Cases Of Adenomatous Polyps Research Articles

Risk prediction and analysis of gallbladder polyps with deep neural network

The aim of this study is to analyze the risk factors associated with the development of adenomatous and malignant polyps in the gallbladder. Adenomatous polyps of the gallbladder are considered precancerous and have a high likelihood of progressing into malignancy. Preoperatively, distinguishing between benign gallbladder polyps, adenomatous polyps, and malignant polyps is challenging. Therefore, the objective is to develop a neural network model that utilizes these risk factors to accurately predict the nature of polyps. This predictive model can be employed to differentiate the nature of polyps before surgery, enhancing diagnostic accuracy. A retrospective study was done on patients who had cholecystectomy surgeries at the Department of Hepatobiliary Surgery of the Second People’s Hospital of Shenzhen between January 2017 and December 2022. The patients’ clinical characteristics, lab results, and ultrasonographic indices were examined. Using risk variables for the growth of adenomatous and malignant polyps in the gallbladder, a neural network model for predicting the kind of polyps will be created. A normalized confusion matrix, PR, and ROC curve were used to evaluate the performance of the model. In this comprehensive study, we meticulously analyzed a total of 287 cases of benign gallbladder polyps, 15 cases of adenomatous polyps, and 27 cases of malignant polyps. The data analysis revealed several significant findings. Specifically, hepatitis B core antibody (95% CI −0.237 to 0.061, p < 0.001), number of polyps (95% CI −0.214 to −0.052, p = 0.001), polyp size (95% CI 0.038 to 0.051, p < 0.001), wall thickness (95% CI 0.042 to 0.081, p < 0.001), and gallbladder size (95% CI 0.185 to 0.367, p < 0.001) emerged as independent predictors for gallbladder adenomatous polyps and malignant polyps. Based on these significant findings, we developed a predictive classification model for gallbladder polyps, represented as follows, Predictive classification model for GBPs = −0.149 * core antibody − 0.033 * number of polyps + 0.045 * polyp size + 0.061 * wall thickness + 0.276 * gallbladder size − 4.313. To assess the predictive efficiency of the model, we employed precision-recall (PR) and receiver operating characteristic (ROC) curves. The area under the curve (AUC) for the prediction model was 0.945 and 0.930, respectively, indicating excellent predictive capability. We determined that a polyp size of 10 mm served as the optimal cutoff value for diagnosing gallbladder adenoma, with a sensitivity of 81.5% and specificity of 60.0%. For the diagnosis of gallbladder cancer, the sensitivity and specificity were 81.5% and 92.5%, respectively. These findings highlight the potential of our predictive model and provide valuable insights into accurate diagnosis and risk assessment for gallbladder polyps. We identified several risk factors associated with the development of adenomatous and malignant polyps in the gallbladder, including hepatitis B core antibodies, polyp number, polyp size, wall thickness, and gallbladder size. To address the need for accurate prediction, we introduced a novel neural network learning algorithm. This algorithm utilizes the aforementioned risk factors to predict the nature of gallbladder polyps. By accurately identifying the nature of these polyps, our model can assist patients in making informed decisions regarding their treatment and management strategies. This innovative approach aims to improve patient outcomes and enhance the overall effectiveness of care.

The Application of Core Needle Biopsy Through the Trocar Hole in the Surgical Operation of Endoscopically Unresectable Giant Colon Polyps: A Systematic Review Study.

The study aimed to investigate the application of core needle biopsy through the trocar hole during surgery on endoscopically unresectable giant colon polyps. The clinical data of 51 patients with endoscopically unresectable giant colon polyps from May 2016 to May 2020 were retrospectively analyzed. The primary observational outcomes were two comparative analyses of pathologic results, using the kappa index: comparison of the pathologic results from the preoperative colonoscopy and the postoperative pathologic results and comparison of the intraoperative pathologic results from core needle biopsy of the intestinal wall and the postoperative pathologic results. The secondary observational outcomes were duration of needle biopsy, operation duration, volume of intraoperative hemorrhage, rate of postoperative wound infection, rate of abdominal cavity infection, length of stay, and number and positivity of lymph node dissections after laparoscopic radical resection of colon cancer. Poor consistency was found between the preoperative (colonoscopy) and postoperative pathologic results, with kappa = 0.222 (i.e., kappa < 0.4), P < 0.05. However, good consistency was found between the intraoperative (core needle biopsy) and postoperative pathologic results, with kappa = 0.923 (i.e., kappa ≥ 0.75), P < 0.05. The postoperative pathologic results were as follows: 7 cases of adenomatous polyps of the colon, 12 cases of low-grade intraepithelial neoplasia, 12 cases of high-grade intraepithelial neoplasia, and 25 cases of invasive colon cancer. There was no incision infection, no abdominal cavity infection or formation of an abdominal abscess, no anastomotic leakage, and no death for any of the 51 patients. Postoperative complications occurred in two cases (3.92%). Biopsy through the trocar hole during laparoscopic surgery produced highly accurate pathologic results and was a fast, safe, and effective diagnostic method. Pathologic results from intraoperative biopsy could accurately determine the nature of colon polyps and provide a basis for choosing an appropriate surgical scheme.

