of telangiectasias. Based on our data, a biopsy larger than 0.3 cm could be a polyp and a biopsy less than 0.3 cm could be a nodule.

Diagnosis, Differential↗
PubMed2005

Vaginal polyps and hormones--is there a link? A case series.

Fibroepithelial stromal polyps (FSP) of the vault after hysterectomy are an uncommon, though well recognised finding. Both tibolone and tamoxifen have been reported to cause polyps in the endometrium but their connection with the same pathology in the vagina has never been described. Here, we report a case of a patient presenting with a symptomatic FSP 30 years after her hysterectomy while on treatment with both tamoxifen and tibolone. This prompted us to see if there was an association between these hormone-modulating agents with vaginal polyp formation. We reviewed all the cases notes of patients having FSP surgically removed in Hull over a 4 years period. Thirty-four women were identified. Some kind of hormonal influence, natural or otherwise, was found in 22 out of the 34 women. Endogenous or exogenous gonadal hormones or hormones modulators thus appear to influence the formation of vaginal polyps, but in this cohort a precise contribution of specific drugs could not be established.

Adult↗
PubMed2005

Chief cell hyperplasia with structural and nuclear atypia: a variant of fundic gland polyp.

A case of an unusual variant of fundic gland polyp (FGP) composed of chief cell hyperplasia with structural and nuclear atypia in an 87-year-old woman is presented. Gastrointestinal endoscopy revealed a sessile polyp in the cardia/ corpus transition zone and a polypoid lesion in the fundus. Histologically, the polyp in the cardia/corpus showed a typical appearance of FGP, while that in fundus demonstrated a tumorous lesion composed of irregular branched tubules with nuclear stratification. Despite the structural distortion and nuclear atypia, mitotic figures were absent and MIB-1 positive cells were less than 3%. Immunohistochemically, the cytoplasms of the tubules were negative for gastric mucin and Muc-5AC glycoprotein, but mostly positive for pepsinogen-I, indicating that the proliferated glands consisted mainly of chief cells, not mucous cells. Parietal cells were occasionally found in the glands. At the periphery of the lesion, microcysts composed of parietal cells, chief cells, and mucous cells had developed. Altogether, the polyp in the fundus was diagnosed as an unusual variant of FGP with chief cell hyperplasia. This FGP should be differentiated from tubular adenocarcinoma. Proliferation of chief cells with occasional parietal cells is critical for the differential diagnosis.

Adenocarcinoma↗
PubMed2005

Cyclooxygenase-2 in sporadic colorectal polyps: immunohistochemical study and its importance in the early stages of colorectal tumorigenesis.

Cyclooxygenase-2 (COX-2) is one of the important targets for the chemoprevention of colorectal cancer by non-steroidal anti-inflammatory drugs (NSAIDs). To evaluate the role of COX-2 in early stages of colorectal tumorigenesis, we immunohistochemically investigated the frequency and localization of COX-2 in sporadic colorectal polyps that showed various histology using a commercially available monoclonal antibody. A total of 105 colorectal polyps were examined. These included 33 low-grade adenomas (LGAs), 28 high-grade adenomas (HGAs), 32 HGAs with p53 overexpression (HGAs-p53), and 12 cases of carcinoma in adenoma (CIA). Regarding the immunohistochemical expression of p53, MIB-1, and CD63, histological classification was made for each case. COX-2 was expressed in neoplastic epithelial cells and interstitial macrophages that were distributed mainly in the superficial areas of polyps. COX-2 labeling indices (LIs) were 8.2% in LGAs, 6.3% in HGAs, 0.9% in HGAs-p53, and 0.6% in the carcinomatous components of CIAs. COX-2 LIs were significantly higher in adenomas, including LGAs and HGAs, than in HGAs-p53 and CIAs (p < 0.001). Within CIAs, significantly higher COX-2 LIs were obtained in the adenomatous components than in the carcinomatous components (p < 0.05). The size of polyps was not correlated with COX-2 expression irrespective of their histology. The results show that COX-2 might be involved in early stages of colorectal tumorigenesis. Colorectal adenomas could be a target for the chemopreventive strategy irrespective of their sizes.

Adenocarcinoma↗
PubMed2005

Metastasis from breast carcinoma to a tamoxifen-related endometrial polyp.

BACKGROUND: Metastasis of extragenital neoplasms to an endometrial polyp is rare and until now, only 6 cases of such involvement has been described. CASE: A 58-year-old woman, who had been diagnosed 4 years ago with infiltrating ductal breast carcinoma and treated with surgery and tamoxifen therapy, was admitted to the gynecology clinic because of endometrial thickening observed during a routine abdominal ultrasonographic examination. A total hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological examination of the specimen showed a large polyp which microscopically showed clusters of cells with signet ring morphology within the polyp stroma. The positivity of tumor cells for GCDFP-15 supported the diagnosis of metastatic breast carcinoma to endometrial polyp. CONCLUSION: Metastatic breast carcinoma should be considered in the differential diagnosis of carcinomas with signet ring cell morphology involving uterus.

