Malignant Change Research Articles

Hematological and biochemical markers in determining the diagnosis and stage prediction of endometrial cancer.

To establish whether there is a statistically significant difference in hematological and biochemical parameters between the patients with premalignant changes of the uterine mucosa and those with malignant changes. The aim is to establish whether hematological and biochemical parameters may be useful in predicting the stages of endometrial malignancy and in differentiating premalignant and malignant endometrial changes. A retrospective study included 100 patients (70 with endometrial carcinoma diagnosis and 30 with atypical hyperplasia). We compared hematological and biochemical parameters in both groups. CRP, granulocytes, platelets, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) are statistically significantly higher in patients with malignant changes. Lymphocyte count is statistically significantly lower in patients with malignant changes. Platelet count is statistically significantly lower in patients with stages I and II in comparison to patients with higher disease stage. NLR and PLR have good discriminatory power for carcinoma presence. Patients with advanced changes have statistically significantly higher CRP values, higher granulocyte and platelet count, as well as higher values of NLR and PLR, and statistically significantly lower values of lymphocytes and MPV in comparison to benign changes. There is a possibility of using hematological and biochemical parameters in the assessment of endometrial changes as well as in the prediction of stages, in confirmed malignant changes of the endometrium.

X-ray Photoelectron Spectroscopy (XPS) Analysis of Nitrogen Environment in Small Extracellular Vesicle Membranes: A Potential Novel Technique with Application for Cancer Screening.

Small extracellular vesicle (EV) membranes display characteristic protein-lipidic composition features that are related to their cell of origin, providing valuable clues regarding their parental cell composition and real-time state. This could be especially interesting in the case of cancer cell-derived EVs, as their membranes could serve as valuable tools in liquid biopsy applications and to detect changes in the tumor malignancy. X-Ray Photoelectron Spectroscopy (XPS) is a powerful surface analysis technique able to detect every chemical element present, being also sensitive to their chemical environment. Here we explore the use of XPS as a fast technique to characterize EV membrane composition, with possible application in cancer research. Notably, we have focused on the nitrogen environment as an indicator of the relative abundance of pyridine-type bonding, primary, secondary and tertiary amines. Specifically, we have analyzed how tumoral and healthy cells have different nitrogen chemical environments that can indicate the presence or absence of malignancy. In addition, a collection of human serum samples from cancer patients and healthy donors was also analyzed. The differential XPS analysis of EVs collected from patients confirmed that the patterns of amine evolution could be related to markers of cancer disease, opening the possibility of their use as a non-invasive blood biomarker.

Role of Molecular Targeted Therapeutic Drugs in Treatment of Glioblastoma: A Review Article.

Glioblastoma is remarkably periodic primary brain tumor, characterizing an eminently heterogeneous pattern of neoplasms that are utmost destructive and threatening cancers. An enhanced and upgraded knowledge of the various molecular pathways that cause malignant changes in glioblastoma has resulted in advancement of numerous biomarkers and the interpretation of various agents that pointedly target tumor cells and microenvironment. In this review, literature or information on various targeted therapy for glioblastoma is discussed. English language articles were scrutinized in plentiful directory or databases like PubMed, ScienceDirect, Web of Sciences, Google Scholar, and Scopus. The important keywords used for searching databases are "Glioblastoma," "Targeted therapy in glioblastoma," "Therapeutic drugs in glioblastoma," and "Molecular targets in glioblastoma."

Characteristics, management and outcomes of choledochal malformations in Finnish adult patients