Construction and practice of cancer genetic clinic

To explore the effect and precautions of setting up a genetic clinic for hereditary colorectal cancers. To collect the information of the patients who received genetic screening and genetic counseling at our hospital from January 2016 to June 2018, and analyze the role of family history collection and follow-up management. The detection rate of family history of tumors has increased by 13.6%. Follow up management was carried out in 156 families with hereditary colorectal cancer confirmed by detection of germline mutations. Five cases of early colorectal cancers and 12 cases of adenomatous polyps were detected and treated. To set up genetic clinic is helpful to standardize the management of high-risk population, and attention should be paid to the role of family history collection and follow-up management.

Histopathological spectrum of lesions in gastrointestinal endoscopic biopsy: A prospective study of 500 cases

Lesion of the gastrointestinal tract is a very common condition encountered in medical science. An endoscopic biopsy is a favourable tool for early diagnosis and management of these conditions. The aim of the work is to study the histopathological spectrum of gastrointestinal endoscopic biopsy. In a prospective study of 500 biopsies, Formalin-fixed tissue was processed and stained with Hematoxylin-Eosin stain and studied under the microscope. A wide spectrum of neoplastic and non-neoplastic lesions was noted with male preponderance in most of the gastrointestinal tract. The commonest age group was 6 decades of life. Mean age being 51.83years. Predominant sample collected was from stomach accounting for 36.6% of total gastrointestinal biopsies. The ratio between non-malignant: malignant lesion was 2.7:1. Majority of the malignancy was Adenocarcinoma seen in 71 out of 135 cases closely followed by Squamous cell carcinoma (62/135). Most of the oesophageal malignancy was squamous cell carcinoma whereas adenocarcinoma was common in rest of the gastrointestinal tract. Gastritis was the commonest non-neoplastic lesion. Celiac disease was common in our study. Eight cases of adenomatous polyp identified, four of them showed high-grade dysplasia. Celiac disease and inflammatory bowel disease need further studies as there were many overlapping features which make a definitive diagnosis difficult. Endoscopy itself is insufficient in the diagnosis and management of gastrointestinal tract disease and biopsy must be performed in all cases of suspected endoscopic finding. Conditions like Barrett’s oesophagus, Celiac disease, Inflammatory Bowel Disease and high-grade dysplasia needs timely intervention to avoid more serious complications.

John Cunningham Virus T-Antigen Expression on Mild and Severe Dysplasia Adenomatous Polyp, Low and High Grade Adenocarcinoma of The Colon

Background: John Cunningham Virus (JCV) was involved in pre-malignant lessions and carcinogenesis of the colon. The purpose of this study was to detect and analyze JCV T-Ag expression in mild and severe dysplasia adenomatous polyp as well as low and high grade adenocarcinoma of the colon.Materials and Methods: This study used analytic descriptive, cross sectional approach. The samples’ paraffin blocks were taken from colon adenomatous polyp cases (all grades of dysplasia) and cases of colon adenocarcinoma (all degrees) at Anatomical Pathology Laboratory, School of Medicine, Atma Jaya Catholic University of Indonesia from 2010-2014 (5 years period). Samples were reviewed from HE slides to determine histopathologic diagnosis, grades of dysplasia and grading. We performed immunohistochemistry staining with monoclonal antibody anti–SV 40-T-Ag to detect JCV T-Ag expression.Results: We found 7 cases of colon adenomatous polyp, of which 4 (57%) were mild dysplasia and 3 (43%) were severe dysplasia. Positive expression of JCV T-Ag was detected in 1 (14%) mild dysplasia case. Data analysis using Fischer’s Exact Test was p&gt;0.05. We also found 16 cases of colon adenocarcinoma. 14 cases (87.5%) of low grade variant and 2 cases (12.5%) of high grade variant. Positive expression of JCV T-Ag was detected in 2 (12.5%) low grade cases. Data analysis using Fischer’s Exact Test was p&gt;0.05.Conclusion: There was no difference of JCV T-Ag expression in colon adenomatous polyp (mild-severe dysplasia) and colon adenocarcinoma (low-high grade) cases at Anatomical Pathology Laboratory School of Medicine, Atma Jaya Catholic University of Indonesia 2010-2014.Keywords: colon adenomatous polyp, adenocarcinoma, JCV T-Ag

