Innocuous Lesions Research Articles

Lacquer cracks in pathological myopia: a clinical review.

Lacquer cracks, described as breaks in the Bruch's membrane, are unique lesions in the spectrum of fundus changes associated with pathological myopia. Lacquer cracks are generally believed to be relatively innocuous lesions by themselves; however, progression to other features of myopic macular degeneration, such as patchy chorioretinal atrophy and choroidal neovascularization, may result in irreversible visual impairment. With the rising prevalence of pathological myopia to epidemic proportions, particularly in the Asian countries, ophthalmologists expect to encounter lacquer cracks more frequently in clinical practice. Therefore, it is crucial for the ophthalmic community to be aware of lacquer cracks and to actively look for these lesions in myopic patients so that early detection and close monitoring can help prevent blinding complications. This article provides a comprehensive review on lacquer cracks in eyes with pathological myopia from a clinical perspective.

Application of bedside HINTS, ABCD2 score and truncal ataxia to differentiate cerebellar–brainstem stroke from vestibular neuritis in the emergency room

Background and purposeAcute vestibular syndrome (AVS) typically manifests as isolated dizziness or vertigo with no apparent neurological impairments. However, distinguishing life-threatening stroke from innocuous peripheral vestibular lesions in the emergency...

The roles of non-productive complexes of DNA repair proteins with DNA lesions

A multitude of different types of lesions is continuously introduced into the DNA inside our cells, and their rapid and efficient repair is fundamentally important for the maintenance of genomic stability and cellular viability. This is achieved by a number of DNA repair systems that each involve different protein factors and employ versatile strategies to target different types of DNA lesions. Intriguingly, specialized DNA repair proteins have also evolved to form non-functional complexes with their target lesions. These proteins allow the marking of innocuous lesions to render them visible for DNA repair systems and can serve to directly recruit DNA repair cascades. Moreover, they also provide links between different DNA repair mechanisms or even between DNA lesions and transcription regulation. I will focus here in particular on recent findings from single molecule analyses on the alkyltransferase-like protein ATL, which is believed to initiate nucleotide excision repair (NER) of non-native NER target lesions, and the base excision repair (BER) enzyme hOGG1, which recruits the oncogene transcription factor Myc to gene promoters under oxidative stress.

Angiosarcomas of the head and neck: Impact of large data analysis on clinical management.

Angiosarcoma is a rare but often fatal malignancy from blood and lymphatic vessels that can arise anywhere in the body and often affects the head and neck region. Although its dismal prognosis is predominantly explained by its aggressive biology, several secondary factors contribute to poor outcomes. These include a phenotypic resemblance to innocuous blood vessel lesions, which contributes to a significant degree of late diagnosis. Another important factor is the rarity of angiosarcoma, which has impaired scientific determination of its optimal treatment significantly. As a result, treatment of angiosarcomas has largely been guided by information derived from the study of sarcomas at large, themselves a highly heterogeneous group of mesenchymal cancers both from a diagnostic as well as therapeutical perspective. The Digital Revolution and resultant Information Age promise to transform the clinical management of rare cancers from a generic to a more customized approach. In this paper, we review the current understanding of head and neck angiosarcomas within the context of this process.

A clinical study on prevalence and management of eyelid tumours – A prospective observational study