Aim: We aimed to assess management, comorbidities, biliary histopathology and outcomes of choledochal malformations (CM) in adults. Methods: All adult CM patients managed during 1987–2021 at the Helsinki University Hospital were retrospectively reviewed. Results: Of the 39 patients (females 79%) identified, 19 (49%) underwent surgery, 5 (13%) therapeutic ERCP with papillotomy for type 3 CM and 15 (38%) were managed conservatively. Twenty-five (66%) patients had ≥1 comorbidity, and five (13%) patients had associated inflammatory bowel disease (IBD); ulcerative colitis (n = 3) and Crohn’s disease (n = 2). Most surgically treated patients underwent hepaticojejunostomy (n = 13) or pancreaticoduodenectomy (n = 3) and they were younger at presentation than other patients [29 (21 – 48) vs. 59 (41 – 71), p = 0.001]. Three patients (23%) suffered from pancreatitis following diagnostic ERCP. Early surgical complications occurred in six (32%) patients, including one anastomotic leakage. Biliary epithelial dysplasia was found in three (15%) patients in resected specimens, while no neoplastic changes were observed. Nine patients (47%) had long-term postoperative complications, cholangitis (n = 5) and anastomotic stricture (n = 3) being the most common ones. No evidence of malignant change was observed after median follow-up of 2.3 (0.60 − 4.5) years included all patient cohorts. Conservatively managed patients remained symptomless with unprogressive biliary tract imaging findings and normal liver biochemistry values during follow-up. Conclusions Nearly half of operated patients developed long-term postoperative complications. A novel association between CMs and IBD was observed. Although no hepatobiliary malignancies regardless of treatment modality were encountered, the number of patients and length of follow-up remained limited.

Research progress and future directions on intraductal papillary mucinous neoplasm: A bibliometric and visualized analysis of over 30 years of research.

Malignant change from low-grade dysplasia to high-grade dysplasia and invasive carcinoma following an adenoma-carcinoma sequence is becoming more common in intraductal papillary mucinous neoplasm (IPMN) of the pancreas. The aim of this study is to analyze their main characteristics and recent research trends in IPMNs and consequently create better understandings of the current situation and trends. A comprehensive search was performed in The Science Citation Index Expanded of the Web of Science. All articles between 1990 and 2021 were searched. VOS viewer (Leiden University, Leiden, Netherlands) was used for a qualitative and quantitative analysis of keywords, constituting maps based on co-occurrence matrix. A total of 1658 eligible articles were screened among the 3950 identified articles for this subject. Finally, 879 articles were included in this study. Many articles on IPMN have been published in Japan and South Korea. Tanaka published the highest number of articles (n = 26, citations = 11,143). The Pancreas published the highest number of articles. (n = 100, citations = 2533). These articles were grouped into 4 clusters including basic research, disease overview, management/prognosis and malignant IPMN by using bibliometric keywords network analysis. Overlay visualization demonstrates, a trend of the studies has been changed from basic research or disease to management or prognosis. In this study, we found and highlight the most cited and influential articles related to IPMN. Plus, this study analyzed global research trends in IPMN over the past 30 years and provides insight into the features and research hotspots of the articles in IPMN research.

Video Laryngoscopy as a Screening Tool for Laryngeal Changes in Chronic Smokers and Alcoholics

Aim and Objectives The main aim of this study was to identify the evolving, early changes, premalignant and malignant lesions of larynx among smokers, and alcoholics by video laryngoscopy and to correlate the duration, frequency, and amount of smoking and alcohol with spectrum of symptoms presented and laryngeal morphology. Methods and Methodology This study was prospective study done on a total of 165 patients who attended the department of otorhinolaryngology, at a tertiary care center in South India with various ENT complaints. Patients who were above 18 years of age from both sexes and gave history of smoking and alcohol consumption were included in this study irrespective of their complaints. All these patients underwent video laryngoscopy, which helped in early diagnosing various laryngeal lesions and screening tool for development of laryngeal lesions. Following diagnosis, patients were treated accordingly with lifestyle modifications and abstinence from smoking and alcohol. The primary outcome measure is screening for laryngeal morphology and secondary outcome measures are identifiable laryngeal benign and malignant lesions among smokers and alcoholics who required appropriate treatment. Results There was a significant association between the type of lesion and age group, type of lesion and smoking, and type of lesion and alcohol when compared with nonsmokers and non-alcoholics. As the pack years and amount of alcohol consumption increased, there was a significant increase in the severity and association of lesions. Conclusion We were able to diagnose a large number of laryngeal lesions that helped in the early detection of premalignant and malignant lesions and their early treatment. The patients who were diagnosed with premalignant and malignant changes underwent microlaryngeal excision of the lesion and were in close follow-up to detect any recurrence.

