Malignant Polyps Research Articles

TP1.2.5Colonoscopic Surveillance Versus Surgical Resection After Polypectomy for Colorectal Polyp Cancers: Are We Overtreating Malignant Colorectal Polyps?

Abstract Aims Colorectal polyp cancers are increasingly detected in the era of screening. This raises the dilemma regarding management by colonoscopic surveillance or surgical segmental resection. The evidence base remains relatively limited and guidelines are still evolving to balance the risk of overtreatment and unnecessary surgical resection or undertreatment and cancer recurrence. In this study we investigate the management of polyp cancers in our centre. Methods This single centre retrospective study in a university teaching hospital included all patients with malignant colorectal polyps found endoscopically and over a 15-month period. All patients were discussed at the colorectal MDT. The threshold for incomplete endoscopic excision was 1mm. Data from endoscopy reports, histopathology reports and operation notes was collected to determine rate of surgical resection and of residual disease. Results 70 patients with colorectal polyps, classified as at least high-grade dysplasia, were included. 22/70 polyp cancers (31%) patients had surgical resection. Residual adenocarcinoma was identified in 1/22 (4%) and one further patient had lymph node metastases. Two individual patients developed post-operative ileus and pancreatitis resulting from surgery. Conclusions Of those patients undergoing surgical resection only 8% patients had malignancy in the postoperative specimen, raising the possibility of overtreatment under current guidelines. This highlights a need to update clinical guidelines to avoid overtreatment without compromising oncological outcomes.

TP9.2.9Luminal Investigation Following CT Diagnosed Acute Diverticulitis

Abstract The commissioning guide for colonic diverticular disease by the Royal Collage of Surgeons (2014) states that all patients should undergo luminal investigations once an acute attack of diverticulitis has passed. The rational behind this is to ensure a malignant polyp is not missed, however there is mounting evidence and opinion that this may not be necessary. We aim to evaluate how our unit follows the commissioning guide and investigate the number of subsequent polyps and cases of malignancy found. Surgical inpatients with a CT proven diagnosis of acute diverticulitis within a one year period (2018) were included. Their CT scans were reviewed to confirm the diagnosis and electronic records examined to see if luminal investigations were requested, occurred and what the findings were. There were 78 cases of CT confirmed diverticulitis. Of these 11 patients underwent emergency Hartmanns procedure. This left 67 patients in whom investigations were requested in 47. Within the 20 cases were follow up was not requested, 50% had a mitigating factor. 40/47 patients who had investigations booked underwent the requested test. In 6 cases a polyp was found and there were no cases of colorectal cancer. Based on current guidance there is scope to improve the follow up investigations in this population of patients with CT proven diverticulitis. As no colorectal cancers were found this is in keeping with the growing notion that colonoscopy may be reserved for those with complicated diverticulitis on CT or with CT findings on a background of ‘red flag’ symptoms.

Heat Shock Proteins HSPA1 and HSP90AA1 Are Upregulated in Colorectal Polyps and Can Be Targeted in Cancer Cells by Anti-Inflammatory Oxicams with Arylpiperazine Pharmacophore and Benzoyl Moiety Substitutions at Thiazine Ring.

Heat shock proteins HSPA1/Hsp70α and HSP90AA1/Hsp90α are crucial for cancer growth but their expression pattern in colorectal polyps or whether they can be modulated by oxicams is unknown. We quantified (RTqPCR) HSPA1 and HSP90AA1 expression in 50 polyp-normal pairs in relation to polyp malignancy potential and examined the effect of piroxicam, meloxicam and five novel analogues on HSPA1 and HSP90AA1 expression (mRNA/protein) in colorectal adenocarcinoma lines. HSPA1 and HSP90AA1 were upregulated in polyps by 3- and 2.9-fold. Expression ratios were higher in polyps with higher dysplasia grade and dominant villous growth pattern, mostly a result of diminished gene expression in normal tissue. Classic oxicams had negligible/non-significant effect on HSP expression. Their most effective analogue inhibited HSPA1 protein and gene by 2.5-fold and 5.7-fold in Caco-2 and by 11.5-fold and 6.8-fold in HCT116 and HSPA1 protein in HT-29 by 1.9-fold. It downregulated HSP90AA1 protein and gene by 1.9-fold and 3.7-fold in Caco-2 and by 2-fold and 5.0-fold in HCT116. HSPA1 and HSP90AA1 are upregulated in colorectal polyps reflecting their potential for malignancy. HSPA1 in cancer cells and, to lesser degree, HSP90AA1 can be reduced by oxicam analogues with thiazine ring substituted via propylene linker by arylpiperazine pharmacophore with fluorine substituents and by benzoyl moiety.

