Incidental Polyps Research Articles

Case Report: Primary follicular lymphoma of the colon presenting as an incidental finding on endoscopy

We present a previously healthy 63-year-old female with incidental polyps in the colon that were detected during a surveillance endoscopy. Clinical examination and imaging studies did not detect any lymphadenopathy or organomegaly. Histopathologic evaluation of polyps showed a low-grade primary follicular lymphoma. We suggest that follicular lymphoma should be considered as a differential diagnosis of polypoid lesions of the colon.

Exploring the spectrum of incidental gastric polyps in autoimmune gastritis.

Gastric polyps represent an abnormal proliferation of the gastric mucosa. Chronic atrophic autoimmune gastritis (CAAG) targets parietal cells and results in hypo-achlorhydria and hypergastrinemia, which exerts a proliferative effect on the gastric mucosa. We investigate the incidence of gastric polyps in CAAG patients. This is a single-center retrospective study examining patients with confirmed CAAG from January 1990 until June 2022. Demographic, clinical, biochemical, and serological data were collected for each included patient. The histopathological characteristics of the detected polyps were recorded. A total of 176 CAAG patients were included. Eighty-nine (50.5%) had 163 incidental polyps. Seventy-six patients (85%) had 130 non-endocrine lesions, among which 118 (90.7%) were inflammatory, 6 (4.6%) adenomatous, and 4 (3%) fundic; 33 patients (37%) had gastric neuroendocrine neoplasms (gNENs), and 21 (23.6%) both; one had MALToma and one gastric adenocarcinoma. Higher circulating levels of gastrin and chromogranin A were observed among patients with polyps (median 668vs 893 pg/ml p=0.0237, 146vs 207ng/ml p=0.0027, respectively). CAAG implies a high incidence of gNENs and exocrine lesions. Gastrin plays a possible trophic role on the mucosa. Further evidence is needed to validate its predictive role for increased polyp risk in CAAG.

Clinical Implications of Microscopic Colitis Isolated to Polyps.

Microscopic colitis is generally identified on random colon biopsies performed for chronic diarrhea, but rarely incidental polyps have histologic features of microscopic colitis. We compared patients with polypoid microscopic colitis to control patients with conventional polyps to determine the implications of polypoid microscopic colitis. Medical records were searched for patients without prior or concurrent microscopic colitis who were found to have polypoid microscopic colitis. For each patient with polypoid microscopic colitis, one patient with conventional polyps was selected as a control. We reviewed the histologic features of each polypoid microscopic colitis specimen, and evaluated endoscopic and clinical findings for polypoid microscopic colitis patients and controls. Twenty-six patients with polypoid microscopic colitis were identified with histologic features of collagenous colitis in 8 patients (31%) and lymphocytic colitis in 18 patients (69%). Polypoid microscopic colitis was unifocal in 14 patients (54%) and multifocal in 12 patients (46%). Patients with polypoid microscopic colitis were older than control patients (median age = 60 years vs 66 years, P = .04). On follow-up 7 patients with polypoid microscopic colitis (33%) developed chronic diarrhea compared to 3 (12%) controls ( P = .16). Of patients with follow-up biopsies, 1 patient with polypoid microscopic colitis (13%) and no control patients developed microscopic colitis ( P = 1). Polypoid microscopic colitis may be identified in asymptomatic patients and most patients do not develop chronic diarrhea, but some patients with polypoid microscopic colitis develop diarrhea (33% vs 12% in controls) or conventional microscopic colitis on follow-up. Thus pathologists should distinguish polypoid microscopic colitis from conventional microscopic colitis but may inform clinicians of the uncertain association with chronic diarrhea to guide decisions regarding follow-up.