Gastrointestinal poliplerin boyutları, lokalizasyonu ve histopatolojik tiplerine göre değerlendirilmesi: bir yıllık periyod

Aim: It was aimed to document gastrointestinal system polyps and evaluated with respect to their frequency, size, anatomic location and histopathologic features. Material and Method: 56 gastrointestinal polyps that were histopathologically diagnosed during the period 2014-2015 were included in the study. Polyps were noted according to their localization, age, gender, size and histopathologic types. Results: 59 % of the patients were males and 41% of the patients were females. Their mean age was 61.7 years. The mean diameter of the adenomatous polyps was 10.12 mm. The mean diameter of the hyperplastic polyps was 5.7 mm.18 cases were diagnosed as tubular adenomas(32 %). 16 cases were diagnosed as tubulovillous adenomas (28%), 21 cases were diagnosed as hyperplastic polyps (37.5%), 1 case was diagnosed as mixed polyps,1 case was diagnosed as juvenile polyps. 10 cases of hyperplastic polyps were localized sigmoid colon (% 47.6) and 6 cases were localized rectum (% 28.5). 16 cases of adenomatous polyps were localized sigmoid colon (% 47). Ages ranged from 4 to 84 years were diagnosed as all polyps. Gender were 33 men and 23 female. Conclusion: In this study, it was showed that the oldest groups of tubulovillous adenoma, the most common groups of hyperplastic polyps, the most common gender of male, the most common location of sigmoid colon.

Applying simple linear combination, multiple logistic and factor analysis methods for candidate fecal bacteria as novel biomarkers for early detection of adenomatous polyps and colon cancer

BackgroundColorectal cancer (CRC) is the third leading cause of cancer, and presents a considerable disease burden, worldwide. Recently, the gut microbiota has been proposed as a potential risk factor for CRC, and even adenomatous polyps (AP). Here, the aim of this study was to investigate the role of selected gut bacteria as fecal bacterial biomarkers, in early detection of CRC and AP. Material and methodsFecal samples (n = 93) were collected from Taleghani Hospital, Tehran, Iran, between 2015 and 2017, from normal controls (NC), AP cases and CRC stage I patients, who were undergoing screening for colonoscopy. Absolute quantitative real time PCR (qPCR) assays were established for the quantification of bacterial marker candidates, in all cases and control groups. In order to evaluate the diagnostic value of bacterial candidates in distinguishing CRC from a polyp, receiver operating characteristic curve (ROC) was performed. Multiple logistic regressions were used to find the best combinations of the bacterial candidates, then, combinations were analyzed based on three methods, including linear combination, multiple logistic and factor analysis models. ResultsAccording to the logistic model, combination of Fusobacterium nucleatum, Enterococcus feacalis, Streptococcus bovis, Enterotoxigenic Bacteroides fragilis (ETBF) and Porphyromonas spp. showed improved diagnostic performance, compared to each bacterium alone, as area under the receiver operating characteristic (AUROC) increases to 0.97, with 95% confidence interval. It was found that a simple linear combination was an appropriate model for discriminating AP and CRC cases, compared to the NC, with a sensitivity of 91.4% and specificity of 93.5%. ConclusionOur results indicated that based on fecal bacterial candidates, statistical simple linear combination model and ROC curve analysis, early detection of AP and CRC might be possible.

Adenoma Detection before and after the age of 50: a retrospective analysis of Lebanese outpatients

Background and aimColorectal cancer (CRC) has an increased impact on the Lebanese population’s morbidity and mortality. This study evaluated the situation of adenoma detection in an outpatient clinic in Lebanon.Patients...