A retrospective study of the malignant change of odontogenic keratocyst

The odontogenic keratocyst (OKC) is a common cystic lesion of the maxilla and mandible. Squamous cell carcinoma (SCC) arising from OKC or dysplasia occurring in OKC is rare. This study aimed to explore the incidence and clinical features of the dysplasia and malignant transformation of OKC. In this study, 544 patients diagnosed with OKC were collected. Among them, 3 patients were diagnosed as SCC arising from OKC, and 12 patients were diagnosed as OKC with dysplasia. The incidence was calculated. Clinical features were analyzed by chi-square test. In addition, a representative case reconstructing mandible with vascularized fibula flap under general anesthesia was reported. And cases reported before were reviewed. The incidence of the dysplasia and malignant transformation of OKC, which are highly associated with the clinical features of swelling and chronic inflammation, is about 2.76%. But the relevance between the dysplasia and malignant transformation and age, gender together with pain is not statistically high. All in all, the clinical features of swelling and chronic inflammation can be considered as characteristics of the dysplasia and malignant transformation of OKC. Although the pain isn't statistically relevant, it may be a dangerous clew. Also, combined with earlier literatures, the dysplasia and malignant transformation of OKC shows unique features of radiographs and histopathology.

Mesenchymal Stem Cell-Derived Exosomes Modulate Angiogenesis in Gastric Cancer

Individualized gastric cancer (GC) treatment aims at providing targeted therapies that translate the latest research into improved management strategies. Extracellular vesicle microRNAs have been proposed as biomarkers for GC prognosis. Helicobacter pylori infection influences the therapeutic response to and the drivers of malignant changes in chronic gastritis. The successful use of transplanted mesenchymal stem cells (MSCs) for gastric ulcer healing has raised interest in studying their effects on tumor neovascularization and in potential antiangiogenic therapies that could use mesenchymal stem cell secretion into extracellular vesicles-such as exosomes-in GC cells. The use of MSCs isolated from bone marrow in order to achieve angiogenic modulation in the tumor microenvironment could exploit the inherent migration of MSCs into GC tissues. Bone marrow-derived MSCs naturally present in the stomach have been reported to carry a malignancy risk, but their effect in GC is still being researched. The pro- and antiangiogenic effects of MSCs derived from various sources complement their role in immune regulation and tissue regeneration and provide further understanding into the heterogeneous biology of GC, the aberrant morphology of tumor vasculature and the mechanisms of resistance to antiangiogenic drugs.

Polycystic ovary syndrome is associated with a higher risk of premalignant and malignant endometrial polyps in premenopausal women: a retrospective study in a tertiary teaching hospital

BackgroundPolycystic ovary syndrome (PCOS) is characterized by anovulation, insufficient progesterone, hyperandrogenism, and insulin resistance. These factors can disrupt the endometrium of PCOS patients and can lead to chronic low-grade inflammation in the endometrium, endometrial hyperplasia, or even endometrial cancer.ObjectiveThe aim of this study was to investigate the prevalence of premalignant and malignant endometrial polyps in premenopausal women and to further explore whether PCOS is associated with premalignant and malignant changes in endometrial polyps.MethodsThis study was conducted by retrieving the medical data of 4236 premenopausal women who underwent hysteroscopic polypectomies between January 2015 and December 2021. Demographic and clinical data regarding age, height, weight, parity, hormone replacement therapy, oral contraceptives, abnormal uterine bleeding, hypertension, diabetes mellitus, PCOS, number of polyps, and size of polyps were collected, and their associations with premalignant and malignant changes in endometrial polyps were analysed.ResultAmong the endometrial polyps removed by hysteroscopic polypectomy in premenopausal women, the prevalence of premalignant and malignant polyps was 2.15%, which comprised hyperplasia with atypia at 1.13% and endometrial carcinoma at 1.02%. PCOS was associated with a higher risk of premalignant and malignant endometrial polyps in premenopausal women after adjustment for potential confounding factors.ConclusionPCOS is associated with a higher risk of premalignant and malignant endometrial polyps in premenopausal women. Therefore, it is important to evaluate the endometrium in PCOS patients with ultrasonography or hysteroscopy, and active management involving hysteroscopic polypectomy should be offered to PCOS patients diagnosed with endometrial polyps regardless of symptoms.