704 Laparoscopic Cholecystectomy for Ultrasound Proven Gallbladder Polyps – an Unsound Indication?

Abstract Aim Current European guidelines recommend cholecystectomy for ultrasound proven gallbladder polyps based on size. Over-diagnosis of gallbladder polyps by conventional transabdominal ultrasound may lead to unnecessary surgery. The aim of this study is to correlate the ultrasound findings of gallbladder ‘polyps’ with histology of the removed gallbladder specimens. Method Data from transabdominal ultrasound reports was collected over a 5-year period and cross-referenced with the histology from patients undergoing a laparoscopic cholecystectomy over the same time-period. Results 60 patients who underwent laparoscopic cholecystectomy with ultrasound proven gallbladder polyps were identified. The age range was 19–79 years. There were 36 females and 24 males. On imaging 30 patients (50%) had a solitary polyp (size range 2–24mm) and 30 (50%) had multiple polyps (largest polyp size range 4–13mm). The indication for cholecystectomy was gallbladder polyps with or without gallstone disease in 32 patients (53%) and gallbladder or gallstone disease with incidental polyps in 28 patients (47%). Only 2/60 (3.3%) patients had adenomatous polyps on histology (9mm and 9.7mm on ultrasound), whilst 18/60 (30%) had pseudopolyps and in the remaining 40 specimens, no lesion of polypoidal type was found. No specimens had evidence of dysplasia or malignancy. Conclusion We propose that an ultrasound abdomen is an inadequate imaging modality alone to diagnose gallbladder polyps and that patients require further imaging or MDT discussion as adjuncts to decision making for those referred for consideration of cholecystectomy.

TU7.3 Laparoscopic Cholecystectomy for Ultrasound Proven Gallbladder Polyps – An Unsound Indication?

Abstract Aim Current European guidelines recommend cholecystectomy for ultrasound proven gallbladder polyps based on size. Over-diagnosis of gallbladder polyps by conventional transabdominal ultrasound may lead to unnecessary surgery. The aim of this study is to correlate the ultrasound findings of gallbladder ‘polyps’ with histology of the removed gallbladder specimens. Methods Data from transabdominal ultrasound reports was collected over a 5-year period and cross-referenced with the histology from patients undergoing a laparoscopic cholecystectomy over the same time-period. Results 60 patients who underwent laparoscopic cholecystectomy with ultrasound proven gallbladder polyps were identified. The age range was 19–79 years. There were 36 females and 24 males. On imaging 30 patients (50%) had a solitary polyp (size range 2–24mm) and 30 (50%) had multiple polyps (largest polyp size range 4–13mm). The indication for cholecystectomy was gallbladder polyps with or without gallstone disease in 32 patients (53%) and gallbladder or gallstone disease with incidental polyps in 28 patients (47%). Only 2/60 (3.3%) patients had adenomatous polyps on histology (9mm and 9.7mm on ultrasound), whilst 18/60 (30%) had pseudopolyps and in the remaining 40 specimens, no lesion of polypoidal type was found. No specimens had evidence of dysplasia or malignancy. Conclusion We propose that an ultrasound abdomen is an inadequate imaging modality alone to diagnose gallbladder polyps and that patients require further imaging or MDT discussion as adjuncts to decision making for those referred for consideration of cholecystectomy.

Incidental Polyp on Colectomy Specimen is Linked with Higher Odds of Polyp on Interval Colonoscopy

Incidentally found polyps on surgical pathology after colectomy is an underreported phenomenon, and management guidelines are lacking. Elucidation of the significance of incidental polyps is needed to determine if post-operative endoscopic surveillance modification is warranted. We sought to determine the relationship between incidental polyp on colectomy specimen and findings on post-operative colonoscopy. A multi-institutional retrospective review was performed on patients that underwent colorectal resection from 2018-2019. Surgical pathology was reviewed for polyps and assigned as expected or incidental based on pre-operative colonoscopy. If performed, post-operative colonoscopy was reviewed for new lesion identification. The odds of detecting new lesion on post-operative colonoscopy was compared between cases with incidental polyp on surgical specimen and patients without incidental findings. In 243 colorectal resections, incidental polyps were identified in 55 cases (22.6%). Post-operative colonoscopy was completed in 65 cases (26.7%) with new polyp detected in 24 cases (9.88%). Of those, 10 had an incidental polyp previously identified on surgical specimen while 14 did not. The presence of incidental surgical specimen polyp was associated with a greater than two-fold higher odds of detecting new polyp on post-operative colonoscopy (odds-ratio 2.76, 95% confidence interval 1.15-6.63;P=0.023). This analysis revealed a high frequency of incidental polyps on surgical specimens with an increased rate of newly found lesions on post-operative colonoscopy. Incidental polyps may be a risk factor for other missed lesions still within the patient. Therefore, providers should consider surveillance interval modification on an individual basis in the setting of incidental surgical specimen polyps.