Abstract A37: Genome-wide association study of colorectal tumors in Latin American individuals from Colombia

Abstract Introduction: Colorectal cancer (CRC) is one of the most common cancers worldwide, with higher incidence among more developed countries. However, mortality rates are higher and increasing in less-developed regions, including Colombia. Incidence and mortality rates of CRC vary across the country, with the lowest rates among populations with increased concentration of Native Americans. Our group previously reported that increased European and African ancestry was associated with higher adenomatous polyps (AP) and CRC risk in Colombians. Based on this observation we hypothesize that genetic contribution to the observed regional variation on CRC development in Colombia might be partly explained by the influence of genetic variants with different frequency distribution in the European, Amerindian, and African ancestral components. Objective: To test our hypothesis we performed a genome-wide association study (GWAS) of colorectal tumors in Colombian CRC and AP cases and controls. Materials and Methods: We conducted a GWAS of Colombians from different regions of the country that included 162 CRC cases, 122 AP cases, and 131 controls. Only SNPs with MAF ≥ 0.05 were included. The role of these common variants was assessed by logistic regression models adjusted for age, sex, and the first 10 principal components (PCs) of the genetic variation. Analyses were performed for a total of 606410 SNPs. The P value threshold for genome-wide significant SNPs was set at the traditional value of ≤ 5 × 10−8. Results: We replicated some of the previously reported associations (8 out of 44 SNPs, P ≤ 0.05) of which 7 had directionally concordant ORs. Regarding the remaining 36 published risk variants, 25 had directionally concordant ORs, even though neither of them was significant at nominal P ≤ 0.05. None of the SNPs analyzed passed the threshold for genome-wide significance. However, we found multiple suggestive associations. One novel SNP within the region 2q11.2-q12 near the gene MAP4K4 was associated with the risk of AP (rs4280476-G; OR 0.36; 95% CI 0.23-0.56; P = 8.7 x 10-6). We also found four novel SNPs across three regions with suggestive CRC risk associations: rs10514122-A located in the locus 5q14 near the TBCA gene (OR 0.30; 95% CI 0.18-0.49; P = 3.6 x 10-6), rs10746883-G (OR 0.37; 95% CI 0.25-0.56; P = 3.2 x 10-6) and the rs10781032-A (OR 0.35; 95% CI 0.22-0.53; P = 1.7 x 10-6), in high LD with each other (R2 = 0.81), located in the locus 9q21.1-q21.2 near the genes TRPM3 and TMEM2 and the SNP rs2800641-G located in the region 6q25.2 near the MYCT1 gene (OR 2.96; 95% CI 1.83-4.77; P = 8.9 x 10-6). The inflation factors (λ), when comparing AP or CRC cases vs controls, were 1.05 and 1.04, respectively, indicating appropriate control for population stratification. Finally, it is of note that the MAF reported for the 5 novel SNPs identified in our study shows important differences between European, Asian, and African reference populations from the public database 1,000 genomes. Conclusions: In this GWAS of AP and CRC in individuals from Colombia, we replicated some of the previously reported associations and identified suggestive signals for 5 novel risk alleles located at four loci (2q11.2-q12, 5q14, 9q21.1-q21.2, and 6q25.2). Further work is needed to replicate our findings in other Latin American populations. Citation Format: Maria Carolina Sanabria-Salas, Laura Fejerman, Konrad Rawlik, Albert Tenesa, Martha L. Serrano-Lopez, Jovanny Zabaleta, Gustavo A. Hernandez-Suarez. Genome-wide association study of colorectal tumors in Latin American individuals from Colombia [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A37.

Analysis of the Pathological Examination Results of 100 Colon Polyps Cases after EMR or ESD Operation

Aim: To study the characteristics of EMR (endoscopic mucosal resection) or ESD (endoscopic submucosal dissection) postoperative pathological examination of colonic polyps in different age groups, and the difference of pathological examination after EMR or ESD operation. Methods: A retrospective analysis was made of the EMR or ESD postoperative pathological data of 100 cases of colonic polyps patients in the Jingzhou Central Hospital digestive internal medicine. The time is from March 2016 to March 2018. Results: In 100 cases of EMR or ESD operation, there are 65 cases of young and middle-aged group. Pathological examination results include: 34 cases of adenomatous polyp, 18 cases of inflammatory polyp, 11 cases of benign tumors, 1 case of malignant tumor, 1 case of hyperplastic polyp. There are 35 cases of elderly group. Pathological examination results include: 27 cases of adenomatous polyp, 2 cases of inflammatory polyp, 2 cases of benign tumors, 4 cases of malignant tumor. 71 cases of complete EMR operation include: 51 cases of adenomatous polyp, 17 cases of inflammatory polyp, 3 cases of benign tumors; 29 cases of complete ESD operation include: 10 cases of adenomatous polyp, 3 cases of inflammatory polyp, 10 cases of benign tumors, 5 cases of malignant tumor, 1 case of hyperplastic polyp. Conclusion: For the pathological examination results after EMR or ESD operation, the proportion of inflammatory polyps in the young and middle-aged group was greater than that in the elderly group. The proportion of adenomatous polyps in the elderly group was larger than that in the young and middle-aged group. The proportion of adenomatous polyps in EMR was greater than that of ESD. The proportion of benign tumors and malignant tumors in ESD was greater than that of EMR. The difference has statistical significance.