A Rare Case of Cutaneous Granular Cell Tumor Misdiagnosed as Sebaceuos Cyst

Granular cell tumor (GCT) is a rare benign skin tumor. The tumor mostly presents with a symptomatic slowly growing solitary nodule and no overlying skin changes; therefore, it is not always considered in the differential diagnosis. We report a case of cutaneous GCT in the right supra-scapular region in a 43-year-old middle eastern female, who presented with a 2-year history of a slowly growing mass, with a dimension of 3 × 2 cm, initially misdiagnosed as a sebaceous cyst and later diagnosed as a GCT at the histopathological examination, followed by second excision with wide margins. The tumor cells had centrally located nuclei and granular eosinophilic cytoplasm and stained positively for S100 and CD68 antibodies on immunohistochemistry. Even though GCTs are rare, they should be thought of when diagnosing soft tissue tumors under the skin. Malignant changes have been reported in cases after long term follow-up, so surgical removal with wide margins is considered the best line of management.

A RARE CASE OF RECURRENT SINONASAL SCHWANNOMA

A rare benign tumour of the peripheral nervous system called a schwannoma can manifest itself in the nasal cavity. In this case study, we describe a rare instance of recurrent sinonasal schwannoma in a 60- year-old woman who had surgery 6 years prior for a sinonasal mass that was later determined to be schwannoma. The patient now exhibits on and off bleeding from the nose for the past 2 years, nasal obstruction, swelling around the nose, and mucopurulent nasal discharge. During inspection, there was swelling in the left dorsum of the nose, extending from the left medial canthus above to the left ala of the nose. A well-dened, heterogeneously increasing soft tissue attenuation lesion measuring 4.6x4x3.6 cm and originating from the left anterosuperior nasal cavity with cribriform plate erosion was seen on the CECT of Nose & PNS. Due to its extension and recurrence, the sinonasal mass was surgically removed using the lateral rhinotomy technique. With nuclear palisading, HPE revealed spindle cell growth and interlacing fascicles. Antoni A and Antoni B have verocay bodies that resemble an ancient schwannoma. At the six-month follow-up, the patient had no symptoms. Sinonasal schwannoma recurrence is quite uncommon. Despite recurrence, the likelihood of malignant change is quite low. The mainstay is total surgical excision.

Carotid Sinus Syndrome - Case Report

Abstract Syncope caused by carotid sinus syndrome due to malignancy of the head and neck is rare. The aim of this paper is an inspection into current knowledge of this syndrome, its clinical characteristics, differential diagnosis and current treatment modalities. We present a case of recurrent syncope resulting from extreme bradycardia based on a malignant process in the neck area that compresses the carotid sinus. To discover the cause of syncope, an extensive diagnosis was made including electrocardiography, 24h holter electrocardiography, computed tomography of the neck, biopsy of the lump on the right side of the neck. In order to perform the biopsy, the patient was implanted with a temporary pacemaker. Pathohistological processing of biopsy showed the existence of squamous cell carcinoma of the neck region. Due to localization of the malignant change, surgical resection was contraindicated, so the patient was treated with radiotherapy. Syncope based on carotid sinus hypersensitivity caused by a malignant process of the neck region is a significant diagnostic challenge for any clinician. Neck tumor is rarely thought of, since its frequency is rare in the general population. The disease is mostly recognized in the advanced stages when episodes of syncope are more frequent.

Evaluation of Odontogenic Tumors Frequency in Biopsies Sent to Isfahan, Shiraz and Yazd Dental Schools

Introduction: Odontogenic cysts and tumors are lesions found in the upper and lower jaw and oral soft tissue. The understanding and correct diagnosis of odontogenic tumors is essential because they can be invasive or recurrent in nature and even rarely show malignant changes. The aim of this study was to evaluate the frequency of odontogenic tumors in Isfahan, Shiraz and Yazd cites.Materials & Methods: This is a cross-sectional descriptive- analytical study that was performed in the mentioned centers. The records of registered samples from the first year of establishment to 2018 have been reviewed which is approximately 18,000 cases. Samples data were extracted and recorded based on sex, age, jaw and location of involvement in affected jaw. Data were analyzed using descriptive statistics and Chi-square test (p value < 0.05).Results: In this study, a total of 498 odontogenic tumors were evaluated. The number of odontogenic tumors in Isfahan, Shiraz and Yazd cities was 313, 130 and 55, respectively. The mean age of the patients was 30.1 ± 15.9 and most of the patients were in the age group of 20 to 40 years and 53.4% were female. The most common sites of involvement were the right mandibular (29.1%) and then the left mandibular (28.3%) and the most common tumor was ameloblastoma (50.2%) and then complex odontoma (16.7%).Conclusion: Due to the frequency observed for odontogenic tumors, understanding the clinical and pathologic features of these lesions is essential for rapid and appropriate diagnosis and treatment.