Prevalence and risk factors of gallbladder polyps in primary health care centers among patients examined by abdominal ultrasonography in Qatar: a case-control study.

Background: Gallbladder (GB) polyps are raised lesions from the GB wall and projected into its lumen. The prevalence of GB polyps ranged between 4.3% and 12.3%. The clinical presentation of GB polypoid lesions vary, can be nonspecific and vague, and may be asymptomatic. Identifying malignant and premalignant polyps is important to provide treatment early and prevent cancer spread or development of malignancy. Ultrasonography (US) is the first imaging modality widely used in abdominal imaging. It is a noninvasive, rapid, painless, and safe imaging technique, with no radiation; thus, it is considered the best available examination with good sensitivity and specificity for GB polyps.Aim of the work: This study aimed to determine the relative frequency of the GB polyps and its risk factors among patients who underwent abdominal US in Primary Health Care Corporation, Qatar.Materials and methods: This was quantitative multicenter observational case–control study nested in a cross-sectional design. For the cross-sectional top-level study, the first step was to assess available abdominal ultrasound studies for the presence of GB polyps and stones. The second step was to perform a case–control study with three groups (a case group and two control groups; first, participants without GB stones and GB polyps; second, patients with GB stones but without GB polyps).Results: The study evaluated the GB images of 7156 individuals. The overall prevalence of GB polyps was 7.4% in the study population. Specifically, the overall prevalence of solitary GB polyp was 4.2% and that of multiple GB polyps was 3.2%. Regarding the size distribution of GB polyps in positive cases, 89.4% were < 6 mm, 9.3% were 69 mm, and 1.3% were ≥ 10 mm. Prevalence rate of selected comorbidities were as follows: liver disease, 1.8%; diabetes mellitus, 25.5%; hypertension, 25.5%; and dyslipidemia, 29.8%. The prevalence in male and female patients was 7.7% and 7%, respectively. The prevalence of GB polyps was higher in south-eastern patients (21.4% of positive cases) and was the highest in the overweight group (8.8%). A higher prevalence was noted in the hypertensive group (hypertensive group, 9.8%; non-hypertensive group, 6.6%) and dyslipidemia group (dyslipidemia group, 7.8%; no dyslipidemia group, 7.2%). Moreover, a higher prevalence was noted in hepatitis B surface (HBS)-positive group (15%) than in the HBS-negative group (8.2%) and slightly higher in Helicobacter pylori antigen positive group than in the negative group.Conclusion: Abdominal US is an important and commonly used imaging modality in the detection of GB polyps. In this study, the prevalence of GB polyps was approximately 7.4%, with higher prevalence in participants who were overweight and had diabetes mellitus, hypertension, and dyslipidemia.

S327 National Trends in the Incidence of Sporadic Malignant Colorectal Polyps in Young Patients (20-49 Years): An 18-Year SEER Database Analysis

