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Journal of Gastroenterology and... Oct 2019Sessile serrated adenoma/polyps (SSA/Ps) are early precursor lesions in the serrated neoplasia pathway, which results in BRAF-mutated colorectal carcinomas with not only... (Review)
Review
Sessile serrated adenoma/polyps (SSA/Ps) are early precursor lesions in the serrated neoplasia pathway, which results in BRAF-mutated colorectal carcinomas with not only high levels of microsatellite instability but also microsatellite stable. SSA/Ps with advanced histology, including cytological dysplasia or minimally invasive carcinomas, are important lesions because SSA/Ps are considered major contributors to "interval cancers" and these lesions can rapidly become dysplastic or invasive carcinomas. Clinicopathologically, SSA/Ps with dysplasia or invasive carcinoma were associated with advanced age, female sex, and proximal colon. Although SSA/Ps with submucosal invasive carcinoma were smaller and invaded less deeply into the submucosal layer than conventional tubular adenomas with submucosal invasive carcinoma, SSA/Ps with submucosal invasive carcinoma frequently had a mucinous component and exhibited a higher potential for lymphatic invasion and lymph node metastasis. In an SSA/P series, endoscopic characteristics, including (semi)pedunculated morphology, double elevation, central depression, and reddishness, may help accurately diagnose SSA/Ps with advanced histology. Removal of SSA/Ps with dysplasia or invasive carcinoma was recommended. Endoscopic treatment such as endoscopic mucosal resection or endoscopic submucosal dissection is useful for those lesions. However, surgical resection with lymph node dissection might be indicated when SSA/Ps with invasive carcinoma are endoscopically suspected, because these have the high risk of lymph node metastasis. Greater awareness may promote further research into improving the detection, recognition, and complete resection rates of SSA/Ps with dysplasia or invasive carcinoma and reduce the interval cancer rates.
Topics: Adenomatous Polyps; Adult; Aged; Aged, 80 and over; Carcinoma; Colectomy; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Disease Progression; Endoscopic Mucosal Resection; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Invasiveness; Treatment Outcome
PubMed: 31158302
DOI: 10.1111/jgh.14752 -
Journal of Feline Medicine and Surgery Feb 2017Objectives The aim of the study was to report the ultrasonographic and clinicopathological findings in cats with confirmed pyloroduodenal adenomatous polyps. Methods...
Objectives The aim of the study was to report the ultrasonographic and clinicopathological findings in cats with confirmed pyloroduodenal adenomatous polyps. Methods Clinicopathological data, ultrasonographic and histopathological findings were collected retrospectively from medical records. Results Pyloroduodenal polyps appeared as small moderately echogenic and homogeneous nodules filling most of the proximal duodenal or pyloroduodenal lumen. The most common presenting signs in this study included acute vomiting and anorexia in 4/6 cats and lethargy in 3/6 cats. Two cats presented with severe anemia, suggestive of active bleeding. One cat presented with increased bilirubin without anemia, suggestive of impaired bile flow. Five cats survived surgical removal of the polyp and were free of clinical signs 817 days after the procedure. Conclusions and relevance Pyloroduodenal polyps have subtle ultrasonographic changes that can easily be mistaken for ingesta. They are characterized by a discrete small (up to 1.5 cm in diameter) homogeneous echogenic nodule filling the pyloroduodenal lumen. Pyloroduodenal polyps are benign lesions but can cause severe clinical signs including gastrointestinal bleeding or biliary obstruction. The prognosis is excellent with surgical removal.
Topics: Adenomatous Polyps; Animals; Cat Diseases; Cats; Diagnosis, Differential; Duodenal Neoplasms; Female; Male; Prognosis; Retrospective Studies; Stomach Neoplasms; Ultrasonography, Doppler; Vomiting
PubMed: 26614062
DOI: 10.1177/1098612X15619206 -
Urologia Internationalis 2006The coexistence of polyp of the verumontanum, epidermoid paraurethral cyst and cryptorchidism presents a mosaic of congenital anomalies of the urogenital tract. We...
The coexistence of polyp of the verumontanum, epidermoid paraurethral cyst and cryptorchidism presents a mosaic of congenital anomalies of the urogenital tract. We present a 30-year-old patient with a medical history of unilateral cryptorchidism, urinary tract infections, obstructive voiding symptoms and perineal discomfort. Clinical and laboratory evaluation revealed a pending filling defect in the prostatic urethra and a palpable elastic mass located on the right side of the bulbar urethra. Transurethral resection of the urethral polyp with a simultaneous excision of the cystic formation via a perineal approach followed by a left-sided funiculolysis and orchiopexy were performed. Discussion focuses on the etiology and differential diagnosis of this unusual complex entity.