To study the incidence of eyelid tumours pertaining to age, sex, lid, globe or orbital involvement and analyse the various aspects of treatment modalities and their functional and cosmetic outcome. A prospective study of 40 cases of eyelid tumours over a period of 1 year, both benign and malignant eyelid lesions were included and those with inflammatory lesions were excluded. Patients were evaluated and treated with appropriate modalities and the outcome was analysed. Malignant tumours were common in the age group between 60-85 years and benign tumours were common in the age group of 30-45 years. Benign tumours were more common among males and malignant tumours more common among females. Out of the 40 cases, 28 (70 %) eyelid lesions were benign and 12 (30%) cases were malignant. Benign tumours were found more commonly in the upper lid and malignant tumours in lower lid. Squamous papilloma was found to be the most common benign tumour, followed by pyogenic granuloma. Meibomian carcinomais the most common malignant tumour. Most common presentation of malignant eyelid tumour was ulcerative growth pattern. Meibomian carcinoma presented in the form of nodule and ulcerative growth pattern. The treatment for most of the benign tumour was simple excision and malignant tumour was wide local excision with 4-5 mm margin clearance. Glabellar rotation flap was performed in one case of meibomian carcinoma involving the medial aspect of lower lid after excision. Hughes tarso-conjunctival flap was performed in two cases of squamous cell carcinoma and basal cell carcinoma, after tumour excision as the defect involved more than 75% of the lower lid without involvement of canthus. Two cases one each of sebaceous carcinoma and squamous cell carcinoma involving the lateral aspect of lower lid was reconstructed after excision, with Tenzel flap. In one case of sebaceous gland carcinoma with diffuse involvement of the upper lid the was excised and reconstructed with Cutler-Beard technique.Histopathologic examination of all excised lesion must be done as an innocuous looking lesion might be malignant. Early clinical suspicion of malignancy and confirmation by incisional biopsy will aid in planning wide excision and appropriate method of lid reconstruction depending on the amount of lid loss. After wide excision of malignant tumour appropriate lid reconstruction technique is done as a primary procedure in all our patients and we could obtain good outcomes with no recurrences. Advanced tumours with orbital involvement and recurrent tumour need adjuvant chemotherapy or radiotherapy.

Study of histopathological spectrum of ovarian lesions

Ovarian pathology ranges from innocuous non-neoplastic lesions to malignant neoplastic entities. The incidence, clinical appearance and the behaviour of the different types of ovarian tumour is extremely variable. In order to have a better understanding of frequency and histomorphological patterns of different ovarian lesions study was encountered in our tertiary care hospital.To study the histopathology of ovarian non-neoplastic and neoplastic lesions and to study the distribution of ovarian lesions with respect to various parameters like age, bilaterality, gross and microscopic features.This is a prospective study of 125 ovarian specimens received in department of pathology, G.K. General Hospital, Bhuj during August 1, 2018 to July 31, 2020. Total 125 cases of ovarian specimens were studied, amongst them 58 were non-neoplastic and remaining 67 were neoplastic. The most common non-neoplastic lesion seen was follicular cysts 12 cases (21%), followed by endometriosis 9 cases (16%). Among 67 neoplastic ovarian lesions 58(87%) cases were benign, 3(4%) cases were borderline and 6 (9%) cases were malignant. In benign ovarian neoplasm, most commonly seen lesions were serous cystadenoma 24 cases (36%) followed by 13 cases (20%) of mature cystic teratoma. In malignant cases, maximum was of high-grade serous cystadenocarcinoma.Ovarian epithelial tumours are the most common type, while serous cystadenocarcinoma was the most common malignancy. Histological examination is gold standard and in certain difficult cases require immunohistochemistry.Ovary is an important reproductive organ with involvement in production of progeny.Ovarian pathology ranges from innocuous non-neoplastic lesions to malignant neoplastic entities. Ovarian neoplasms have become increasingly important not only because of the wide range of neoplasms, but also because they have gradually increased the mortality rate. The incidence, clinical appearance and the behaviour of the different types of ovarian tumour is extremely variable.

