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The British Journal of Radiology Feb 2023Incidental findings are commonly detected during examination of the gallbladder. Differentiating benign from malignant lesions is critical because of the poor prognosis... (Review)
Review
Incidental findings are commonly detected during examination of the gallbladder. Differentiating benign from malignant lesions is critical because of the poor prognosis associated with gallbladder malignancy. Therefore, it is important that radiologists and sonographers are aware of common incidental gallbladder findings, which undoubtedly will continue to increase with growing medical imaging use. Ultrasound is the primary imaging modality used to examine the gallbladder and biliary tree, but contrast-enhanced ultrasound and MRI are increasingly used. This review article focuses on two common incidental findings in the gallbladder; adenomyomatosis and gallbladder polyps. The imaging features of these conditions will be reviewed and compared between radiological modalities, and the pathology, epidemiology, natural history, and management will be discussed.
Topics: Humans; Gallbladder; Gallbladder Diseases; Gallbladder Neoplasms; Ultrasonography; Magnetic Resonance Imaging; Hyperplasia; Polyps
PubMed: 35731858
DOI: 10.1259/bjr.20220115 -
Best Practice & Research. Clinical... Jul 2016Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs. AUB frequently co-exists with fibroids, but the relationship... (Review)
Review
Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs. AUB frequently co-exists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint. A structured approach for establishing the cause using the Fédération International de Gynécologie et d'Obstétrique (FIGO) PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy (and hyperplasia), Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic and Not otherwise classified) classification system will facilitate accurate diagnosis and inform treatment options. Office hysteroscopy and increasing sophisticated imaging will assist provision of robust evidence for the underlying cause. Increased availability of medical options has expanded the choice for women and many will no longer need to recourse to potentially complicated surgery. Treatment must remain individualised and encompass the impact of pressure symptoms, desire for retention of fertility and contraceptive needs, as well as address the management of AUB in order to achieve improved quality of life.
Topics: Adenomyosis; Blood Coagulation Disorders; Female; Humans; Leiomyoma; Leiomyosarcoma; Metrorrhagia; Polyps; Uterine Neoplasms
PubMed: 26803558
DOI: 10.1016/j.bpobgyn.2015.11.012 -
World Journal of Gastroenterology May 2020In recent years, the serrated neoplasia pathway where serrated polyps arise as a colorectal cancer has gained considerable attention as a new carcinogenic pathway.... (Review)
Review
In recent years, the serrated neoplasia pathway where serrated polyps arise as a colorectal cancer has gained considerable attention as a new carcinogenic pathway. Colorectal serrated polyps are histopathologically classified into hyperplastic polyps (HPs), sessile serrated lesions, and traditional serrated adenomas; in the serrated neoplasia pathway, the latter two are considered to be premalignant. In western countries, all colorectal polyps, including serrated polyps, apart from diminutive rectosigmoid HPs are removed. However, in Asian countries, the treatment strategy for colorectal serrated polyps has remained unestablished. Therefore, in this review, we described the clinicopathological features of colorectal serrated polyps and proposed to remove HPs and sessile serrated lesions ≥ 6 mm in size, and traditional serrated adenomas of any size.
Topics: Adenoma; Clinical Decision-Making; Colectomy; Colon; Colonic Polyps; Colorectal Neoplasms; Humans; Hyperplasia; Intestinal Mucosa; Narrow Band Imaging; Practice Guidelines as Topic; Precancerous Conditions; Proctectomy; Rectum; Treatment Outcome
PubMed: 32476792
DOI: 10.3748/wjg.v26.i19.2276 -
Nature Aug 2018Barrier tissue dysfunction is a fundamental feature of chronic human inflammatory diseases. Specialized subsets of epithelial cells-including secretory and ciliated...