Topics: Adenomatous Polyps; Adult; Cryptorchidism; Epidermal Cyst; Humans; Male; Urethral Diseases; Urethral Neoplasms
PubMed: 16888430
DOI: 10.1159/000093919 -
The Journal of Laboratory and Clinical... Sep 2000
Topics: Adenomatous Polyps; Colonic Polyps; Colonoscopy; Humans
PubMed: 10985505
DOI: No ID Found -
Journal of the National Medical... Jul 1954
Topics: Adenomatous Polyps; Humans; Intestine, Large; Intestines; Neoplasms; Polyps
PubMed: 13175032
DOI: No ID Found -
Human Pathology Jul 2015Although recognized 25 years ago, the traditional serrated adenoma (TSA) remains an ongoing source of diagnostic and biologic debate. Recent research has greatly... (Review)
Review
Although recognized 25 years ago, the traditional serrated adenoma (TSA) remains an ongoing source of diagnostic and biologic debate. Recent research has greatly improved our understanding of the morphological and molecular aspects of these polyps. In particular, the recognition of ectopic crypt foci (ECFs) in combination with typical cytology and slitlike serrations improves diagnostic reproducibility. Awareness that many TSAs, particularly BRAF-mutated TSAs, arise in precursor microvesicular hyperplastic polyps and sessile serrated adenomas can aid in making this diagnosis and should not be confused with a sessile serrated adenoma with dysplasia. At a molecular level, TSAs can be divided into 2 groups based on their BRAF or KRAS mutation status. The development of overt cytologic dysplasia is accompanied by TP53 mutation, Wnt pathway activation, and, in some cases, silencing of CDKN2A. Importantly, however, mismatch repair enzyme function is retained. Thus, the TSA is an important precursor of aggressive molecular subtypes of colorectal carcinoma.
Topics: Adenomatous Polyps; Biomarkers, Tumor; Biopsy; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; DNA Mutational Analysis; Diagnosis, Differential; Gene Expression Regulation, Neoplastic; Genetic Predisposition to Disease; Humans; Immunohistochemistry; Mutation; Phenotype; Predictive Value of Tests; Prognosis; Proto-Oncogene Proteins; Proto-Oncogene Proteins B-raf; Proto-Oncogene Proteins p21(ras); Signal Transduction; Tumor Suppressor Protein p53; ras Proteins
PubMed: 26001333
DOI: 10.1016/j.humpath.2015.04.002 -
Digestive Diseases and Sciences Feb 2022Colonoscopic screening and surveillance for colorectal cancer could be made safer and more efficient if endoscopists could predict histology without the need to biopsy...
BACKGROUND
Colonoscopic screening and surveillance for colorectal cancer could be made safer and more efficient if endoscopists could predict histology without the need to biopsy and perform histopathology on every polyp. Elastic-scattering spectroscopy (ESS), using fiberoptic probes integrated into standard biopsy tools, can assess, both in vivo and in real time, the scattering and absorption properties of tissue related to its underlying pathology.
AIMS
The objective of this study was to evaluate prospectively the potential of ESS to predict polyp pathology accurately.
METHODS
We obtained ESS measurements from patients undergoing screening/surveillance colonoscopy using an ESS fiberoptic probe integrated into biopsy forceps. The integrated forceps were used for tissue acquisition, following current standards of care, and optical measurement. All measurements were correlated to the index pathology. A machine learning model was then applied to measurements from 367 polyps in 169 patients to prospectively evaluate its predictive performance.
RESULTS
The model achieved sensitivity of 0.92, specificity of 0.87, negative predictive value (NPV) of 0.87, and high-confidence rate (HCR) of 0.84 for distinguishing 220 neoplastic polyps from 147 non-neoplastic polyps of all sizes. Among 138 neoplastic and 131 non-neoplastic polyps ≤ 5 mm, the model achieved sensitivity of 0.91, specificity of 0.88, NPV of 0.89, and HCR of 0.83.
CONCLUSIONS
Results show that ESS is a viable endoscopic platform for real-time polyp histology, particularly for polyps ≤ 5 mm. ESS is a simple, low-cost, clinically friendly, optical biopsy modality that, when interfaced with minimally obtrusive endoscopic tools, offers an attractive platform for in situ polyp assessment.
Topics: Adenocarcinoma; Adenomatous Polyps; Artificial Intelligence; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Diagnosis, Computer-Assisted; Humans; Sensitivity and Specificity; Spectrum Analysis
PubMed: 33761089
DOI: 10.1007/s10620-021-06901-x -
International Journal of Surgical... May 2016Gastric polyps are found in 1% to 4% of patients undergoing gastroscopy. The vast majority are sporadic, but some gastric polyps indicate an underlying syndrome. Gastric... (Review)
Review
Gastric polyps are found in 1% to 4% of patients undergoing gastroscopy. The vast majority are sporadic, but some gastric polyps indicate an underlying syndrome. Gastric polyps can manifest in each of the gastrointestinal polyposis syndromes, including the recently described gastric adenocarcinoma and proximal polyposis of the stomach syndrome. In addition, gastric polyps occur in Lynch syndrome and in a few rare conditions that are not primarily gastrointestinal. While some of these syndromes are clearly associated with an increased risk of gastric cancer, others are not. Interestingly, even in disorders with a well-established risk of gastric cancer, the neoplastic potential and the precursor status of these gastric polyps are not always clear. Although rare, recognition of syndromic gastric polyps is important for individual patient management. These conditions also serve as important models to study gastric homeostasis and gastric tumorigenesis.