Breast Neoplasms↗
PubMed2003

Adenomas at resection margins do not influence the long-term development of pouch polyps after restorative proctocolectomy for familial adenomatous polyposis.

BACKGROUND: The aim of this study was to consider whether adenomas in the resection margins could represent a risk factor for pouch polyps in familial adenomatous polyposis (FAP) patients. METHODS: We reviewed 46 patients treated by restorative proctocolectomy (RPC) for FAP: 9 hand-sewn and 37 stapled ileal pouch-anal anastomosis (IPAA). We analyzed the presence of polyps in the doughnuts from stapled anastomosis and in the resection margins from hand-sewn anastomosis. The presence of polyps in the IPAA was then assessed in 30 patients (6 hand-sewn and 24 stapled IPAA): 4 from the histology of the excised pouch and 26 by endoscopy (range 4 months to 12 years after operation, mean 6 years). RESULTS: Surprisingly, pouch adenomas were found in only 2 of 30 (7%) of patients, 1 of 6 hand-sewn and 1 of 24 stapled anastomosis (P > 0.1), 9 and 11 years, respectively, after operation. However, there were 6 patients with inflammatory (3), fibroepithelial (2), or lymphoid (1) polyps. The risk of pouch adenomas after 8 years was 20% (P < 0.05). Pouch adenomas were found in 1 of 11 patients having adenomas in the margins or in the doughnuts (9%) and in 1 of 19 with no adenomas at the margins (5%; P > 0.1). CONCLUSIONS: Incidence of pouch adenomas was low. There was no correlation between adenomas in the resection margins and the development of pouch adenomas.

Adenoma↗
PubMed2004

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy.

BACKGROUND: For colorectal cancer screening, the predictive value of distal findings in the ascertainment of proximal lesions is not fully established. The aims of this study were to assess distal findings as predictors of advanced proximal neoplasia and to compare the predictive value of endoscopy alone vs. combined endoscopic and histopathologic data. METHODS: Primary colonoscopy screening was performed in 2210 consecutive, average-risk adults. Age, gender, endoscopic (size, number of polyps), and histopathologic distal findings were used as potential predictors of advanced proximal neoplasms (i.e., any adenoma > or =1 cm in size, and/or with villous histology, and/or with severe dysplasia or invasive cancer). Polyps were defined as distal if located in the descending colon, the sigmoid colon, or the rectum. Those in other locations were designated proximal. RESULTS: Neoplastic lesions, including 11 invasive cancers, were found in 617 (27.9%) patients. Advanced proximal neoplasms without any distal adenoma were present in 1.3% of patients. Of the advanced proximal lesions, 39% were not associated with any distal polyp. Older age, male gender, and distal adenoma were independent predictors of advanced proximal neoplasms. The predictive ability of a model with endoscopic data alone did not improve after inclusion of histopathologic data. In multivariate logistic regression analysis, the predictive ability of models that use age, gender, and any combination of distal findings was relatively low. The proportion of advanced proximal neoplasms identified if any distal polyp was an indication for colonoscopy was only 62%. CONCLUSIONS: A strategy in which colonoscopy is performed solely in patients with distal colonic findings is not effective screening for the detection of advanced proximal neoplasms in an average-risk population.

Adenoma↗
PubMed1980

Diagnostic implications of the spatial distribution of colonic mass lesions (polyps and cancers). A prospective colonoscopic study.

A prospective colonoscopic study of 642 consecutive patients demonstrated that 156 (66%) mass lesions including 131 polyps and 25 cancers were located within 60 cm of the anus and 82 (34%) mass lesions including 68 polyps and 14 cancers were located beyond 60 cm, the working length of the rigid sigmoidoscope. One hundred twenty-one (61%) polyps and 14 (36%) cancers were located above 25 cm but less than 60 cm from the anus, the working length of the flexible sigmoidoscope. Sixty-eight (34%) polyps and 14 (36%) cancers were located beyond the reach of the flexible sigmoidoscope. Although the flexible sigmoidoscope detects more lesions than the rigid sigmoidoscope, 50% of colon cancers located beyond detection by the rigid sigmoidoscope would not have been detected with the flexible sigmoidoscope. Of all mass lesions located beyond 25 cm, 38% would not have been detected with the use of the flexible sigmoidoscope. It appears that total colonoscopy rather than flexible sigmoidoscopy must play an increasingly prominent role in the evaluation of patients with suspected colonic mass lesions.

Colonic Neoplasms↗
PubMed1996

Endoscopic resection of large pedunculated colorectal polyps using a detachable snare.

