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PubMed2004

Histological quality of polyps resected using the cold versus hot biopsy technique.

BACKGROUND AND STUDY AIMS: The monopolar hot biopsy technique is a widespread method of removing and cauterizing small colonic polyps. Due to the insulated cups of the biopsy forceps, it also allows adequate histological interpretation of the resected specimen. In our experience, polyps removed using the monopolar hot biopsy technique have been less histologically interpretable in comparison with polyps removed using cold biopsy forceps. The aim of this study was to assess and compare the diagnostic quality of polyps obtained using the hot biopsy and cold biopsy techniques. PATIENTS AND METHODS: This was a prospective study of consecutive patients undergoing colonoscopy with removal of polyps using either hot biopsy or cold biopsy techniques. One experienced endoscopist using the same techniques carried out the biopsies. An experienced gastrointestinal pathologist, blinded to the technique used, evaluated the specimens for diameter, artifacts, cautery damage, tissue fragmentation, and general histological and diagnostic quality. Statistical analysis was carried out using the chi-squared test, Fisher's exact test, and Student's t-test. RESULTS: Forty-three consecutive patients (84 % men; mean age 63.8 +/- 15 years) underwent 88 biopsies (45 hot biopsies and 43 cold biopsies). There were no statistically significant differences between the two study groups with regard to demographic data, indications for colonoscopy, endoscopic findings, or polyp size. Cautery damage, architectural distortion, and tissue fragmentation occurred more frequently in polyps resected using the hot biopsy technique ( P < 0.001). CONCLUSIONS: The quality of the specimens removed by cold biopsy was generally better than when using hot biopsy technique. Histological evaluation is more difficult in polyps resected with the hot biopsy technique in comparison with the cold biopsy technique. When the nature of polyps affects the patient's management, a biopsy may be obtained before polyp coagulation.

Aged↗
PubMed2005

Computed tomographic virtual colonoscopy computer-aided polyp detection in a screening population.

BACKGROUND & AIMS: The sensitivity of computed tomographic (CT) virtual colonoscopy (CT colonography) for detecting polyps varies widely in recently reported large clinical trials. Our objective was to determine whether a computer program is as sensitive as optical colonoscopy for the detection of adenomatous colonic polyps on CT virtual colonoscopy. METHODS: The data set was a cohort of 1186 screening patients at 3 medical centers. All patients underwent same-day virtual and optical colonoscopy. Our enhanced gold standard combined segmental unblinded optical colonoscopy and retrospective identification of precise polyp locations. The data were randomized into separate training (n = 394) and test (n = 792) sets for analysis by a computer-aided polyp detection (CAD) program. RESULTS: For the test set, per-polyp and per-patient sensitivities for CAD were both 89.3% (25/28; 95% confidence interval, 71.8%-97.7%) for detecting retrospectively identifiable adenomatous polyps at least 1 cm in size. The false-positive rate was 2.1 (95% confidence interval, 2.0-2.2) false polyps per patient. Both carcinomas were detected by CAD at a false-positive rate of 0.7 per patient; only 1 of 2 was detected by optical colonoscopy before segmental unblinding. At both 8-mm and 10-mm adenoma size thresholds, the per-patient sensitivities of CAD were not significantly different from those of optical colonoscopy before segmental unblinding. CONCLUSIONS: The per-patient sensitivity of CT virtual colonoscopy CAD in an asymptomatic screening population is comparable to that of optical colonoscopy for adenomas > or = 8 mm and is generalizable to new CT virtual colonoscopy data.

Adenomatous Polyps↗
PubMed2004

Possible relationship between Helicobacter pylori infection and cap polyposis of the colon.