Innocuous Lesions and Not so Innocuous Lesions of the Skin and Soft Tissue

Background: Cystic lesions of the skin and soft tissue are often neglected and thought to be innocuous or harmless. These lesions need to be excised to exclude malignancy. The lesions may present in unusual sites and may also be of infective origin. Thus, there is an urgent need to determine the prevalence and identify the histopathological features of the cystic lesions as the innocuous appearing lesions may actually not be so innocuous. In addition, it is the histopathological features that determine the treatment modality.
 Aim: To determine the features and prevalence of the types of cysts in skin and soft tissue.
 Materials and Methods: A retrospective study of the cystic lesions of the skin and soft tissue was conducted. The records from the Department of Pathology, Saveetha Medical College were retrieved and reviewed for patients with cystic lesions of the skin and soft tissue over a one year period extending between January 2019 and December 2019. The records were examined for the following data : age, sex, type of lesion, clinical and histopathological diagnosis.
 Results: In all 109 cases with skin and soft tissue swellings were analyzed. Among these 53 were males and 56 were more females reported (51 %) of cystic swellings as compared to males (48%). Cystic lesions were most commonly encountered in the age group of 18 to 40 years, which suggests that there may be a role for trauma or occupation related occurrence. A variety of cysts were encountered such as epidermoid cysts (70%), Trichilemmal cyst (7%), and Ganglion (7%).Phaeohyphomycotic cyst, mucous retention cyst, hemangioma and pilomatrixoma. Epidermal cysts were more frequently encountered in males (54%) than females (46%).Most lesions occurred in the back.
 Conclusion: Epidermal cysts may frequently be associated certain syndromes, hence it is important to evaluate these cysts. In addition phaeohyphomycotic cysts may be mistaken for Ganglion, so histopathological examination is necessary to initiate appropriate therapy.

Traumatic Ulcerative Granuloma with Stromal Eosinophilia: Sinister Appearing Innocuous Lesion

Trauma within the oral cavity is one of the common incidence of occurrence which can be an inducer as well as propagator for wide range of oral lesion of diverse course. A unique combination of formation of granulomatous lesion with reactive eosinophilic stromal infiltration in response of trauma is “traumatic ulcerative granuloma with stromal eosinophilia (TUGSE)”. It is a reactive, infrequent, self-limiting condition of oral mucosa. The commonly involved site and the clinical presentation might click to suspect it as a lesion of oral cancer. Clinical history and examination guide through the diagnosis whereas histopathology forms the basis of the diagnosis.

Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesions.

Squamous cell carcinoma is the most common form of malignancy of the oral cavity, and is often proceeded by oral potentially malignant disorders (OPMD). Early detection of oral cavity squamous cell carcinoma (oral cancer) can improve survival rates. The current diagnostic standard of surgical biopsy with histology is painful for patients and involves a delay in order to process the tissue and render a histological diagnosis; other diagnostic tests are available that are less invasive and some are able to provide immediate results. This is an update of a Cochrane Review first published in 2015. Primary objective: to estimate the diagnostic accuracy of index tests for the detection of oral cancer and OPMD, in people presenting with clinically evident suspicious and innocuous lesions. to estimate the relative accuracy of the different index tests. Cochrane Oral Health's Information Specialist searched the following databases: MEDLINE Ovid (1946 to 20 October 2020), and Embase Ovid (1980 to 20 October 2020). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were also searched for ongoing trials to 20 October 2020. No restrictions were placed on the language or date of publication when searching the electronic databases. We conducted citation searches, and screened reference lists of included studies for additional references. We selected studies that reported the diagnostic test accuracy of the following index tests when used as an adjunct to conventional oral examination in detecting OPMD or oral cavity squamous cell carcinoma: vital staining (a dye to stain oral mucosa tissues), oral cytology, light-based detection and oral spectroscopy, blood or saliva analysis (which test for the presence of biomarkers in blood or saliva). Two review authors independently screened titles and abstracts for relevance. Eligibility, data extraction and quality assessment were carried out by at least two authors, independently and in duplicate. Studies were assessed for methodological quality using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Meta-analysis was used to combine the results of studies for each index test using the bivariate approach to estimate the expected values of sensitivity and specificity. This update included 63 studies (79 datasets) published between 1980 and 2020 evaluating 7942 lesions for the quantitative meta-analysis. These studies evaluated the diagnostic accuracy of conventional oral examination with: vital staining (22 datasets), oral cytology (24 datasets), light-based detection or oral spectroscopy (24 datasets). Nine datasets assessed two combined index tests. There were no eligible diagnostic accuracy studies evaluating blood or salivary sample analysis. Two studies were classed as being at low risk of bias across all domains, and 33 studies were at low concern for applicability across the three domains, where patient selection, the index test, and the reference standard used were generalisable across the population attending secondary care. The summary estimates obtained from the meta-analysis were: - vital staining: sensitivity 0.86 (95% confidence interval (CI) 0.79 to 0.90) specificity 0.68 (95% CI 0.58 to 0.77), 20 studies, sensitivity low-certainty evidence, specificity very low-certainty evidence; - oral cytology: sensitivity 0.90 (95% CI 0.82 to 0.94) specificity 0.94 (95% CI 0.88 to 0.97), 20 studies, sensitivity moderate-certainty evidence, specificity moderate-certainty evidence; - light-based: sensitivity 0.87 (95% CI 0.78 to 0.93) specificity 0.50 (95% CI 0.32 to 0.68), 23 studies, sensitivity low-certainty evidence, specificity very low-certainty evidence; and - combined tests: sensitivity 0.78 (95% CI 0.45 to 0.94) specificity 0.71 (95% CI 0.53 to 0.84), 9 studies, sensitivity very low-certainty evidence, specificity very low-certainty evidence. At present none of the adjunctive tests can be recommended as a replacement for the currently used standard of a surgical biopsy and histological assessment. Given the relatively high values of the summary estimates of sensitivity and specificity for oral cytology, this would appear to offer the most potential. Combined adjunctive tests involving cytology warrant further investigation. Potentially eligible studies of blood and salivary biomarkers were excluded from the review as they were of a case-control design and therefore ineligible. In the absence of substantial improvement in the tests evaluated in this updated review, further research into biomarkers may be warranted.