S1697 Incidental Finding of Lung Adenocarcinoma During Routine Colonoscopy

INTRODUCTION: Routine colonoscopy in asymptomatic individuals often reveals lesions of varying significance and are performed in an effort to detect colorectal cancer and remove precancerous polyps. About 70% of polyps are adenomas, which have malignant potential. For polyps less than 1 cm in size, there is less than a 1% chance of being cancerous. Even more rarely do these lesions result in diagnosis of a primary malignancy in a distant organ system. CASE DESCRIPTION/METHODS: A 68 year old woman, former smoker, presented to clinic for screening colonoscopy. She had no family or personal history of malignancy and was asymptomatic. Her prior colonoscopy in 2015 showed tubular adenomas in the transverse colon and a prominent fold in ascending colon that pathology revealed as sessile serrated adenoma. She returned for repeat colonoscopy in 2020 that was significant for tubular adenomas and a 4 mm sessile polyp with overlying ulcer in the ascending colon. This polyp resulted as poorly differentiated adenocarcinoma of lung origin. Immunostains demonstrate that the tumor cells are positive for CK7, Cam 5.2, TTF1, Napsin and patchy positive for CK20. This prompted CT which showed a new 2.2 cm spiculated lung nodule, a 1.5 cm stable appearing lung nodule, new mixed sclerotic and lytic lesions of the S1 vertebral body, prominent mediastinal and right hilar lymph nodes. She was diagnosed with metastatic lung adenocarcinoma and referred to oncology. DISCUSSION: Lung cancer is the second most commonly diagnosed cancer in the United States, and the deadliest. Non-small cell lung cancers (NSCLC) make up 85% of lung cancers, and have distant metastases in 39.9% of cases, most commonly to bone (34%), liver (32%), brain (28%), and adrenal glands (17%). Metastasis to the colon is rarely reported, and usually discovered due to symptoms of bleeding or obstruction. This case reports detection of primary lung neoplasia found in an incidental polyp during screening colonoscopy in an asymptomatic patient. It is difficult to determine the incidence of metastasis to the colon, but one study found a single patient in 1,542 with NSCLC. Multiple studies have shown that the site of metastasis is correlated with prognosis, but there is no data on the prognostic indications of intestinal metastasis. This case demonstrates the importance of pathological evaluation of polyps seen on colonoscopy. Once diagnosed with cancer of pulmonary origin, these patients should be evaluated for other sites of metastasis.