Evaluation of Gastrointestinal Polyps According to Their Size, Localization and Histopathologic Types; Annual Period

Aim: It was aimed to document gastrointestinal system polyps and evaluated with respect to their frequency, size, anatomic location and histopathologic features. Material and Method: 56 gastrointestinal polyps that were histopathologically diagnosed during the period 2014-2015 were included in the study. Polyps were noted according to their localization, age, gender, size and histopathologic types. Results: 59 % of the patients were males and 41% of the patients were females. Their mean age was 61.7 years. The mean diameter of the adenomatous polyps was 10.12 mm. The mean diameter of the hyperplastic polyps was 5.7 mm.18 cases were diagnosed as tubular adenomas(32 %). 16 cases were diagnosed as tubulovillous adenomas (28%), 21 cases were diagnosed as hyperplastic polyps (37.5%), 1 case was diagnosed as mixed polyps,1 case was diagnosed as juvenile polyps. 10 cases of hyperplastic polyps were localized sigmoid colon (% 47.6) and 6 cases were localized rectum (% 28.5). 16 cases of adenomatous polyps were localized sigmoid colon (% 47). Ages ranged from 4 to 84 years were diagnosed as all polyps. Gender were 33 men and 23 female. Conclusion: In this study, it was showed that the oldest groups of tubulovillous adenoma, the most common groups of hyperplastic polyps, the most common gender of male, the most common location of sigmoid colon.

Abstract LB-162: Common genetic variants within TEP1 gene (14q11.2 locus) and TK1 gene (17q25.3 locus) are associated with the risk of colorectal tumors in Latinos

Abstract Introduction: Around 63 common risk variants have been associated with colorectal cancer (CRC) through genome-wide association studies (GWAS) in European and Asian populations; these variants, together with the high penetrance genes responsible for 5% of the cases, do not completely explain the CRC heritability estimated at ~ 35%. Objective: To discover new common variants associated with the risk of colorectal tumors, taking advantage of the high level of admixture in Latino populations. Materials and methods: We performed a candidate gene association (CG) and GWAS analyses, in a multicenter case-control study that included 313 cases of CRC, 200 cases of adenomatous polyps (AP) and 506 controls from six Colombian cities. The role of these common variants was assessed by basic SNP association analyses (X2) and logistic regressions adjusted for age, sex and ancestry proportions. Selected SNPs were genotyped by TaqMan in additional samples. Results: European ancestry was associated with the risk of AP while African ancestry was associated with the risk of both, AP and CCR, (P ≤ 0.01). In the adjusted logistic regression analyses of the CG study, we found that the minor allele (A) of the SNP 14q11.2:rs1760898 (C&amp;gt;A) was associated with the risk of CRC (OR 0.48; 95% CI 0.33-0.69; UNADJ P = 6.8 x 10-5; 100,000 Pperm = 0.03). This association persisted in the adjusted logistic regressions analyses with additional samples genotyped by TaqMan (P = 0.03). In the basic SNP association analyses (X2) of the GWAS study, we found that the minor allele (A) of the SNP 17q25.3:rs1065768 (G&amp;gt;A) was associated with the risk of AP (OR 0.35; 95% CI 0.24 -0.51; UNADJ P = 3.4 x 10-8; Bonferroni corrected P = 0.02). This association persisted after including additional samples genotyped by TaqMan, both, in the basic SNP analysis (P = 1.7 x 10-7) and in the adjusted logistic regressions analysis (P = 9.7 x 10-5). Moreover, the association remained when other variables were also included in the model, such as the first 10 major principal components of genetic variability, ancestry proportions along chromosome 17 and locus-specific ancestry (P = 1.7 x 10-4). Conclusions: The SNP rs1760898 (TEP1, Telomerase Associated Protein 1 gene) confers a change of Asparagine (Asn) to Lysine (Lys) within the RNA binding domain, TROVE. This change could affect the activity of telomerase enzyme that has an important role in cancer development. The SNP rs1065768 (3'UTR TK1, Thymidine kinase 1 gene) could affect mRNA stability and protein production of TK1, which is essential in DNA synthesis. Although, functional analyses are required to confirm their potential role in colorectal tumorogenesis, our findings help increase our understanding about the biological basis for the development of colorectal tumors, as well as will contribute to the overall knowledge on the heritability of CRC. Citation Format: María Carolina Sanabria-Salas, Konrad Rawlik, Albert Tenesa, Adriana Umaña-Pérez, Martha Lucía Serrano-López, Myriam Sánchez de Gómez, Jovanny Zabaleta, Gustavo Hernández-Suárez. Common genetic variants within TEP1 gene (14q11.2 locus) and TK1 gene (17q25.3 locus) are associated with the risk of colorectal tumors in Latinos [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr LB-162. doi:10.1158/1538-7445.AM2017-LB-162