BACKGROUND: Colonoscopic resection of pedunculated polyps with heads 1 cm or greater in diameter is difficult because of the risk of bleeding. To minimize this complication, we used a detachable snare that allowed endoscopic ligation of the stalk of a large pedunculated polyp and evaluated its safety and effectiveness in comparison with conventional endoscopic snare polypectomy. METHODS: Patients with pedunculated polyps with heads 1 cm or greater in diameter were randomly assigned to colonoscopic polypectomy with (N = 47) or without (N = 42) a detachable snare. Arterial pumping bleeding immediately after colonoscopic polypectomy or hematochezia resulting in a 10% or greater drop in hematocrit was defined as "bleeding." RESULTS: No bleeding occurred during or after polypectomy with a detachable snare, but bleeding occurred significantly more frequently (five patients, 12%) without a snare. Moreover, the use of a detachable snare reduced the duration of hospitalization after polypectomy. CONCLUSIONS: Colonoscopic polypectomy with a detachable snare may be safer than conventional polypectomy without a detachable snare for resection of large, pedunculated polyps.

Blood Loss, Surgical↗
PubMed1996

Development of hyperplastic polyps following laser therapy for watermelon stomach.

BACKGROUND: Our goal was to evaluate the long-term sequelae of repeated thermal injury to the gastric mucosa of patients undergoing laser therapy for watermelon stomach. METHODS: A retrospective review of all patients who underwent endoscopic laser therapy for watermelon stomach from 1987 to 1994 was performed to identify patients with antral polyps following laser photoablation therapy. Statistical analysis was performed using the paired t test. RESULTS: Antral hyperplastic polyps as large as 4 cm developed in 4 of 60 patients (7%) and were associated with recurrent anemia in 3. All patients had received significantly more laser thermal energy during the course of therapy for their watermelon stomach. Conventional polypectomy was used to remove the polyps. CONCLUSIONS: Repeated thermal injury to the antral mucosa in patients with the watermelon stomach may result in the development of hyperplastic polyps. These may be large, may contribute to significant blood loss with anemia, and are amenable to conventional polypectomy.

Adult↗
PubMed1998

Juvenile polyp in esophageal colon interposition.

Esophageal polyps are rare in children, whereas colorectal juvenile polyps are common. An 11-year-old boy with an esophageal colonic interposition for an esophageal stricture secondary to caustic injury was found to have a polypoid mass in the interposed colon. Fiberoptic endoscopic removal with diathermy was performed. Histological examination confirmed it was a juvenile polyp. The occurrence of a polyp in a colon removed from its natural location and serving a different function suggests the possibility that an unknown factor produced by colonic cells play a pivotal role in its development.

Burns, Chemical↗
PubMed1994

Ultrasonographic diagnosis of juvenile colonic polyps.

To reduce the risks of air-contrast barium enemas and colonoscopy, we studied the use of saline enemas for ultrasonographic examination of children with rectal bleeding. Thirty-nine children, from 2 years 8 months to 8 years 3 months of age, were examined. Juvenile colonic polyps were ultrasonographically demonstrated and histologically confirmed in 25 children; all the polyps were solitary and pedunculated, and were located in the splenic flexure in 3 children, the descending colon in 6, the sigmoid colon in 12, and the rectum in 4. Ultrasonographic findings by hydrocolonic ultrasonography were identical to those obtained by immersion ultrasonography of removed specimens. Hypoechoic areas within more hyperechoic polyps were shown histologically to be dilated glandular canals. The 14 children in whom no abnormal ultrasonographic findings were shown had no further rectal bleeding after resuming regular defecation, and 5 of these 14 had negative colonoscopic findings. No adverse reactions were noted in any child during or after the saline enema examination. We conclude that ultrasonographic examination with a saline enema is a safe and accurate method of assessing children with rectal bleeding, especially for the diagnosis of juvenile colonic polyps.

Child↗
PubMed1981

Multiple juvenile polyposis. A study of the pathogenesis of juvenile polyps and their relationship to colonic adenomas.

Solitary juvenile polyps are common lesions whose pathogenesis is poorly understood. Multiple juvenile polyposis is characterized by large numbers of these lesions either confined to the colon or throughout the gastrointestinal tract. A study of two cases of multiple juvenile polyposis provided fresh insight into the pathogenesis of juvenile polyps and their relationship to colonic adenomas. Mucosal ulceration in very early lesions, together with glandular epithelial calcification, suggested that impaired cell renewal resulting from disturbed regenerative kinetics may predispose to surface epithelial erosion, setting in motion a cycle of ulceration, inflammation, and granulation tissue formation. We postulate that a dyskinetic continuum may link juvenile, "metaplastic," and adenomatous polyps. The finding in our second case of multiple adenomatous lesions, including a villoglandular polyp, emphasizes the neoplastic potential of juvenile polyposis.

Adenoma↗