Barrier tissue dysfunction is a fundamental feature of chronic human inflammatory diseases. Specialized subsets of epithelial cells-including secretory and ciliated cells-differentiate from basal stem cells to collectively protect the upper airway. Allergic inflammation can develop from persistent activation of type 2 immunity in the upper airway, resulting in chronic rhinosinusitis, which ranges in severity from rhinitis to severe nasal polyps. Basal cell hyperplasia is a hallmark of severe disease, but it is not known how these progenitor cells contribute to clinical presentation and barrier tissue dysfunction in humans. Here we profile primary human surgical chronic rhinosinusitis samples (18,036 cells, n = 12) that span the disease spectrum using Seq-Well for massively parallel single-cell RNA sequencing, report transcriptomes for human respiratory epithelial, immune and stromal cell types and subsets from a type 2 inflammatory disease, and map key mediators. By comparison with nasal scrapings (18,704 cells, n = 9), we define signatures of core, healthy, inflamed and polyp secretory cells. We reveal marked differences between the epithelial compartments of the non-polyp and polyp cellular ecosystems, identifying and validating a global reduction in cellular diversity of polyps characterized by basal cell hyperplasia, concomitant decreases in glandular cells, and phenotypic shifts in secretory cell antimicrobial expression. We detect an aberrant basal progenitor differentiation trajectory in polyps, and propose cell-intrinsic, epigenetic and extrinsic factors that lock polyp basal cells into this uncommitted state. Finally, we functionally demonstrate that ex vivo cultured basal cells retain intrinsic memory of IL-4/IL-13 exposure, and test the potential for clinical blockade of the IL-4 receptor α-subunit to modify basal and secretory cell states in vivo. Overall, we find that reduced epithelial diversity stemming from functional shifts in basal cells is a key characteristic of type 2 immune-mediated barrier tissue dysfunction. Our results demonstrate that epithelial stem cells may contribute to the persistence of human disease by serving as repositories for allergic memories.
Topics: Adolescent; Adult; Aged; Case-Control Studies; Cells, Cultured; Epigenesis, Genetic; Epithelial Cells; Humans; Hyperplasia; Hypersensitivity; Interleukin-13; Interleukin-4; Interleukin-4 Receptor alpha Subunit; Middle Aged; Nasal Polyps; Respiratory Mucosa; Rhinitis; Sequence Analysis, RNA; Single-Cell Analysis; Sinusitis; Stem Cells; Transcription, Genetic; Transcriptome; Young Adult
PubMed: 30135581
DOI: 10.1038/s41586-018-0449-8 -
Clinical Gastroenterology and... Nov 2013The endoscopic finding of a gastric polyp and the histopathologic report that follows may leave clinicians with questions that have not been addressed in formal... (Review)
Review
The endoscopic finding of a gastric polyp and the histopathologic report that follows may leave clinicians with questions that have not been addressed in formal guidelines: do all polyps need to be excised, or can they just be sampled for biopsy? If so, which ones and how many should be sampled? What follow-up evaluation is needed, if any? This review relies on the existing literature and our collective experience to provide practical answers to these questions. Fundic gland polyps, now the most frequent gastric polyps in Western countries because of widespread use of proton pump inhibitors, and hyperplastic polyps, the second most common polyps notable for their association with gastritis and their low but important potential for harboring dysplastic or neoplastic foci, are discussed in greater detail. Adenomas have had their name changed to raised intraepithelial neoplasia and are decreasing in parallel with Helicobacter pylori infection; however, they do retain their importance as harbingers of gastric cancer, particularly in East Asia. Gastrointestinal stromal tumors have low incidence and no known associations, but their malignant potential is high; early diagnosis and proper management are crucial. Although rare and benign, inflammatory fibroid polyps need to recognized, particularly by pathologists, to avoid misdiagnosis. Gastric neuroendocrine tumors (carcinoids) are important because of their association with either atrophic gastritis or the multiple endocrine neoplasia syndromes; those that do not arise in these backgrounds have high malignant potential and require aggressive management. The review concludes with some practical suggestions on how to approach gastric polyps detected at endoscopy.
Topics: Endoscopy, Digestive System; Humans; Polyps; Stomach Neoplasms
PubMed: 23583466
DOI: 10.1016/j.cgh.2013.03.019 -
Annual Review of Pathology Jan 2017Chronic rhinosinusitis (CRS) is a troublesome, chronic inflammatory disease that affects over 10% of the adult population, causing decreased quality of life, lost... (Review)
Review
Chronic rhinosinusitis (CRS) is a troublesome, chronic inflammatory disease that affects over 10% of the adult population, causing decreased quality of life, lost productivity, and lost time at work and leading to more than a million surgical interventions annually worldwide. The nose, paranasal sinuses, and associated lymphoid tissues play important roles in homeostasis and immunity, and CRS significantly impairs these normal functions. Pathogenic mechanisms of CRS have recently become the focus of intense investigations worldwide, and significant progress has been made. The two main forms of CRS that have been long recognized, with and without nasal polyps, are each now known to be heterogeneous, based on underlying mechanism, geographical location, and race. Loss of the immune barrier, including increased permeability of mucosal epithelium and reduced production of important antimicrobial substances and responses, is a common feature of many forms of CRS. One form of CRS with polyps found worldwide is driven by the cytokines IL-5 and IL-13 coming from Th2 cells, type 2 innate lymphoid cells, and probably mast cells. Type 2 cytokines activate inflammatory cells that are implicated in the pathogenic mechanism, including mast cells, basophils, and eosinophils. New classes of biological drugs that block the production or action of these cytokines are making important inroads toward new treatment paradigms in polypoid CRS.