Topics: Adenomatous Polyps; Humans; Stomach Neoplasms
PubMed: 26721304
DOI: 10.1177/1066896915620013 -
Indian Journal of Gastroenterology :... Jul 2016Incidence of colorectal carcinoma is increasing all over world. There is limited data on colorectal polyps from India. We evaluated the histomorphological features of...
INTRODUCTION
Incidence of colorectal carcinoma is increasing all over world. There is limited data on colorectal polyps from India. We evaluated the histomorphological features of colorectal polyps and determined risk stratification in adenomatous polyps.
METHODS
In 4970 consecutive colonoscopies, colorectal polyps were detected in 515 cases (10.3 %). Polyps were classified using standard histological criteria. Each polyp was evaluated for presence of dysplasia. Adenomatous polyps were classified as low-risk adenomas (1-2 tubular adenomas <10 mm) and high-risk adenomas characterized by villous histology, high-grade dysplasia, size ≥10 mm, or ≥3 adenomas.
RESULTS
Of 515 colorectal polyps, 270 (52.4 %) were adenomatous, followed by 78 (15.1 %) inflammatory, 78 (15.1 %) hyperplastic, 32 (6.2 %) hamartomatous polyps, 25 (4.8 %) benign epithelial polyps, 5 (0.9 %) cap polyps, 5 (0.9 %) lipomatous polyps, 3 (0.5 %) angiomatous polyps, 4 (0.7 %) lymphoid, and 15 (2.9 %) cases with adenocarcinoma masquerading as polyps. Mean (SD) age with colorectal polyps was 54.8 (33.0) years while for adenomatous polyps, 59.5 (14.8) years with male to female ratio of 2:1. Majority of adenomatous polyps 124 (45.9 %) were tubular adenomas present in rectosigmoid. High-grade dysplasia was found in 38 (14 %) adenomas. One hundred and fifty-five (57.4 %) were high risk of which majority were villous adenomas and nine (7.2 %) tubular adenomas.
CONCLUSION
The most common colorectal polyps found during routine colonoscopy were 270 adenomatous (52.4 %) cases. Of these, 155 (57.4 %) adenomatous polyps were high-risk category. Population prevalence data of colonic polyps in general population beyond the age of 50 years needs to be obtained.
Topics: Adenomatous Polyps; Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Colonic Neoplasms; Female; Humans; India; Male; Middle Aged; Sex Distribution; Tertiary Care Centers; Young Adult
PubMed: 27510706
DOI: 10.1007/s12664-016-0681-9 -
Annals of Diagnostic Pathology Oct 2024High risk features in colorectal adenomatous polyps include size >1 cm and advanced histology: high-grade dysplasia and villous architecture. We investigated whether...
High risk features in colorectal adenomatous polyps include size >1 cm and advanced histology: high-grade dysplasia and villous architecture. We investigated whether the diagnostic rates of advanced histology in colorectal adenomatous polyps were similar among institutions across the United States, and if not, could differences be explained by patient age, polyp size, and/or CRC rate. Nine academic institutions contributed data from three pathologists who had signed out at least 100 colorectal adenomatous polyps each from 2018 to 2019 taken from patients undergoing screening colonoscopy. For each case, we recorded patient age and sex, polyp size and location, concurrent CRC, and presence or absence of HGD and villous features. A total of 2700 polyps from 1886 patients (mean age: 61 years) were collected. One hundred twenty-four (5 %) of the 2700 polyps had advanced histology, including 35 (1 %) with HGD and 101 (4 %) with villous features. The diagnostic rate of advanced histology varied by institution from 1.7 % to 9.3 % (median: 4.3 %, standard deviation [SD]: 2.5 %). The rate of HGD ranged from 0 % to 3.3 % (median: 1 %, SD: 1.2 %), while the rate of villous architecture varied from 1 % to 8 % (median: 3.7 %, SD: 2.5 %). In a multivariate analysis, the factor most strongly associated with advanced histology was polyp size >1 cm with an odds ratio (OR) of 31.82 (95 % confidence interval [CI]: 20.52-50.25, p < 0.05). Inter-institutional differences in the rate of polyps >1 cm likely explain some of the diagnostic variance, but pathologic subjectivity may be another contributing factor.
Topics: Humans; Adenomatous Polyps; Middle Aged; Male; Female; Colorectal Neoplasms; Aged; Colonoscopy; Colonic Polyps; Adult; United States; Risk Factors
PubMed: 38733674
DOI: 10.1016/j.anndiagpath.2024.152323