Oral Cancer: Raising Awareness of the Importance of Suspicion in Early Detection.

Oral cancer is a significant cause of morbidity and mortality worldwide. In this article we present two cases of potentially innocuous looking lesions, initially thought to be traumatic in origin, but later diagnosed as cancer. The first patient presented with a persistent laceration thought to be caused by an accidental shaving injury, which was subsequently diagnosed as squamous cell carcinoma. The second patient presented with a hyperplastic mucosal lesion, suspected as forming due to denture-clasp irritation, which was subsequently diagnosed as proliferative verrucous carcinoma. The importance of early detection and palpation of suspicious lesions is emphasised in this article.

Bilateral multiple iridociliary cysts causing secondary pigment dispersion.

Primary epithelial iris cysts are benign innocuous lesions, which are mostly bilateral and asymptomatic in nature. They can lead to creeping angle closure, when the angle progressively narrows due to age-associated changes. This photoessay, herewith, signifies the dual importance of identifying minute bumpy elevations in the iris by a thorough slit lamp examination as well as the use of ultrasound biomicroscopy in patients presenting with creeping angle closure, frequently misdiagnosed in the primary angle closure disease spectrum.

Polidocanol sclerotherapy for intraoral hemangioma of buccal mucosa: a rare case report

The term hemangioma derives from the Greek word, “hema” which expresses blood, “angio” implies vessel, “oma” corresponds to tumor. A hemangioma is a type of an innocuous lesion of blood vessels or vascular components defined by a proliferative growth stage and a very prolonged involutive stage. The prevalence of hemangiomas is estimated to be around 2-3% in neonates, 10-12% in the first year of life, and 22-30% found amongst babies whose weight is less than 1000g at the time of birth. Most of the hemangiomas occur as single lesion. Peripheral hemangiomas treated by surgical excision is an example of gold standard treatment for hemangiomas. Alternatively sclerosing solutions may be used as they obliterate blood vessels, thereby leading to fibrosis and disappearance of the hemangioma. It is relatively uncommon in the oral cavity. Polidocanol (aethoxysklerol) is a detergent solution which act by causing localized inflammatory reaction.

Pigmented Lesions of the Oral Cavity - A Brief Review

Pigmentation is a common clinical finding of an oral cavity, but a proper diagnosis of the lesions is very challenging. Pigmentation can be focal, multifocal, associated with systemic/genetic disorder, or due to exogenous agents. Pigmented lesions are either melanocytic or nonmelanocytic. Pigmented lesions of the oral cavity have a broad spectrum of diversity. They present as racial pigmentation, innocuous lesions (amalgam tattoo, oral melanotic macule), benign nevi, and life-threatening malignant melanoma, and they can also produce a diagnostic dilemma. Thus, a proper diagnosis of a pigmented lesion in an early stage is very important for the accurate treatment plan. In this review, pigmented lesions of the oral cavity are briefly discussed.