Topics: Adult; Chronic Disease; Humans; Nasal Polyps; Rhinitis; Sinusitis
PubMed: 27959637
DOI: 10.1146/annurev-pathol-052016-100401 -
Yonsei Medical Journal Apr 2020To evaluate factors associated with endometrial pathology during tamoxifen use in premenopausal breast cancer (BC) patients. (Review)
Review
PURPOSE
To evaluate factors associated with endometrial pathology during tamoxifen use in premenopausal breast cancer (BC) patients.
MATERIALS AND METHODS
We reviewed the medical records of premenopausal BC patients treated with tamoxifen who underwent endometrial biopsy with or without hysteroscopy. Clinical characteristics were compared between women with endometrial pathology (endometrial hyperplasia or cancer) and those with normal histology or endometrial polyps.
RESULTS
Among 284 endometrial biopsies, endometrial hyperplasia was diagnosed in 7 patients (2.5%), endometrial cancer was diagnosed in 5 patients (1.8%), normal histology was noted in 146 patients (51.4%), and endometrial polyp was present in 114 patients (40.1%). When comparing women with endometrial cancer (n=5) to women with normal histology, abnormal uterine bleeding was more common (=0.007), and endometrial thickness was greater (=0.007) in women with endometrial cancer. Chemotherapy for BC was also more common in patients with endometrial cancer (=0.037). When comparing women with endometrial polyps and those with endometrial hyperplasia or cancer, the presence of abnormal uterine bleeding was more common in patients with endometrial hyperplasia or cancer (<0.001); however, tamoxifen duration and endometrial thickness did not differ significantly between the two groups.
CONCLUSION
In premenopausal BC patients treated with tamoxifen, abnormal uterine bleeding, increased endometrial thickness, and chemotherapy for BC were associated with the occurrence of endometrial cancer. These findings may provide useful information for gynecologic surveillance and counseling during tamoxifen treatment in premenopausal BC patients.
Topics: Adult; Antineoplastic Agents, Hormonal; Biopsy; Breast Neoplasms; Endometrial Hyperplasia; Endometrial Neoplasms; Endometrium; Female; Humans; Hysteroscopy; Middle Aged; Polyps; Premenopause; Risk Factors; Tamoxifen; Time Factors; Uterine Diseases; Uterine Neoplasms
PubMed: 32233174
DOI: 10.3349/ymj.2020.61.4.317 -
Gastroenterology Jan 2017Certain subsets of colorectal serrated polyps (SP) have malignant potential. We performed a systematic review and meta-analysis to investigate the association between... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND & AIMS
Certain subsets of colorectal serrated polyps (SP) have malignant potential. We performed a systematic review and meta-analysis to investigate the association between modifiable lifestyle factors and risk for SPs.
METHODS
We conducted a systematic search of Medline, Embase, and Web of Science for observational or interventional studies that contained the terms risk or risk factor, and serrated or hyperplastic, and polyps or adenomas, and colorectal (or synonymous terms), published by March 2016. Titles and abstracts of identified articles were independently reviewed by at least 2 reviewers. Adjusted relative risk (RR) and 95% confidence interval (CI) were combined using random effects meta-analyses to assess the risk of SP, when possible.
RESULTS
We identified 43 studies of SP risk associated with 7 different lifestyle factors: smoking, alcohol, body fatness, diet, physical activity, medication, and hormone-replacement therapy. When we compared the highest and lowest categories of exposure, factors we found to significantly increase risk for SP included tobacco smoking (RR, 2.47; 95% CI, 2.12-2.87), alcohol intake (RR, 1.33; 95% CI, 1.17-1.52), body mass index (RR, 1.40; 95% CI, 1.22-1.61), and high intake of fat or meat. Direct associations for smoking and alcohol, but not body fat, tended to be stronger for sessile serrated adenomas/polyps than hyperplastic polyps. In contrast, factors we found to significantly decrease risks for SP included use of nonsteroidal anti-inflammatory drugs (RR, 0.77; 95% CI, 0.65-0.92) or aspirin (RR, 0.81; 95% CI, 0.67-0.99), as well as high intake of folate, calcium, or fiber. No significant associations were detected between SP risk and physical activity or hormone replacement therapy.