S1737 A Rare Case of an Appendiceal Mucosal Schwann-Cell Hamartoma

INTRODUCTION: Mucosal Schwann-cell hamartomas (MSCH) are a relatively new and rare pathological entity. These neuronal sheath polyps are distinct from neuromas and neurofibromas since are composed of Schwann cells that show diffuse positivity to S-100 stain. Case reports have described these polyps as small (< 1cm), usually located on the left side of the colon and predominantly seen in middle-age female patients. We present a rare case of a MSCH located in the appendix. CASE DESCRIPTION/METHODS: 73 y/o asymptomatic male with history of type II diabetes mellitus, hypertension, and hypothyroidism. The patient had a previous colonoscopy with two tubular adenomas less than 1cm in size on the transverse colon; but no personal or family history of colon cancer. He was referred for a surveillance colonoscopy. Colonoscopy revealed an erythematous polyp at the appendiceal orifice and 4 additional diminutive sessile polyps at the transverse colon, hepatic flexure, sigmoid and rectum, respectively. All were removed with cold biopsy forceps. Pathology revealed an appendiceal MSCH, 3 tubular adenomas in hepatic flexure, transverse colon and sigmoid, respectively and 1 hyperplastic polyp at rectum. Immunohistochemistry relevant for diffuse strong positivity for S-100 protein in the appendiceal lesion. DISCUSSION: Gibson and Hornick (2009) first described these colorectal polyps of mesenchymal cell origin as mucosal Schwann cell hamartomas to distinguish them from other benign or malignant lesions. These neuronal polyps are sporadic and have not been associated to inherited syndromes like type 1 neurofibromatosis or multiple endocrine neoplasia type 2B. Differential diagnosis of MSCH include neurofibromas, ganglioneuromas, neuromas, perineuromas, inflammatory fibroid polyps and gastrointestinal stromal tumors. The latter is the most common spindle cell tumor in the gastrointestinal tract, but it can be easily distinguished from the MSCH by their immunoreactivity to c-kit. After excluding other more common lesions, histological evidence of spindle cell proliferation within the lamina propria and immunohistochemistry stain diffusely positive for S-100 can establish the diagnosis of MSCH. Given the rarity of this benign and incidental polyp, there are no established guidelines for surveillance. Awareness of this entity is relevant to pathologists and gastroenterologists and raises the importance of immunostaining when evaluating spindle cell tumors to avoid unnecessary treatment and establish an accurate diagnosis.Figure 1.: Appendiceal polyp measuring <0.5 cm seen in surveillance colonoscopy.Figure 2.: Sections of the biopsy show focal expansion of the lamina propria by a spindle cell proliferation.Figure 3.: Immunohistochemical stains show the spindle cells to be strong and diffusely positive for S-100.

19. The many faces of colonic malakoplakia: A case series and review of the literature

Background: Malakoplakia is a rare inflammatory response to Gram-negative bacteria, involving intracellular deposition of iron and calcium. It is associated with immunosuppression, and occurs most often in the bladder. Although rare, the colon is the most common extra-genitourinary site. Aims and methods: To identify cases of colonic malakoplakia, the Royal Prince Alfred Hospital histopathology data base was searched from 2009. A literature review was performed using PubMed with the term ‘malakoplakia’. Formalin-fixed paraffin-embedded slides were stained with haematoxylin and eosin, PAS and von Kossa. Results and conclusions: A 10-year case file review identified four cases of colonic malakoplakia. Ages ranged from 50–79 with 2 males and 2 females. Clinical presentation and endoscopic appearances varied widely with an incidental polyp, mucosal changes mimicking inflammatory bowel disease, and a pelvic mass lesion with overlying normal mucosa seen. In all cases the biopsies revealed numerous histiocytes and chacteristic Michaelis-Gutmann bodies highlighted with PAS and von Kossa stains diagnostic of malakoplakia. A literature review identified 31 published case reports in adults and 10 in children of colonic malakoplakia. These cases highlight the protean manifestations of colonic malakoplakia. Consideration should be given to the diagnosis in histiocytic infiltrates in the large bowel to facilitate appropriate clinical management.

3211 An Incidental Duodenal Lymphangioma Presenting as Diarrhea

Introduction: The small bowel is a rare site for neoplasia and only account for over 3% of the cases in the digestive tract. Lymphangiomas are benign tumors formed by dilated lymphatic channels that occur more commonly in the neck and axillary regions. Duodenal lymphangiomas are extremely rare in the adult population. It s thought to be a benign congenital malformation of the lymphatic vasculature that is able to grow to form a mass lesion. Their clinical presentation ranges from asymptomatic to obscure bleeding, small bowel obstruction, intussusception or even volvulus. We present a case of a duodenal lymphangioma presenting with chronic abdominal pain and diarrhea. CASE DESCRIPTION/METHODS: A 37-year-old male with no significant past medical history presented with chronic diarrhea, constipation and abdominal discomfort for 3 years. Physical examination and laboratory data were in the normal limits. Remainder of his infectious and inflammatory workup for diarrhea was negative. He underwent endoscopy which revealed a 1-cm polypoid submucosal lesion in the post-bulbar area. Multiple deep bites-on-bite biopsies were obtained from the lesion. Histological examination showed dilated lymphatics with reactive epithelial changes, consistent with Lymphangioma. During the follow up visit the patient referred improvement of the presenting symptoms. DISCUSSION: Lymphangiomas of the duodenum are a very rare lymphatic system tumor. The clinical presentations are usually variable and nonspecific and may mimic a variety of vague abdominal symptoms like abdominal discomfort, diarrhea, anorexia, nausea, and vomiting. These lesions typically exist as small incidental polyps; however, some of these tumors present as mass lesions capable of causing bowel obstruction, abdominal pain, and gastrointestinal bleeding. By endoscopic examination, they usually appear as a sessile or semi-pedunculated mass with smooth surface mucosa with lymphatic cystic dilatation with a whitish granular appearance. These benign tumors require treatment if they are accompanied by symptoms and complications such as infection, obstruction and hemorrhage. Endoscopic unroofing or polypectomy has become the treatment of choice for small to intermediate lymphangiomas. Physicians must thus be cognizant of the differentials for small bowel nodules in order to avoid unnecessary surgical interventions.