Immunomodulators in the Treatment of Psoriasis

Psoriasis is a chronic T lymphocyte mediated systemic inflammatory disease characterised by recurrent exacerbations and remission of thickened, erythematous and scaling plaque and multiple comorbidities. Based on morphology and extend of involvement dermatosis may range from innocuous lesion to wide spread life threatening pustular and erythrodermic forms. Psoriasis is a multifactorial skin disease and it involves a complex pathogenesis. It can be explained by a immunological disregulation of cell function along with differentiation or proliferation of keratinocyte. Psoriasis treatment aims to reduce skin inflammation and to clear skin. Conventional therapy usually includes topical, light and systemic medications. All the three therapies are found to be good for the treatment but are associated with a number of side effects like increased skin sensitivity, burning, skin staining, xerosis and alopecia etc. Nowadays various recent therapeutic advances are attempting to control the T cell expression by the suppression of same and are correlates with the clinical remission. Immunomodulators and biological therapy contribute a new way for psoriasis therapy. These drugs are more safer, effective and selective immunosuppressive agents as compared to conventional agents. This review summarisesthe variousimmunomodulators used in the treatment of psoriasis Keywords: Psoriasis, conventional therapy, immunomodulators

Innocuous presentation of low-grade mucoepidermoid carcinoma of the palate

Mucoepidermoid carcinoma (MEC) is a malignant epithelial tumor and is the most common minor salivary gland neoplasm. The initial presentation of this pathology can resemble benign lesions and can be misleading. They often present as asymptomatic swellings along minor salivary gland bearing areas. Proper attention to clinical features and the use of advanced imaging is of paramount importance to detect these innocuous lesions. We report an incidental finding of a palatal swelling in a 27-year-old female. This paper reports a low-grade MEC with unremarkable clinical features showing underlying bone involvement. It highlights the need for decisive investigations and accurate diagnosis in cases of malignant tumors of the minor salivary glands as it can reduce morbidity and prevent mortality.

Another oral cancer clinical guideline - but does it propose changes to dental practice?

Scope and purpose This guideline concerns patients with no lesions, innocuous or nonsuspicious lesions, lesions suspected to be potentially malignant as well as malignant lesions of the oral cavity. The audience for this guideline is health care workers who examine the mouth as well as community dental health co-ordinators and policy makers. Methodology The Appraisal of Guidelines Research & Evaluation reporting checklist II and the GIN-McMaster Guideline Development Checklist were followed and the guideline is partly informed by systematic reviews and diagnostic test accuracy meta-analyses. Studies assessing patients' values and preferences were also considered. The process of moving from the evidence to decisions and the formulation was guided by GRADE (Grading of Recommendations Assessment, Development and Evaluation).Review and Updating Updates for this guideline will be conducted every five years or when new emerging evidence indicates a potential change in the recommendation statements from the expert panel. Any updated versions of this guideline will be available at the ADA Center for Evidence-Based Dentistry's website: www.ebd.ada Recommendations The expert panel developed six conditional recommendations, all based on evidence rated as low to very low quality using GRADE. 1. For patients with a clinically evident oral mucosal lesion with an unknown clinical diagnosis considered to be seemingly innocuous or nonsuspicious of malignancy, or other symptoms, clinicians should follow up periodically to determine the need for further evaluation. If the lesion has not resolved and the clinical diagnosis of a potentially malignant disorder cannot be ruled out, then clinicians should perform a biopsy of the lesion or refer the patient to a specialist.2. For patients with a clinically evident oral mucosal lesion considered to be suspicious of a potentially malignant or malignant disorder, or other symptoms, clinicians should perform a biopsy of the lesion or provide immediate referral to a specialist.3. Cytologic adjuncts for the evaluation of potentially malignant disorders among adult patients with clinically evident, seemingly innocuous or suspicious lesions are not recommended. Should a patient decline the clinician's recommendation for performing a biopsy of the lesion or referral to a specialist, the clinician can use a cytologic adjunct to provide additional lesion assessment. A positive or atypical cytologic test result reinforces the need for a biopsy or referral.A negative cytologic test result indicates the need for periodic follow-up of the patient. If the clinician detects persistence or progression of the lesion, immediately performing a biopsy of the lesion or referral to a specialist is indicated.4. The panel does not recommend autofluorescence, tissue reflectance or vital staining adjuncts for the evaluation of potentially malignant disorders among adult patients with clinically evident, seemingly innocuous or suspicious lesions.5. The panel suggests that for patients with no clinically evident lesions or symptoms, no further action is necessary at that time.6. The panel does not recommend commercially available salivary adjuncts for the evaluation of potentially malignant disorders among adult patients with or without clinically evident, seemingly innocuous or suspicious lesions and their use should be considered only in the context of research.Research recommendations There is a need for better estimation of the prevalence of potentially malignant disorders (PMDs) and oral squamous cell carcinoma (OSCC) in populations with different baseline risks. More information on patients' values and preferences is required as well as studies on the diagnostic test accuracy of cytologic and salivary adjuncts.