The value of adding DWI and FLAIR signal changes in the resection cavity on the diagnostic performance of BT-RADS category 3 for tumor progression prediction in post-treated glioma patients: a prospective pilot study

BackgroundBT-RADS is a structured reporting system of post-treatment glioma. BT-RADS category 3 carries a probability of recurrent malignancy versus treatment-related changes. The aim of this study is to evaluate the additive value of DWI and resection cavity FLAIR signal changes to BT-RADS category 3 in the prediction of tumor progression. We prospectively evaluated follow-up contrast-enhanced MR imaging where 27 post-treated glioma patients were assigned BT-RADS category 3. In all images, FLAIR signal, enhancement component, mass effect, and ADCmean were assessed. We used imaging follow-up from the second stage of the study as the gold standard for comparing the diagnostic performance of BT-RADS category 3 for predicting tumor recurrence before and after the addition of DWI and resection cavity FLAIR signal changes. ROC curves analyses were assessed and compared using the Delong test.Results48.1% of patients had tumor recurrence and 51.9% of patients had treatment-related changes. There was significant difference between ADCmean in recurrent and non-recurrent groups measuring 0.9 and 1.15 × 10−3mm2/s, respectively (p value < 0.001). BT-RADS, BT-RADS added DWI, and BT-RADS added DWI and resection cavity FLAIR signal had a specificity of 64.3, 71.4, and 71.4%, sensitivity of 76.9, 84.6, and 92.3%, and accuracy of 70.5, 77.8, and 81.5%, with improved AUC from 0.706 (95% CI of 0.50–0.86) to 0.78 (95% CI of 0.58–0.92) to 0.819 (95% CI of 0.64–0.94), respectively.ConclusionsAdding DWI and resection cavity FLAIR signal alteration improves the diagnostic performance of BT-RADS category 3.

Chronic PFOA exposure in vitro causes acquisition of multiple tumor cell characteristics in rat liver cells

Perfluorooctanoic acid (PFOA) is tumorigenic in rats and mice and potentially tumorigenic in humans. Here, we studied long-term PFOA exposure with an in vitro transformation model using the rat liver epithelial cell, TRL 1215. Cells were cultured in 10 μM (T10), 50 μM (T50) and 100 μM (T100) PFOA for 38 weeks and compared to passage-matched control cells. T100 cells showed morphological changes, loss of cell contact inhibition, formation of multinucleated giant and spindle-shaped cells. T10, T50, and T100 cells showed increased LC50 values 20%, 29% to 35% above control with acute PFOA treatment, indicating a resistance to PFOA toxicity. PFOA-treated cells showed increases in Matrix metalloproteinase-9 secretion, cell migration, and developed more and larger colonies in soft agar. Microarray data showed Myc pathway activation at T50 and T100, associating Myc upregulation with PFOA-induced morphological transformation. Western blot confirmed that PFOA produced significant increases in c-MYC protein expression in a time- and concentration-related manner. Tumor invasion indicators MMP-2 and MMP-9, cell cycle regulator cyclin D1, and oxidative stress protein GST were all significantly overexpressed in T100 cells. Taken together, chronic in vitro PFOA exposure produced multiple cell characteristics of malignant progression and differential gene expression changes suggestive of rat liver cell transformation.

A Case Report of Neurocutaneous Melanosis with Associated Dandy-Walker Complex

Background: Neurocutaneous melanosis (NCM) and Dandy-Walker malformation (DWM) are two forms of rare congenital neurodysplasia. NCM is a rare dysmorphogenesis characterized by single or multiple giants pigmented cutaneous nevi and the involvement of benign and/or malignant melanocytic tumors of the leptomeninges. DWM is a rare congenital malformation of the brain. Cystic enlargement of the fourth ventricle is its characteristic that communicates with an enlarged posterior fossa, cerebellar dysgenesis, high tentorial insertion, and hydrocephalus. However, these two conditions are rare, and NCM associated with DWC is even more unusual.&#x0D; Case Report: Here, we report a male newborn with macrocephaly and multiple pigmented nevi over his whole body with regular borders and normal weight, height, and spine. He was finally diagnosed as NCM in association with DWC.&#x0D; Conclusion: After diagnosing NCM in association with DWC, appropriate follow-up is recommended; however, there is no particular treatment to prevent the malignant change.

