Malignancy In Adenomas Research Articles

Correlation between Helicobacter pylori enrichment and clinical and pathological characteristics of colorectal adenoma

Objective: Aim to observe the enrichment of Helicobacter pylori (Hp) in adenoma tissue of patients with colorectal adenoma and analyze its effect on the clinical and pathological characteristics of colorectal adenoma. Methods: The data of 1 622 cases of gastroenteroscopy in the Endoscopy Center of Wenzhou Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine from January 2019 to June 2021 were collected retrospectively. The general data, gastric HP infection, clinical and pathological features, HP methyl blue special staining, HP immunohistochemical staining and toll-like receptor5(TLR5) protein immunofluorescence of colorectal adenomas were compared between the colorectal adenoma group (743 cases) and the control group (879 cases). Results: There were 743 cases in the colorectal adenoma group, aged (54.5±12.3) years, and 56.0% were male. There were 879 cases in the control group, aged (55.6±12.1), and 58.4% were male. Gastric Hp was positive in 361 cases in the colorectal adenoma group with a positive rate of 48.6% and in 331 cases in the control group with a positive rate of 37.7%. The difference was statistically significant (P<0.001). Gastric HP infection significantly increased the risk of Hp enrichment in colorectal adenomas (OR=28.590;95%CI:18.554-44.055; P<0.001). At the same time, Hp enrichment in colorectal adenomas was the promoting factor of positive events in adenoma diameter, pathological adenoma type, and adenoma malignancy (RR=0.804,3.163,3.089,2.463, P<0.001). It was also found that the expression of TLR5 protein was increased in HP-enriched adenomas. Conclusion: There is a positive correlation between gastric HP infection and intestinal HP enrichment. The effect of intestinal HP enrichment on the clinical and pathological characteristics of colorectal adenoma is statistically significant, and its tumor-promoting effect may be related to the upregulation of mucosal TLR5 protein.

Risk of Malignancy in Adenomas Detected During Screening Colonoscopy

A higher incidence of proximal interval cancers after colonoscopy has been reported in several follow-up studies. One possible explanation for this might be that proximally located adenomas have greater malignant potential. The aim of the present study was to assess the risk of malignancy in proximal versus distal adenomas in patients included in a large screening colonoscopy database; adenoma shape and the patients' age and sex distribution were also analyzed. Data for 2007-2012 from the German National Screening Colonoscopy Registry, including 594,614 adenomas identified during 2,532,298 screening colonoscopies, were analyzed retrospectively. The main outcome measure was the rate of high-grade dysplasia (HGD) in adenomas, used as a surrogate marker for the risk of malignancy. Odds ratios (ORs) for the rate of HGD found in adenomas were analyzed in relation to patient- and adenoma-related factors using multivariate analysis. HGD histology was noted in 20,873 adenomas (3.5%). Proximal adenoma locations were not associated with a higher HGD rate. The most significant risk factor for HGD was adenoma size (OR 10.36 ≥1 cm vs <1 cm), followed by patient age (OR 1.26 and 1.46 for age groups 65-74 and 75-84 vs 55-64 years) and sex (OR 1.15 male vs female). In comparison with flat adenomas as a reference lesion, sessile lesions had a similar HGD rate (OR 1.02) and pedunculated adenomas had a higher rate (OR 1.23). All associations were statistically significant (P ≤ .05). In this large screening database, it was found that the rates of adenomas with HGD are similar in the proximal and distal colon. The presence of HGD as a risk marker alone does not explain higher rates of proximal interval colorectal cancer. We suggest that certain lesions (flat, serrated lesions) may be missed in the proximal colon and may acquire a more aggressive biology over time. A combination of endoscopy-related factors and biology may therefore account for higher rates of proximal versus distal interval colorectal cancer.