Human Papilloma Virus-Oral Perspective

The oral cavity is a common site for human papillomavirus (HPV) infection, however much is still unknown about the spectrum of oral lesions associated with HPV. HPV is associated with a variety of clinical conditions that range from innocuous lesions to cancer. HPV types are divided into high and low-risk types, according to the oncogenic potential. Molecular and epidemiologic studies have identified the association between highrisk HPV types (especially HPV-16 and HPV-18) and oral potentially malignant and malignant lesions. Although HPV is one of the etiologic agent of oral cancer, it is not a single contributing factor and a variety of factors contribute to the cancer development. Risk factors include smoking, panchewing, alcohol consumption.

Oral squamous cell carcinoma: a clinicopathological study on 194 cases in northeastern Brazil. A cross-sectional retrospective study.

Only a few studies have evaluated the clinicopathological features of oral squamous cell carcinoma (SCC) in Brazil, and most were conducted in the most industrialized region of the country, i.e. the southeastern region. The aim of this study was to evaluate the clinicopathological features of this malignant neoplasm in northeastern Brazil. Retrospective study performed in an oral pathology laboratory in Recife, Brazil. All cases of oral SCC that occurred between 2000 and 2015 were studied. Clinical data were recorded and histological slides were reviewed. Statistical analysis was performed using the chi-square test (P ≤ 0.05). A total of 194 cases were evaluated. The male-to-female ratio was 1.5:1. The mean age was 65.4 years, and only 6.6% of the cases occurred in patients younger than 41 years. Most tumors consisted of well-differentiated SCC (54.6%). The findings of this study highlight the higher prevalence of oral SCC among women and the increasing number of cases among young patients. Thus there is no specific risk group for oral SCC, as in the past. This fact needs to be taken into consideration in clinical routine care, so that apparently innocuous malignant lesions do not go unnoticed in these individuals.

Brain-stem hemangioblastomas: The seemingly innocuous lesion in a perilous location.