CONCLUSIONS
Several lifestyle factors, most notably smoking and alcohol, are associated with SP risk. These findings enhance our understanding of mechanisms of SP development and indicate that risk of serrated pathway colorectal neoplasms could be reduced with lifestyle changes.
Topics: Adenoma; Alcohol Drinking; Anti-Inflammatory Agents, Non-Steroidal; Body Mass Index; Colon; Colonic Polyps; Diet; Exercise; Humans; Hyperplasia; Life Style; Protective Factors; Rectal Diseases; Rectum; Risk Factors; Smoking
PubMed: 27639804
DOI: 10.1053/j.gastro.2016.09.003 -
The New England Journal of Medicine Sep 2001Although many studies have found an association between Helicobacter pylori infection and the development of gastric cancer, many aspects of this relation remain...
BACKGROUND
Although many studies have found an association between Helicobacter pylori infection and the development of gastric cancer, many aspects of this relation remain uncertain.
METHODS
We prospectively studied 1526 Japanese patients who had duodenal ulcers, gastric ulcers, gastric hyperplasia, or nonulcer dyspepsia at the time of enrollment; 1246 had H. pylori infection and 280 did not. The mean follow-up was 7.8 years (range, 1.0 to 10.6). Patients underwent endoscopy with biopsy at enrollment and then between one and three years after enrollment. H. pylori infection was assessed by histologic examination, serologic testing, and rapid urease tests and was defined by a positive result on any of these tests.
RESULTS
Gastric cancers developed in 36 (2.9 percent) of the infected and none of the uninfected patients. There were 23 intestinal-type and 13 diffuse-type cancers. Among the patients with H. pylori infection, those with severe gastric atrophy, corpus-predominant gastritis, and intestinal metaplasia were at significantly higher risk for gastric cancer. We detected gastric cancers in 21 (4.7 percent) of the 445 patients with nonulcer dyspepsia, 10 (3.4 percent) of the 297 with gastric ulcers, 5 (2.2 percent) of the 229 with gastric hyperplastic polyps, and none of the 275 with duodenal ulcers.
CONCLUSIONS
Gastric cancer develops in persons infected with H. pylori but not in uninfected persons. Those with histologic findings of severe gastric atrophy, corpus-predominant gastritis, or intestinal metaplasia are at increased risk. Persons with H. pylori infection and nonulcer dyspepsia, gastric ulcers, or gastric hyperplastic polyps are also at risk, but those with duodenal ulcers are not.
Topics: Adult; Aged; Disease-Free Survival; Duodenal Ulcer; Dyspepsia; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Hyperplasia; Male; Middle Aged; Polyps; Prospective Studies; Stomach; Stomach Neoplasms; Stomach Ulcer
PubMed: 11556297
DOI: 10.1056/NEJMoa001999 -
Gut Oct 2019The effect of colonoscopy on colorectal cancer mortality is limited by several factors, among them a certain miss rate, leading to limited adenoma detection rates... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The effect of colonoscopy on colorectal cancer mortality is limited by several factors, among them a certain miss rate, leading to limited adenoma detection rates (ADRs). We investigated the effect of an automatic polyp detection system based on deep learning on polyp detection rate and ADR.
DESIGN
In an open, non-blinded trial, consecutive patients were prospectively randomised to undergo diagnostic colonoscopy with or without assistance of a real-time automatic polyp detection system providing a simultaneous visual notice and sound alarm on polyp detection. The primary outcome was ADR.
RESULTS
Of 1058 patients included, 536 were randomised to standard colonoscopy, and 522 were randomised to colonoscopy with computer-aided diagnosis. The artificial intelligence (AI) system significantly increased ADR (29.1%vs20.3%, p<0.001) and the mean number of adenomas per patient (0.53vs0.31, p<0.001). This was due to a higher number of diminutive adenomas found (185vs102; p<0.001), while there was no statistical difference in larger adenomas (77vs58, p=0.075). In addition, the number of hyperplastic polyps was also significantly increased (114vs52, p<0.001).
CONCLUSIONS
In a low prevalent ADR population, an automatic polyp detection system during colonoscopy resulted in a significant increase in the number of diminutive adenomas detected, as well as an increase in the rate of hyperplastic polyps. The cost-benefit ratio of such effects has to be determined further.
TRIAL REGISTRATION NUMBER
ChiCTR-DDD-17012221; Results.
Topics: Adenoma; China; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Prospective Studies; Reproducibility of Results; Time Factors
PubMed: 30814121
DOI: 10.1136/gutjnl-2018-317500