BACKGROUND: Cap polyposis is a rarely encountered disease characterized by multiple distinctive inflammatory colonic polyps located from the rectum to the distal colon. The etiology of this disease is still unknown, and no specific treatment has been established. AIM: We report three cases of cap polyposis that were cured following eradication therapy for Helicobacter pylori infection. METHODS AND RESULTS: Three women were referred to Shinshu University Hospital because of mucoid and/or bloody diarrhea. Laboratory data showed hypoproteinemia in all cases; markers of inflammation such as C-reactive protein were negative. Colonoscopy revealed multiple sessile polyps with mucus adherent on the apices of the mucosal folds in the rectum and/or the sigmoid colon. The intervening mucosa was normal. Microscopic examinations of biopsy specimens taken from sessile polyps revealed inflamed mucosa with elongated tortuous crypts attenuated towards the mucosal surface. A granulation tissue 'cap' was observed on the surface of the mucosa. Various treatments were unsuccessful, including administration of metronidazole or prednisolone, avoidance of straining at defecation, and surgical or endoscopic resection. All were diagnosed with H. pylori infection in the stomach. Helicobacter pylori was not detected in the biopsy specimens from the colonic inflammatory polyps by immunohistochemical study using polyclonal anti-H. pylori antibody. After successful eradication therapy the clinical symptoms improved. Disappearance of cap polyposis was confirmed by colonoscopy in all three cases. CONCLUSION: We speculate that H. pylori infection might play a role in the pathogenesis of cap polyposis.

Adult↗
PubMed2000

Accuracy of double-contrast barium enema in diagnosing colorectal polyps and cancer.

CRC is a common malignancy, and reduced mortality can be achieved through detection and treatment of early cancers and by removal of colonic adenomas. Although current screening recommendations, especially in the average-risk individual, typically promote the use of FOBT and FS, a substantial minority of colonic cancers and many colonic adenomas are not detected by these methods. Modalities that examine the entire colon, such as the barium enema and colonoscopy, can detect most clinically important colorectal neoplasms; however, their additional costs and potential risks have limited their use as initial screening examinations. But recent changes in governmental policies regarding reimbursement for CRC screening and increasing emphasis on total colon examinations have altered these recommendations. This review on the accuracy of the DCBE has emphasized the detection of colonic polyps and cancers and has updated the changing role of this examination in screening patients at variable risk for CRC. The efficacy of the barium enema depends on many factors that radiologists must understand and control to perform accurate examinations. Current recommendations for CRC screening and approved reimbursement of the barium enema for that purpose provide a new impetus to radiologists to maintain and improve their skills in performing and interpreting this radiologic examination. The barium enema may have a future in the new millennium.

Barium Sulfate↗
PubMed2005

The pathophysiology, clinical presentation, and diagnosis of colon cancer and adenomatous polyps.

A review of the pathophysiology, clinical presentation, and diagnosis of colon cancer and colonic polyps is important and timely. This field is rapidly changing because of breakthroughs in the molecular basis of carcinogenesis and in the technology for colon cancer detection and treatment. This article reviews colon cancer and colonic polyps, with a focus on recent dramatic advances, to help the pri-mary care physician and internist appropriately refer patients for screening colonoscopy and intelligently evaluate colonoscopic findings to reduce the mortality from this cancer.

Adenomatous Polyps↗
PubMed2005

A large inflammatory fibroid polyp of the colon treated by endoclip-assisted endoscopic polypectomy: A case report.

Inflammatory fibroid polyp is a rare benign polypoid lesion of the gastrointestinal tract. Histologically, inflammatory fibroid polyp is characterised by an admixture of numerous small vessels, fibroblasts and oedematous connective tissue, accompanied by marked inflammatory infiltration by eosinophils. A 40-year-old man visited our hospital for the purpose of colorectal screening due to a positive faecal occult blood test. A pedunculated and reddish polyp was found endoscopically in the ascending colon. The polyp was large but was resected endoscopically without any problems. Histologically, the abnormal tissue of the polyp was located in the submucosal and mucosal layer. Proliferation of spindle cells and infiltration of inflammatory cells, such as plasma cells and eosinophils, were observed. Immunohistochemically, the spindle cells were positive for CD34, which was localised in the cytoplasm. These cells were also positive for S100 protein but were negative for c-kit and muscle markers. These findings are compatible with the histological diagnosis of inflammatory fibroid polyp. The surgical margin of the polyp was free of the tumour. Inflammatory fibroid polyp is more commonly found in the stomach or small intestine, and rarely in the colon, and therefore our case is a rare example of large and pedunculated colonic inflammatory fibroid polyp, which was treated successfully by endoscopic polypectomy.