Immunohistochemical Expression of the Tumor Suppressor Protein p16INK4a in Cervical Adenocarcinoma.

Objective To evaluate the diagnostic utility of the p16ink4a protein expression as a marker for adenocarcinoma of the cervix. Methods In a cross-sectional study, p16ink4a expression was evaluated in 30 cervical biopsies from patients diagnosed with invasive adenocarcinoma from 2 reference clinics in Brazil, and compared with 18 biopsies of endocervical polyps (control cases). The performance of the tests for p16ink4a was evaluated using a conventional contingency table, and the Kappa (κ) index was used to evaluate the agreement of the marker with the tissue diagnosis. Results In total, 66% of the invasive adenocarcinoma cases were positive for p16ink4a. All of the adenomatous polyps cases used as negative controls were shown to be negative for p16ink4a. The marker showed a high sensitivity and a high negative predictive value. The Kappa index was good for p16ink4a (κ = 0.6). Conclusion Considering the strong association between the p16ink4a marker and the cervical adenocarcinoma, its use represents an important tool for reducing incorrect diagnoses of adenocarcinoma and thereby avoiding overtreatment.

Prevalence of altered mismatch repair protein nuclear expression detected by immunohistochemistry on adenomas with high-grade dysplasia and features associated with this risk in a population-based study

Abstract Introduction Alteration of mismatch repair system protein expression detected by immunohistochemistry (IHQ) in tumoural tissue is a useful technique for Lynch Syndrome (LS) screening. A recent review proposes LS screening through immunohistochemical study not only in all diagnosed cases of colorectal cancer (CRC) but also in advanced adenomas, especially in young patients. Objective To assess the prevalence of altered IHQ carried out in all adenomas with high-grade dysplasia (HGD) diagnosed in our community in 2011, as well as the variables associated with this alteration. Methods We included all the cases of adenomatous polyps with HGD diagnosed in the three public pathology laboratories of Navarre during 2011 and performed a statistical study to assess the association between different patient and lesion characteristics and altered IHQ results. Results A total of 213 colonic adenomas with HGD were diagnosed, and 26 (12.2%) cases were excluded from the final analysis (2 known LS, 22 without IHQ study and 2 with inconclusive IHQ studies). The final number of adenomas included was 187. Pathologic results were found in 10 cases (5.35%)–6 cases in MLH1 and PMS2, 2 cases in PMS2, 1 case in MSH6 and 1 case in MSH2 and MSH6. The factors showing a statistically significant association with the presence of abnormal proteins were the synchronous presence of CRC, the presence of only one advanced adenoma, proximal location of HGD and age Conclusions The percentage of pathologic nuclear expression found in IHQ is high. Consequently, screening of all diagnosed HGD could be indicated, especially in young patients, with a single AA and proximal HGD.

Prevalencia de alteración de expresión nuclear de proteínas reparadoras con inmunohistoquímica sobre adenomas con displasia de alto grado y características asociadas a dicho riesgo en un estudio de base poblacional