Introduction: Recent changes in the USPSTF guidelines recommend that CRC (Colorectal Cancer) screening in average-risk patients should commence at 45 years with the intent of finding sporadic premalignant or malignant polyps, allowing early endoscopic interventions to improve clinical outcomes. This study aims to find the incidence of sporadic malignant polyps in adult patients < 50 years of age) from the National Cancer Institute's SEER (Surveillance Epidemiology and End Results) database over a period of 18 years. Methods: We interrogated the SEER database (2000-2017) on patients aged 20-49 years diagnosed with at least a single malignant sporadic colorectal polyp. Data extraction was performed through a case listing session using SEER*Stat v8.3.9 on combined SEER 18 incidence registries using specific codes for CRC polyps with cancer (Table). Microsatellite instability (MSI-H) high lesions and adenomatous polyposis coli (APC) were excluded from the analysis. Descriptive statistical analysis was performed using SPSS v27 for Mac. Results: A total of 10,742 patients with a diagnosis of colorectal polyps with a malignant component were identified. Female patients comprised 42.9% of the cohort with a mean age of any malignant polyp incidence of 43.07 years (42.91-43.23, 95% CI). The annual mean age (95% CI) of incidence of new-onset malignant polyps over time is shown in Figure 1. Approximately 50% of malignant polyps were diagnosed between 45-49 years of age, and about 25-30% were diagnosed between 40-45 years of age (Table). The incidence of malignant villous adenomas decreased, whereas malignant adenomas and tubulovillous adenomas increased over time (Table). A rising temporal trend for the total number of patients diagnosed with malignant polyps was also observed. Serrated polyps with cancer were noted to be scarce in the population studied. Conclusion: Our results show the mean age of sporadic malignant colorectal polyp incidence occurrence at 43 years. Approximately half of the malignant polyps under age 50 occurred in patients under age 45, below the current screening threshold of 45 years. Also observed was a temporal change in the histological patterns of colorectal malignant polyps, with malignant tubulovillous and adenomatous adenomas increasing and villous adenomas decreasing with the scarcity of serrated polyps with cancer in this population. These results have profound implications for colorectal cancer screening.Figure 1.: Age of malignant colorectal polyp incidence over time in 20 to 49 year age group.Table 1.: Distribution of gender and histological trend over time (2000-2017) of sporadic* malignant colorectal polyps in patients aged 20-49 years.

S220 Cancer-Specific 5-Year Survival Following Endoscopic Polypectomy versus Surgery for Malignant Colorectal Polyps

Introduction: Current guidelines recommend polyp resection strategies, endoscopic resection (ER) or surgical resection (SR) based on high-risk histological features and depth of invasion to ensure complete removal of the malignant lesion, minimizing the risk of progression through micrometastasis. Data comparing cancer-specific survival following ER or SR for localized malignant polyps based on the AJCC staging (Stage 0, I & II & grade) are scarce. Methods: We used the Surveillance Epidemiology and End Results (SEER) database (2004-2015) on patients diagnosed with at least a single malignant colorectal polyp (Table) on the colonoscopies performed for any indication or screening. Data extraction was through a case listing session using SEER*Stat v8.3.9 on combined SEER 18 incidence registries using specific codes for CRC polyps with cancer. Statistical analysis was performed using SPSS v27 for Mac. Results: A total of 63,147 patients with a diagnosis of a colorectal polyp with a malignant component were identified. The mean age was 47.48 years (± 12.15 SD), 45.6% were females. T stages ranged T1-T3. Patients with stage 0 (carcinoma in situ) polyps showed equivalent 5-year cancer-specific survival regardless of ER or SR (mean 170 vs 169 months, 94.2% vs 93.7%, P=0.429, Figure 1A). Stage I and II patients showed superior 5-year survival with SR than ER (mean 165 vs 159 months, 91.1% vs 88%, p< 0.001, Figure 1B). Patients with well-differentiated histological grade demonstrated no survival differences regardless of ER or SR (mean 165 vs 166 months, 92.7% vs 93%, P=0.175, Figure 1C). In contrast, those with polyps of poor differentiation or anaplastic features showed superior 5-year cancer-specific survival with SR than ER (mean 161 vs 145months, 90% vs 88%, P=< 0.001, Figure 1E). Patients with polyps of moderate differentiation showed superior 5-year cancer-specific survival with SR compared with ER (mean 164 vs 159months, 92% vs 90% p< 0.001, Figure 1D) Conclusion: Our results show that cancer-specific survival improved in patients with malignant polyps with AJCC Stage I or II who underwent SR compared with ER, but not Stage 0 (carcinoma in situ). Another novel finding was superior 5-year cancer-specific survival in patients with polyps of moderately-differentiated histological grade, in addition to poorly differentiated and anaplastic grades, which has not been reported before. These novel findings warrant further corroboration from well-constructed clinical trials.Figure 1.: Five-year cancer specific survival comparing endoscopic resection versus surgical resection for colorectal polyps by cancer stage and histological grade.Table 1.: Number of patients diagnosed with polyps with a malignant component by stage and year of diagnosis.

Incidence of polyp formation following bariatric surgery.