190 – The Incidence and Impact of Incidental Polyps Found At the Time of Evaluation for Esd/Emr of a Known Large Sessile Benign Polyp

190 – The Incidence and Impact of Incidental Polyps Found At the Time of Evaluation for Esd/Emr of a Known Large Sessile Benign Polyp

Partial unilateral lentiginous and colon polyp in a young male patient

Partial unilateral lentiginosis is an unusual pigmentary disorder characterized by numerous lentigines grouped within an area of normal skin. Pigmented macules are usually localized in one half of the body. Associations with café-au-lait spots, cutis marmorata, acanthosis nigricans, nevus depigmentosus, vitiligo, blue nevus, segmental neurofibromatosis, central nervous system diseases, celiac disease, and sickle cell anemia have been reported. We describe a 17-year-old male patient with a partial unilateral lentiginous lesion on the left side of the body and left upper back and incidental polyp in the descending colon.

An incarcerated Amyand's hernia: Shall we apply appendectomy routinely?

Partial unilateral lentiginosis is an unusual pigmentary disorder characterized by numerous lentigines grouped within an area of normal skin. Pigmented macules are usually localized in one half of the body. Associations with cafe-au-lait spots, cutis marmorata, acanthosis nigricans, nevus depigmentosus, vitiligo, blue nevus, segmental neurofibromatosis, central nervous system diseases, celiac disease, and sickle cell anemia have been reported. We describe a 17-year-old male patient with a partial unilateral lentiginous lesion on the left side of the body and left upper back and incidental polyp in the descending colon.

2023 Genome-wide copy number changes and CD133 expression characterized distinct subset of colon polyps: Differentiation between incidental polyps and cancer associated polyps

2023 Genome-wide copy number changes and CD133 expression characterized distinct subset of colon polyps: Differentiation between incidental polyps and cancer associated polyps

Genome-wide copy number changes and CD133 expression characterized distinct subset of colon polyps: differentiation between incidental polyps and cancer-associated polyps.

Colorectal polyps are generally believed to be the precursors of colorectal cancers (CRC); however, the proportion and speed of progression differed widely in different subsets of polyps. Using microarray-based comparative genomic hybridization (aCGH) platform and CD133 immunostaining, we characterized colon polyps according to their association with CRC that developed in the same individual. aCGH was performed to unveil genomic changes in 18 cancer-synchronous polyps (CSP), and 9 cancer-preceding polyps (CPP), together with their corresponding cancers and 16 cases of incidental polyps (IP), were examined for comparison. aCGH profiles were analyzed to determine the clonal relationship (CR) between the paired adenoma and carcinoma. CD133 expressions in each subset of polyps were quantified by immunohistochemistry (IHC) staining. Progressive genomic changes were observed from IP, CSP/CPP to CRC; they encompass an entire chromosomal region in IP and sub-chromosomal region in CSP/CPP and CRC. CR analyses demonstrated that 50 % of CSP and 67 % of CPP were clonally related to the concurrent or later developed carcinomas, respectively. The CD133 expression levels were significantly higher in CSP/CPP than those in IP (P < 0.0001) and even higher in CSP/CPP that were clonally related to their corresponding carcinomas than CSP/CPP that were unrelated (P < 0.05). There were more genomic changes in CSP/CPP than IP; more than half of the CSP/CPP were clonally related to the corresponding carcinomas. Genomic changes at sub-chromosomal regions and/or high CD133 expression were associated with CSP/CPP and highlighted their carcinogenic potential.