IntroductionAlteration of mismatch repair system protein expression detected by immunohistochemistry (IHQ) in tumoural tissue is a useful technique for Lynch Syndrome (LS) screening. A recent review proposes LS screening through immunohistochemical study not only in all diagnosed cases of colorectal cancer (CRC) but also in advanced adenomas, especially in young patients. ObjectiveTo assess the prevalence of altered IHQ carried out in all adenomas with high-grade dysplasia (HGD) diagnosed in our community in 2011, as well as the variables associated with this alteration. MethodsWe included all the cases of adenomatous polyps with HGD diagnosed in the three public pathology laboratories of Navarre during 2011 and performed a statistical study to assess the association between different patient and lesion characteristics and altered IHQ results. ResultsA total of 213 colonic adenomas with HGD were diagnosed, and 26 (12.2%) cases were excluded from the final analysis (2 known LS, 22 without IHQ study and 2 with inconclusive IHQ studies). The final number of adenomas included was 187. Pathologic results were found in 10 cases (5.35%)–6 cases in MLH1 and PMS2, 2 cases in PMS2, 1 case in MSH6 and 1 case in MSH2 and MSH6. The factors showing a statistically significant association with the presence of abnormal proteins were the synchronous presence of CRC, the presence of only one advanced adenoma, proximal location of HGD and age <50 years. ConclusionsThe percentage of pathologic nuclear expression found in IHQ is high. Consequently, screening of all diagnosed HGD could be indicated, especially in young patients, with a single AA and proximal HGD.

Diagnostic value of high-resolution micro-endoscopy for the classification of colon polyps.

To study a new imaging equipment, high-resolution micro-endoscopy (HRME), in the diagnosis and pathological classification of colon polyps. We selected 114 specimens of colon polyps, 30 of which were colon polyps with known pathological types and 84 that were prospective polyp specimens; 10 normal colon mucosa specimens served as controls. We obtained images of 30 colon polyp specimens with known pathological types using HRME and analyzed the characteristics of these images to develop HRME diagnostic criteria for different pathological types of colon polyps. Based on these criteria, we performed a prospective study of 84 colon polyp specimens using HRME and compared the results with those of the pathological examination to evaluate the diagnostic value of HRME in the pathological classification of different types of colon polyps. In the 30 cases of known pathological type of colon polyp samples, there were 21 cases of adenomatous polyps, which comprised nine cases of tubular adenoma, seven cases of villous adenoma and five cases of mixed adenomas. The nine cases of non-adenomatous polyps included four cases of inflammatory polyps and five cases of hyperplastic polyps five. Ten cases of normal colonic mucosa were confirmed pathologically. In a prospective study of 84 cases using HRME, 23 cases were diagnosed as inflammatory polyps, 11 cases as hyperplastic polyps, 18 cases as tubular adenoma, eight cases as villous adenoma and 24 cases as mixed adenomas. After pathological examination, 24 cases were diagnosed as inflammatory polyps, 11 cases as hyperplastic polyps, 19 cases as tubular adenoma, eight cases as villous adenoma and 22 cases as mixed adenomas. Compared with the pathological examinations, the sensitivities, specificities, accuracies, and positive and negative predictive values of HRME in diagnosing inflammatory polyps (87.5%, 96.7%, 94.0%, 91.3% and 95.1%), hyperplastic polyps (72.7%, 95.9%, 92.9%, 72.7% and 95.9%), tubular adenomas (73.7%, 93.8%, 89.3%, 77.8% and 92.4%), villous adenomas (75.0%, 97.4%, 95.2%, 75.0% and 97.4%), and mixed adenomas (75.0%, 93.3%, 88.1%, 81.8% and 90.3%) were relatively high. HRME has a relatively high diagnostic value in the pathological classification of colon polyps. Thus, it may be an alternative to confocal microendoscopy in lower-resource or community-based settings.

Genetic Variation in Glutamate Carboxypeptidase II and Interaction with Dietary Natural Vitamin C May Predict Risk for Adenomatous Polyp Occurrence.

The C1561T variant of the glutamate carboxypeptidase II (GCPII) gene is critical for natural methylfolylpolyglutamte (methylfolate) absorption, and has been associated with perturbations in folate metabolism and disease susceptibility. However, little is known on C1561T-GCPII as a risk factor for colorectal cancer. Therefore, this study examined whether C1561T-GCPII influences folate metabolism and adenomatous polyp occurrence. 164 controls and 38 adenomatous polyp cases were analysed to determine blood folate and plasma homocysteine (Hcy) level, dietary intake of natural methylfolate, synthetic pteroylglutamic acid (PteGlu), vitamin C and C1561T-GCPII genotype. In controls and cases, 7.3 and 18.4 percent of subjects respectively, were found to have the CT genotype, increasing the risk for adenomatous polyp occurrence 2.86 times (95% CI:1.37-8.0, p=0.035). Total dietary folate, methylfolate and PteGlu intake and the level of erythrocyte folate and plasma Hcy did not predict the occurrence of an adenomatous polyp. However, dietary natural vitamin C intake was associated with adenomatous polyp risk within C1561T-GCPII CT genotype subjects (p=0.037). The findings suggest that C1561T-GCPII variation may be associated with risk for adenomatous polyp, and vitamin C may modify risk by interacting with the variant gene, its expression product and/or folate substrates.