762 Morphologic features and assessment of carcinomas risk development in patients with colorectal adenomas

The clinical significance of colorectal polyps emerges from the adenomacarcinoma sequence theory. This theory includes size-dependent risk of malignancy in adenomas and a failure to find minute, “de novo” carcinomas surrounded only by normal mucosa. The retrospective study was carried out on 141 colorectal adenomas diagnosed in 94 patients; male to female ratio 2.35:1. Polyps were obtained by endoscopic polypectomy performed during the total colonoscopy. Most adenomas were located in the sigmoid colon and the rectum, and the percentage decreased proximally to the right colon. Histological examination revealed that, among 141 adenomatous polyps, there were 122 (86.52%) tubular, 12 (8.51%) tubulovillous and 7 (4.96%) villous adenomas. The epithelial dysplasia was graded as mild in 57 (40.42%) adenomas, moderate in 44 (31.20%) and severe in 6 (4.25%). Invasive carcinoma was observed in 11 (7.80%), while 23 (16.31%) adenomas were without dysplasia. The percentage of severe dysplasia was greater in villous than in tubular adenomas ( P P

Practical aspects of endoscopic management of malignant polyps.

World experience now overwhelmingly supports the policy of conservative management by endoscopic snare polypectomy of "focal" cancer in polyps (malignancy in adenomas and polypoid carcinomas), providing that the polyp is pedunculated and that endoscopic and histological criteria are favorable. Invasion to within 2-3 mm of the snare-resection line is acceptable, providing that the advancing tumour margin is well-circumscribed. Unfavourable characteristics include poorly differential tumour, involvement of stalk vessels, and sessile configuration. This management policy applied to 90 patients between 1971 and 1981 resulted in successful 5-year follow-up of the 74 patients treated by polypectomy alone. Among the 16 patients managed surgically, no local lymph nodes were involved in any case, although 4 patients were found to have residual local tumour at the polypectomy site.

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.

Biphasic oral contraceptives.

This article briefly summarizes the action and uses administration contraindications and nursing implications of biphasic oral contraceptives (OCs). Biphasic contraceptives which provide an appropriate hormonal balance for both the follicular and luteal phases of the menstrual cycle permit the use of low doses of estrogen and progestogen while minimizing the incidence of breakthrough bleeding. The contraceptives are available in both a 21-tablet and a 28-tablet regimen (containing 7 tablets of inert ingredients). Absolute contraindications to combined OCs include thromboembolic disorder cerebrovascular accident coronary artery disease impaired liver function hepatic adenoma malignancy of the breast or reproductive system and pregnancy. Some relatively strong contraindicated include severe headaches hyertension diabetes prediabetes gallbladder disease previous cholestasis during pregnancy acute mononucleosis sickle-cell disease undiagnosed abnormal vaginal bleeding long leg casts elective surgery planned within 4 weeks over 40 years of age heavy smokers over 25 years of age or impaired liver function during the previous year. Nurses should advise women who use biphasic OCs that some spotting and missed menstrual periods can be expected. A wait-and-see approach with adequate supervision is recommended. Women should also be advised about the warning signs that may indicate discontinuation of the preparation: severe abdominal pain severe chest pain eye problems and severe leg pain in either the calf or thigh.

Adenomas of the colon and rectum.

The existing confusion about colorectal adenomas is largely the result of their variable biological behavior pattern, which is inevitable, and partly the result of the failure of many writers to state the precise basis for their diagnosis, which is avoidable. Preventable bewilderment is also caused by the clinical use of such terms as malignant adenoma or adenocarcinoma, grade 1, which are purported to connote a benign process, while the term invasive adenoma is applied to connote cancer. The terms atypical and carcinoma in situ appear to convey benignity to some clinicians and malignancy to others. This chaos of names has clouded our clear ideas and thoughts. The family tendency toward the development of solitary or scattered adenomas has received but scant attention. To avoid misleading connotations, adenomas are best thought of as being either benign or malignant. Malignancy in adenomas is regarded as noninvasive or invasive, the determining or boundary

MALIGNANCY IN ADENOMAS OF THE THYROID

Except for the rare case of the microscopic diagnosis of carcinoma in hyperplastic thyroid glands, it is now quite generally accepted that the origin of cancer of the thyroid is, for practical purposes, in the preexisting adenoma of the gland. While this premise has been repeatedly promoted by us and by many others, there is still a great variation in the reported percentage incidence of malignant disease in the various types of adenomatous goiter, and there is even mild disagreement by some that the incidence of malignant degeneration in adenomatous goiter is such as to make it worth while for a patient or a physician to concern himself with it. We should particularly like to give credit to Dr. Allen Graham for his interest and persistence in clarifying and promoting the above thesis. His work in connection with malignancy in adenoma of the thyroid has been of inestimable value to