Abstract 5176: Implications of clonality relationship and CD133 expression between cancer synchronous/preceding adenomas and their colorectal adenocarcinoma pairs

Abstract Background: It is thought that each cell only generates a unifocal lineage that is independent from one another in colorectal adenoma-carcinoma progression. This study compared the genome-wide copy number aberration profiles of adenoma and primary colorectal carcinomas (CRCs) derived from the same patient to trace their clonality relationship. The CD133 positive cells, putative colorectal cancer stem cells, are capable of tumor initiation and metastasis. Therefore, we also investigated the use of CD133 expression as a potential marker for prediction of subsequent risk of colorectal cancer. Methods: Microarray-based comparative genomic hybridization (aCGH) experiments were performed on 18 cancer-synchronous polyps (CSP) and 9 cancer-preceding polyps (CPP), together with their corresponding cancers, and 16 cases of incidental polyps (IP). Genome-wide copy number imbalances revealed by aCGH were analyzed to determine the clonal relationship between the paired adenomas and carcinomas. CD133 expression in cancerous tissue was evaluated by immunohistochemistry (IHC) staining. Results: There were more CGH lesions in CRC than CSP/CPP, and least in IP. Clonal relationship determined by tissues' aCGH profiles showed that 50 percent of CSP and 67 percent of CPP were clonally related to the concurrent or subsequent cancers, respectively. The expression level of stem cell marker CD133 was significantly higher in CSP/CPP than in IP (P&amp;lt;0.0001), and even higher CD133 staining were observed in CSP/CPP that were clonally related to the corresponding carcinomas than CSP/CPP that were unrelated (P&amp;lt;0.05). Conclusions: In the present study more than half of the polyp-carcinoma pairs share highly similar pattern of numerical chromosomal aberrations implying that the pairs might descent from the same monoclonal cell origin. The high expression of stem cell marker CD133 in colorectal adenomas is predictive of high cancer risk for polyp-bearing patients. Citation Format: Chih-Yung Yang, Ju-Yu Tseng, Chi-Hung Lin. Implications of clonality relationship and CD133 expression between cancer synchronous/preceding adenomas and their colorectal adenocarcinoma pairs. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5176. doi:10.1158/1538-7445.AM2014-5176

Inflammatory Fibroid Polyp of the Gastroesophageal Junction in a Patient Presenting with Melena

Purpose: Inflammatory fibroid polyps (IFPs) are uncommon masses that have been reported throughout the gastrointestinal (GI) tract. They are difficult to distinguish endoscopically and echo-endoscopically from other gastrointestinal mesenchymal tumors. To the best of our knowledge, no cases of IFPs at the location of the GE junction presenting with upper GI bleed were previously reported in the medical literature. Methods: We present a case of an inflammatory fibroid polyp of the gastroesophageal (GE) junction, initially thought to be a gastrointestinal stromal tumor (GIST), in a patient presenting with melena. Results: A 66-year-old female presented with a two-week history of weakness and fatigue associated with melena. Esophagogastroduodenoscopy (EGD) revealed a 3 cm mass with central ulceration at the GE junction, which was likely the source of her upper GI bleed. Biopsies were negative for malignancy, but the mass appeared suspicious. The patient was referred for endoscopic ultrasound (EUS), which revealed a hypoechoic mass that appeared to arise from the muscularis propria. Both the endoscopic and echo-endoscopic appearance of the mass were suspicious for a GIST. EUS-guided fine-needle aspiration was nondiagnostic. The patient was referred for surgery and oncology was consulted for possible adjuvant chemotherapy. The patient underwent gastric wedge resection with removal of the cardia and tissues were sent for pathology, which surprisingly came back with a diagnosis of inflammatory fibroid polyp. Gross upper GI bleeding is a rare presenting symptom of IFPs, which are mostly encountered as incidental polyps during EGD. The endoscopic appearance of an IFP and GIST are very similar. EUS is usually helpful, as GISTs nearly always arise from the muscularis propria, while IFPs are typically submucosal lesions. This case was unique in that the IFP involved the muscularis propria, making it very difficult to differentiate from a GIST on EUS. Immunohistochemistry is the only reliable method of properly distinguishing between a GIST and an IFP. GISTs are typically positive for DOG-1 and CD-117, while IFPs are negative for those markers. Conclusion: Due to the difficulty in distinguishing between inflammatory fibroid polyps and other mesenchymal tumors (including GISTs) by endoscopic appearance and even on EUS, the use of immunohistochemistry is essential to help differentiate between them, as their treatment and prognosis can differ markedly.