Cyclooxygenase-2 (COX2) gene polymorphisms and the risk of sporadic colorectal cancer and polyps among Jordanian population.

Cyclooxygenase-2 (COX2) is a crucial enzyme involved in the metabolism of Prostaglandins and it has been implicated in several processes. This study was done to investigate the associations of polymorphisms in COX2 gene with the risk of colorectal cancer or polyps development among Jordanian population and to correlate with other ethnicities. One hundred and thirty five cases (135) of colorectal carcinoma were studied for COX2 -A1195G polymorphisms employing PCR-RFLP technique, in addition to 104 cases of adenomatous polyps and 115 matched controls taken from the general population. Sixty eight colorectal cancer patients were males and 67 of patients were females with a median age of (58.0±13.9 year). Sixty six (66) of polyp cases were males and 38 were females with a median age of (58.1±14.16). The A-1195G AA carriers were 3.1 times less likely to develop CRC (95% CI: 1.8-5.3, p<0.0001), and 1.8 times less likely to develop polyps (95% CI: 0.99-3.2, p=0.056).The A-1195G AG carriers were at higher risk to develop cancer in a dose dependent manner. The AG carriers were 2.9 time more likely to develop CRC and two times more likely to develop polyps when compared to controls. The A allele was more predominant in controls than in polyps or CRC cases. Carriers of the A allele were 1.6 times less likely to develop polyps and 2.6 times less likely to develop CRC. The presence of the COX-2 -1195AA genotype may protect against risk of developing colorectal cancer.

Gene-Nutrient Interaction between Folate and Dihydrofolate Reductase in Risk for Adenomatous Polyp Occurrence: A Preliminary Report.

Folate and related gene variants are significant risk factors in the aetiology of colorectal cancer. Dihydrofolate reductase (DHFR) is critical in the metabolism of synthetic folic acid (pteroylmonoglutamatamic, PteGlu) to tetrahydrofolate following absorption. Therefore, the 19bp deletion variant of DHFR may lead to the alteration of folate-related colorectal disease susceptibility. This study examined the association between PteGlu and 19bp del-DHFR, and adenomatous polyp (AP) occurrence, an antecedent of colorectal cancer. A total of 199 subjects (162 controls and 37 AP cases) were analysed to determine dietary intake of total folate, natural methylfolate and synthetic PteGlu, level of erythrocyte folate and plasma homocysteine (tHcy), and genotype of 19bp del-DHFR. Dietary folate intake, erythrocyte folate, tHcy and 19bp del-DHFR variants did not independently predict the occurrence of AP. However, a gene-nutrient interaction was observed when subjects were stratified according to dietary folate intake. In subjects with a folate intake above the median value due to significant dietary PteGlu content, the presence of the 19bp-deletion allele decreased the risk for AP (OR=0.35, 95% CI: 0.13-0.97). However, such association was not evident in individuals with a folate intake below the median value. In conclusion, the finding suggests that folate nutrition and 19bp del-DHFR variation may interact to modify AP risk.

Expression of human telomerase reverse transcriptase mRNA in the peripheral blood of gallbladder carcinoma patients

Objective To study the human telomerase reverse transcriptase (hTERT) mRNA in peripheral blood of patients with gallbladder carcinoma and its clinical significance.Methods Fifty cases of gallbladder cancer (GBC group),50 cases of adenomatous polyps (AMP group) and 50 normal volunteers (control group) were selected.The expression of hTERT mRNA in peripheral blood was detected by using real-time fluorescent quantitative polymerase chain reaction (FQ-PCR).Results The positive rate of hTERT mRNA in GBC group (66％) was significantly higher than in AMP group (14％) (P ＜ 0.05),and that in AMP group was higher than in control group (P ＜ 0.05).There was significant difference in the hTERT mRNA expression between T3 + T4 and T1 + T2 or between negative and positive lymph nodes (P ＜ 0.05).Conclusion The hTERT mRNA expression in peripheral blood of GBC was significantly increased,and associated with depth of invasion and lymph node metastasis. Key words: Gallbladder; Human telomerase reverse transcriptase; Polymerase chain reaction