Adult↗
PubMed1983

An unusual pedunculated polyp of the colon: association with schistosomiasis.

A patient with long-standing, nonspecific abdominal symptoms had a barium enema showing a single pedunculated polyp. This was removed by colonoscopic polypectomy and found to be an inflammatory polyp associated with Schistosoma mansoni infection. We review the relationship and significance of schistosomiasis to colonic polyps.

Barium Sulfate↗
PubMed1982

Diminutive polyps: histopathology, spatial distribution, and clinical significance.

This retrospective study of 329 diminutive colon polyps revealed that 49.2% of the polyps were neoplastic, whereas 49.9% were nonneoplastic. 36.8% of the polyps were metaplastic, and 0.9% had mixed metaplastic and adenomatous components. The metaplastic polyps had a predominance in the distal portion of the large bowel, with 76.9% being located distal from the splenic flexure and 52.9% being located in the rectosigmoid area. Neoplastic polyps were distributed throughout the colon, with 65.4% located from the splenic flexure distally and 34.5% located proximal to the splenic flexure. These findings suggest that a much larger proportion of diminutive polyps are neoplastic and therefore at risk to progress to carcinoma than previously considered.

Adult↗
PubMed1986

Benign colonic neoplasm at the site of ureterosigmoidostomy.

A benign colonic polyp with epithelial dysplasia developed in a young male at the site of ureteral implantation in the sigmoid colon following ureterosigmoidostomy for urinary incontinence. Patients with ureterosigmoidostomy represent a high-risk cancer group, and a review of the literature suggests the necessity of a life-long follow-up in these patients. A follow-up plan with Hemoccult test each year and a sigmoidoscopy every 3rd year is proposed.

Adult↗
PubMed2000

Adenocarcinoma of the rectum with associated colorectal adenomatous polyps in tuberous sclerosis: a case report.

The authors present the case of a 17-year-old girl with tuberous sclerosis (TS) who presented with symptoms of intussusception. Although endoscopically diagnosed with multiple colonic polyps, presumed to be hamartomas, and an invasive rectal adenocarcinoma, postoperative pathology findings confirmed the rectal cancer and showed multiple colonic adenomas. Multiple colonic adenomatous polyps in a young girl with tuberous sclerosis is extremely rare. Furthermore, we believe that this is the first report of an invasive adenocarcinoma of the large intestine occurring in a patient with TS.

Adenocarcinoma↗
PubMed2000

Variations in the expression of platelet-derived endothelial cell growth factor in human colorectal polyps.

Platelet-derived endothelial cell growth factor (PD-ECGF) has been identified to be an angiogenic factor, and a close relationship between the expression of PD-ECGF and tumor development has been postulated. This study was designed to assess both the role of PD-ECGF in human colorectal polyps as well as its relationship to the expression of other oncogenes during colorectal carcinogenesis. One hundred twenty patients with colon polyps who had undergone a polypectomy were studied. The polyps were classified based on the pathological findings as nonneoplastic or sporadic adenoma. The polyps were immunostained for PD-ECGF and vascular endothelial cell growth factor (VEGF), as well as for Ki-67 antigen and p53. The correlations between expression of PD-ECGF and clinicopathologic factors were examined. PD-ECGF was expressed at significant levels only in adenomas: in 4 of the 20 polyps with severe dysplasia (20%), and in 5 of the 20 cases of carcinoma in adenoma (25%). PD-ECGF was not detected in the nonneoplastic polyps and in adenomas with low-grade dysplasia. The intensity of immunostaining for PD-ECGF in adenomas correlated with the expression of Ki-67 antigen (P < 0.001) but not with that of p53. VEGF was not detected in any types of polyps. Angiogenic factors in colorectal adenomas might play an important role in carcinogenesis. The correlated expression of PD-ECGF and Ki-67 antigen suggests that PD-ECGF might not only act as an angiogenic factor, but also as a tumor growth factor.