Incidental Para-Nasal Polyps on Brain MRI Images in a Cameroonian Population

Rationale: Paranasal polyp is a soft tissue pear-shaped mass seen in the sinuses around the nostril. Allergy and inflammations are the major implicating factors. Small polyps could be of no concern to patients but large size could be a disturbance with perennial nasal obstruction and rhinorrhea. MRI with its superlative soft tissue contrast and multi-planarity facilitates the detection of paranasal polyps in brain MRI even when the referral is un-related to otorrhinolarygological features.Objective: To evaluate the prevalence and regional localisation of incidental polyps seen in brain MRI. Design and equipments: Prospective pioneer study using 0.3Tesla Hitachi AIRIS 11 MRI equipment. Setting: Polyclinic Bonanjo, Douala, Cameroon, a Specialist Hospital. Patients: 103 Patients referred for brain MRI from June 2009- Jan 2010 with only neurological symptomatology. Main outcome measured: Paranasal sinus was evaluated for polyps using T1W, T2W, FLAIR in different acquisitions. Results: 103 Patients were studied, 20 Patients had paranasal polyps with 14 (70%) males and 6 (30%) females forming a ratio of 2.33:1. Peak age range was 20-29years with 7 polyps (30%) followed by 50-59years with 25%. Polyps were rare in extremes of age. These 20 patients had 23 polyps due to 2 cases of bilateral maxillary polyps and single case of multiple polyps. The highest number of paranasal polyps 17 (73.91%) were in the maxillary sinus, followed by sphenoidal and frontal sinuses. Majority of polyps were pedunculated and < 2cm. Conclusion: Paranasal polyps are easily detected by MRI. The highest location is in the maxillary sinus with male preponderance.

Sialomucins and carcinoembryonic antigen in the evolution of colorectal cancer.

We have explored the merit of a simultaneous study of sialomucin content and carcinoembryonic antigen (CEA) expression in the identification of early malignancy in adenomas. One hundred and thirteen colorectal adenomas were investigated by histochemical and immunocytochemical techniques. We compared adenomas from 'high risk' patients having synchronous carcinoma and 'low risk' groups with incidental polyps only. Twenty-three metaplastic and eight inflammatory polyps were also included. Our data suggest that size and dysplasia are not always closely related and that synchronous adenomas seem to carry a higher malignant potential than incidental polyps irrespective of size. The degree of O-acylation of sialic acids appears to be a sensitive indicator of early malignant change: loss of O-acylation was seen in all II adenomas with highly atypical foci ('focal carcinoma') but noted in only four of the remaining polyps with lower grade dysplasia (P less than 0.005). By contrast the intensity of staining for CEA was a gradual phenomenon and showed no statistically significant increase with the onset of malignancy. Inflammatory polyps showed staining characteristics similar to normal mucosa. Metaplastic polyps, however, revealed increased expression of CEA and reduced O-acylation with increased size which may reflect a disorder of growth and differentiation. Finally, by comparing these profiles of staining with those of normal mucosa, 'transitional' mucosa adjacent to carcinoma and carcinoma, we further illustrate a progression of changes occurring in colonic mucosa in carcinogenesis.