Hemangioblastomas [75% sporadic, 25% with Von Hippel Lindau (VHL) disease] are highly vascular, benign lesions. The surgical nuances, management, and complication avoidance in brain-stem hemangioblastomas (BHs) have been studied. Over 18 years, 27(mean age: 29 years; range 15-60 years) consecutive cases of BH underwent microsurgical excision. All patients were assessed clinico-radiologically for neurological deficits and screened for VHL disease. Outcome of the patients was based on Karnofsky Performance Status scale (KPS). 12 out of 19 (70.4%) patients with hydrocephalus underwent a cerebrospinal fluid (CSF) diversion procedure. Lower cranial nerve palsy was present in 10 (37%) patients and motor weakness in 13 (48%). The tumours [mean size 3.34 ± 1.06 cm, range: 1.4-5.5 cm; 11 solid, rest solid-cystic; 18 (66.7%) subpial and 9 (33.33%) intramedullary] were divided into four categories based on size: A: <2 cm (n = 5,18.5%); B: 2-3 cm (n = 10,37%); C: 3-4 cm (n = 6,22.2%); D: >4 cm (n = 6,22.2%). Their location was at posterior cervicomedullary junction (n = 12); pontomedullary junction (n = 7); pons (n = 3), medulla (n = 3) and ponto-mesencephalic region (n = 2). Multiple flow voids were seen in >50% patients with tumour >2 cm. 5 patients had syringomyelia; and, 8 had diffuse cervical cord expansion. Two patients with a large vascular tumour underwent preoperative embolization. Six patients had VHL disease; one underwent bilateral adrenalectomy for refractory hypertension; and, the another, nephrectomy for renal cell carcinoma. Twenty-six patients underwent a midline suboccipital craniectomy; and, 1 with a cerebellopontine angle tumour, a retromastoid craniectomy. 15 patients underwent total excision; 10 patients, near-total (<10% remaining) excision, and 2 patients, a subtotal (>10% remaining)) excision. Three patients (2 with VHL disease) expired due to exsanguinating hemorrhage, spreading venous thrombosis and aspiration pneumonitis, respectively. At follow-up visit (median: 25 ± interquartile range 2-56months), 17 patients had improved KPS, 4 remained in same status and 3 (recently operated, on tracheostomy) had worsened KPS. Significant improvement is achievable in neurological status in patients following successful extirpation of a brain-stem hemangioblastoma, despite a turbulent perioperative period. Leaving tumour capsule adherent to the brain-stem often helps in preserving brain-stem function. Postoperatively, the patients should be monitored for their respiratory and lower cranial nerve status to prevent aspiration pneumonitis.

Investigating Prevalence and Progression of Serrated Polyps: Tampa VA Experience

Introduction: Adenomas have historically been considered the sole precursor lesions that lead to colorectal cancer (CRC) via the adenoma-carcinoma sequence. A recently recognized pathway in colorectal carcinogenesis involves “serrated polyps”, which until recently were considered to be innocuous lesions. Serrated polyps are classified into sessile serrated adenomas (SSA), traditional serrated adenomas (TSA) and serrated adenomas (SA). Despite the serrated neoplastic pathway accounting for up to 10-20% of all sporadic colorectal cancers, these polyps remain under diagnosed and poorly understood. We aim to identify the prevalence and potential progression of serrated polyps in our veteran population. Methods: Retrospective analysis was performed on all patients who underwent all cause colonoscopies over a 10-year period from 1/1/2005-12/31/2015. Our primary aim was to analyze the trend in prevalence of serrated polyps. Secondary outcomes were to correlate prevalence of serrated polyps with modifiable lifestyle factors. Low risk adenomas were categorized as tubular adenoma and high-risk adenomas were categorized as tubulo-villous adenomas.Table: Table. Risk factors affecting TA vs. SA and TA vs.TSATable: Table. Risk factors affecting TA vs. SSAFigure: Prevalence of serrated polyps over 10 years.Results: An electronic databank was created after analyzing 14,593 pathology reports from a 10-year period. The individual cases were categorized as SSA, TSA, SA, SSA+high-risk adenoma, SSA+low risk adenoma, SA+high-risk adenoma, SA+low risk adenoma, TSA+high risk adenoma, TSA+low risk adenoma and TA (control). There was a progressive increase in the percentage of serrated polyps per all lesions identified on colonoscopy over the 10-year period. There was no significant correlation between HgA1c, total cholesterol, HLD, LDL and triglycerides between TA vs. TSA and SA. There was a statistical significance between TA vs. SSA in regards to LDL (P<0.03).Figure: Categories of polyps in the study.Conclusion: A database of serrated polyps detected undergoing colonoscopy was generated. Temporal trends in the detection of these lesions and variables that might affect their prevalence were identified and analyzed. Further data is being collected including correlation with Vitamin D and ASA use. Serrated polyps are increasingly being recognized as lesions that can progress into cancer. Therefore, it is imperative that gastroenterologists and pathologists are aware to remove and properly classify these serrated lesions. To our knowledge, this is the first study to date investigating the prevalence of serrated polyps in the veteran population.