Adult↗
PubMed1994

Association of APC gene mutations and histological characteristics of colorectal adenomas.

Fifty-nine colonic adenomas and 6 hyperplastic colonic polyps were analyzed by single-strand conformation polymorphism analysis for mutations in the adenomatous polyposis coli gene (APC). Frameshifts and premature stop codons in at least one copy of APC were detected in 25 of these adenomas. Five adenomas carried 2 APC mutations. No mutations in APC were found in any of the 6 hyperplastic polyps. The detection of APC mutations increased with size and degree of dysplasia and in rectal as compared to colonic adenomas, although the association was not statistically significant. The frequency of detectable APC mutations was higher in tubulovillous and villous adenomas (10 of 13) than in tubular adenomas (15 of 45) (odds ratio, 6.67; 95% confidence limits, 1.39-41.83; P = 0.005). The significance of the association between the detection of APC mutations and a villous architecture was confirmed in multivariate analysis (relative risk, 6.67; 95% confidence limits, 1.54-28.8; P = 0.005). In conclusion, APC mutation plays a role in adenoma progression; its frequency is significantly higher in lesions with a more villous morphology.

Adenoma, Villous↗
PubMed1988

Colonoscopy in the diagnosis and management of colorectal neoplasia in a DGH.

Patients presenting to a district general hospital (DGH) with colorectal neoplasms have been studied before and after the introduction of a colonoscopy service, in order to investigate the diagnostic, therapeutic and economic benefits of performing colonoscopy in preference to sigmoidoscopy and double contrast barium enema (DCBE). Colonoscopy led to a 3-fold increase in the incidence of colonic polyps, and 22% of all adenomas showed worrying features. Severe dysplasia and malignancy was seen most frequently in large adenomas (greater than 2 cm), and in those with a villous component. Laparotomy was avoided in 31 patients with proximal polyps, giving colonoscopy an added therapeutic and economic advantage over sigmoidoscopy and DCBE. Colonoscopy was used less frequently to detect colonic carcinomas, as over half of these were rectal, or presented as emergencies. These findings confirm the value of performing colonoscopy in patients who present with colorectal symptoms.

Adenoma↗
PubMed1978

Synchronous cancer of the colon: a case for more definitive resection in colon cancer.

Carcinoma of the colon is reported to be the most common visceral cancer today in the United States, second only to cancer of the lung as a cause of cancer-related mortality. Three consecutive cases of multiple primary colon cancers-synchronous carcinoma, two of which were additionally associated with colonic polyps, prompted a review of the literature as it related to synchronous colon cancer. The incidence of this phenomenon seems to be in the range of three percent of colon cancers. These patients tend to have a higher than usual incidence of associated polyps and of metachronous colon cancer. Inasmuch as the colons of these patients have a clear proclivity to neoplastic transformation and recurrence, subtotal colectomy as the initial curative colon procedure is practiced. This diagnosis is more often made in retrospect. It would seem that subtotal colectomy should be the initial curative procedure for any cancer of the large bowel proximal to the rectum in otherwise healthy patients less than 60 years of age.

Aged↗
PubMed2006

Laparoscopic colon resection for polyps: a good novice case?