Anastrozole is not Always Successful in Preventing Endometrial Hyperplasia in Patients with Estrogen (+) Breast Cancer – Case Report

Breast cancer is the most common malignancy among women. Anastrozole is the recommended therapeutic for long-term postoperative therapy in postmenopausal women with estrogen (+) breast cancer. Its advantage over Tamoxifen lies in the fact that it does not have a stimulating effect on the proliferation of the endometrium, and therefore does not represent a risk for the development of endometrial atypia and endometrial cancer. However, it is not always 100% effective in suppressing endometrial proliferation and anaplasia. Our case shows exactly the same situation. In our case, endometrial atypia was diagnosed despite Anastrazole therapy for estrogen (+) breast cancer. The lesson that can be drawn from our case is that cases that are on long-term hormonal therapy with Anastrazole due to previous estrogen (+) breast cancer should be vigilantly monitored for the possible development of premalignant and malignant endometrial changes, including ultrasound gynecological examination at least once/6 months and, if necessary, performance of fractional exploratory curettage.

Association Between Smoking and Smokeless from of Tobacco With candida Species in The Oral Cavity.

Candida species constitute a part of the human oral commensal flora in 2 to 71 percent of healthy subjects. Several previous studies have reported that tobacco smoking, either alone or in combination with other systemic or local factors, is associated with increased oral candidal colonization or with the development of oral candidosis. It has been suggested that cigarette smoking might lead to localized epithelial alterations allowing candidal colonization. Cigarette smoke may also provide nutrition for candida albicans. Theories offer partial explanations why smokers may be more prone to candidal leukoplakia with higher potential for malignant changes than other leukoplakias. Aim of the study was to assess and compare the quantitative oral colonization of Candida species between a group of tobacco smokers and smokeless form of tobacco users

Estimation of cell lineages in tumors from spatial transcriptomics data

Spatial transcriptomics (ST) technology through in situ capturing has enabled topographical gene expression profiling of tumor tissues. However, each capturing spot may contain diverse immune and malignant cells, with different cell densities across tissue regions. Cell type deconvolution in tumor ST data remains challenging for existing methods designed to decompose general ST or bulk tumor data. We develop the Spatial Cellular Estimator for Tumors (SpaCET) to infer cell identities from tumor ST data. SpaCET first estimates cancer cell abundance by integrating a gene pattern dictionary of copy number alterations and expression changes in common malignancies. A constrained regression model then calibrates local cell densities and determines immune and stromal cell lineage fractions. SpaCET provides higher accuracy than existing methods based on simulation and real ST data with matched double-blind histopathology annotations as ground truth. Further, coupling cell fractions with ligand-receptor coexpression analysis, SpaCET reveals how intercellular interactions at the tumor-immune interface promote cancer progression.

Upper Gastrointestinal Screening of Polyp Load in Children With Familial Adenomatous Polyposis: Is It Required?

Patients with familial adenomatous polyposis (FAP) have a propensity to form not only large bowel polyps but also upper gastrointestinal (GI) polyps with malignant potential. International guidance suggests that upper GI screening need not begin until patients are at least into their twenties. It is our experience that patients develop upper GI polyps long before this point which have the potential for malignant change. A prospective record of all upper GI endoscopies in children (aged 9 to 17) with FAP was kept across a 12-year period by 1 surgeon in our center. For each scope performed, we recorded the location, histology, and treatment of upper GI polyps. Twent-eight patients aged 9 to 17 underwent a total of 48 esophagogastroduodenoscopies across a 12-year period. Thirty-eight esophagogastroduodenoscopies (79%) identified at least 1 gastric or duodenal polyp in 22 (79%) patients; 10 (36%) patients had gastric adenomas. Eight (29%) patients showed very high numbers of polyps. All 21 patients who had duodenal polyps had adenomas. None had yet developed malignancy, but 1 patient required extensive polyp excision and one is awaiting endoscopic mucosal resection. Our results demonstrate that young people with FAP are at the risk of developing upper GI polyps long before current guidance suggests screening the upper GI tract. We advocate for screening of the upper GI tract to start along with colonoscopy and happen at the same sitting for pediatric and young adult patients with FAP.