PURPOSE: Laparoscopic colon resection of the endoscopically unresectable polyp has been considered an ideal case for the surgeon with moderate laparoscopic colectomy experience because tissues are not inflamed and the lymphadenectomy may not need to be as extensive compared with that required for cancer. To assess the appropriateness of this approach, we evaluated the incidence of invasive cancer in a series of laparoscopic colon resections for polyps. METHODS: A retrospective review was performed of 55 consecutive patients undergoing laparoscopic colon resection for endoscopically unresectable polyps during a 35-month period. Colonoscopy data, polyp characteristics, and final colon pathology were reviewed. RESULTS: On final pathologic examination, 18.2 percent of patients had invasive adenocarcinoma. Patient age, gender, indication for colonoscopy, polyp size, polyp location, polyp characteristics, and colonoscopic biopsy pathology were not predictive of adenocarcinoma on final pathology. CONCLUSIONS: A significant number of endoscopically unresectable polyps harbor adenocarcinoma, thereby requiring a formal lymphadenectomy at resection. Caution should be exercised when considering the laparoscopic resection of an endoscopically unresectable polyp as a "learning" case.

Adenocarcinoma↗
PubMed2000

[Laparoscopic surgery for benign colorectal diseases].

Since 1991 when the first cases of laparoscopic colectomy were reported, this technique has become widespread in colorectal surgery. Its reliability in colorectal cancer has been demonstrated but indications must still be limited to strictly controlled clinical trials that will determine its impact in terms of cancerology outcome. Inversely, for benign colorectal disease, the efficacy, low morbidity and the generally observed clinical benefit of laparoscopy compared with laparotomy, particularly in terms of patient comfort in the post-operative period and delay to normal activities, has been clearly demonstrated in several, though too often uncontrolled, trials. Laparoscopy will thus become more and more widespread and probably predominant for benign colorectal disease. Today, it is warranted to propose first-intention laparoscopic procedures for elective diverticulitis sigmoidectomy, for ileocecal resection for Crohn's disease, for derivation stomies, and finally, for surgical ablation of voluminous colonic polyps. In hands well trained in laparoscopic and colorectal surgery, laparoscopic procedures will be proposed in the near future for total colectomy, rectopexia, or even ileo-anal anastomosis.

Anal Canal↗
PubMed1983

Surgical pathology of endoscopically removed malignant polyps of the colon and rectum.

Fifty-six endoscopically removed malignant polyps of the colon and rectum were studied to assess criteria for adequacy of therapeutic polypectomy. Features examined were: 1) tumor grade; 2) lymphatic invasion; 3) tumor extent (head, stalk, margin); 4) sessile versus pedunculated; 5) size; and 6) type of background adenoma. Thirty-four patients underwent colon resection while the remaining 22 malignant polyps were followed for a mean of 4.5 years. Five (8.9%) malignant polyps metastasized to lymph nodes while three cases showed metachronous liver metastases. Pathologically, malignant polyps were grouped into 28 long stalk (LS), 21 short stalk (SS), and seven sessile types, with a lymph node metastatic rate of 0%, 19%, and 14%, respectively. Only one of six malignant polyps with lymphatic invasion had any lymph node metastases (16.5), while 66% of grade III cancers had lymph node metastases. In those 24 cases with tumor at or near the resection margin (17 SS and seven sessile cases), the incidence of lymph node metastases or local recurrence was 25%. The incidence of lymph node metastases or local recurrence was 0% among the 28 LS polyps and the four SS polyps with tumor limited to the head. Two of seven polypoid carcinomas (28.5%) metastasized; however, both had positive resection margins. There was no difference in size between metastasizing and nonmetastasizing malignant polyps. Of the 36 cases where histological criteria indicated polypectomy inadequate, the incidence of lymph node metastases or local recurrence was 17%. There were no metastases or recurrences where polypectomy was considered histologically adequate. LS polyps may be treated by polypectomy alone, except in those cases with grade III cancer, lymphatic invasion, or tumor at the resection margin. SS polyps with cancer limited to the head may be treated similarly to LS polyps, while all other SS polyps and sessile polyps should undergo resection postpolypectomy.

Adult↗