Multiple studies have linked obesity to an increased risk of cancer. The correlation is so strong that the national cancer prevention guidelines recommend weight loss for patients with obesity to reduce their risk of cancer. Bariatric surgery has been shown to be very effective in sustained weight loss. However, there have been mixed findings about bariatric surgery and its effects on the risk of colorectal cancer. This study sought to examine bariatric surgery patients and their risk of pre-cancerous or cancerous polyps to elucidate any risk factors or associations between bariatric surgery and colorectal cancer. A retrospective review of the academic medical center's bariatric surgery database was performed from January 2010 to January 2017. Patients who underwent medical or surgical weight loss and had a subsequent colonoscopy were included in the study. Positive colonoscopy findings were described as malignant or premalignant polyps. A total of 1777 patients were included, with 1360 in the medical group and 417 in the surgical group. Data analysis included patient demographics, co-morbidities, procedure performed, surgical approach, weight loss, and colonoscopy findings. A multivariate analysis was used to determine whether an association exists between weight loss and incidence of colorectal polyps, and if so, whether the association different for medical versus surgical weight loss. A higher percentage of body mass index (BMI) reduction was seen in the surgical group. An overall comparison showed average reductions in BMI of 27.7% in the surgical group and 3.5% in the medical group (P < .0001). Patients with the greatest reduction in BMI, regardless of medical or surgical therapy, showed a lower incidence of precancerous and cancerous polyps (P = .041). This study offers a unique approach in examining the incidence of colorectal polyps related to obesity. Patients with the greatest reduction in their BMI, more common in the surgical group, had a lower incidence of precancerous and cancerous polyps.

S3157 A Polypectomy a Day Keeps the Cancer Away: A Case of a High Burden of Fundic Gland Polyps Exhibiting Low and High-Grade Dysplasia

Introduction: Fundic gland polyps are commonly encountered in Western countries where PPI use is high and H.pylori prevalence is low, thought to be precipitated by an iatrogenic hypergastrinemic state. They can also be seen in polyposis syndromes: FAP, MAP, and GAPPS. Those associated with PPI typically have no malignant potential, however may show low grade dysplasia. Patient with GAPPS have a high risk of gastric cancer, while fundic gland polyps associated with FAP rarely progress to malignancy. We present a case of a patient without known family hx of polyposis syndrome presenting with a high burden of fundic gland polyps exhibiting low and high-grade dysplasia. Case Description/Methods: A 57F with PMH of HTN, HLD, GERD, hypothyroidism was referred to GI clinic for evaluation of intermittent, burning epigastric abdominal pain, worse after eating. Her symptoms showed minimal response to PPI; endorsed occasional NSAID use. No known FHx of gastric cancer. 4 years prior EGD showed evidence of gastritis and C-scope with hyperplastic polyps. She underwent repeat C-scope which showed diverticulosis and EGD which revealed over 20 3-20 mm polyps throughout the stomach. Some large and ulcerated polyps were removed, but overall none removed exhibited drastically concerning appearance to suggest malignancy. She reported improvement in her symptoms post-polypectomy along with PPI BID. Antral biopsies were negative for H.pylori. Interestingly pathology of the polyps revealed fundic gland polyps with low and high-grade dysplasia; findings were confirmed by a second pathologist. Given these findings, plans were made to continue with serial EGDs until all polyps could be removed. At the time of writing, she has undergone 6 additional EGDs with polypectomy with all further pathology showing fundic gland polyps negative for dysplasia or malignancy. Discussion: Endoscopists sometimes rely on the gross morphology of polyps in assessing the probability of malignant potential and determining the need for polypectomy. As illustrated by this case, visual inspection alone may not suffice in developing therapy plans. The resultant implications to practice patterns is significant, as practitioners may opt to similarly aim to remove all polyps, though tedious, over serial EGDs given the risk of potentially malignant polyps masquerading behind a benign facade. Furthermore, there may be implications to endoscopic surveillance trends in such patients that exhibited high-grade dysplasia on pathology in the past.Figure 1.: Figure A - Endoscopic view of mass Figure B - CD117 Negative Figure C - S-100 Positive Figure D - Sox1 Positive.

ANALYSIS OF TISSUE EOSINOPHILS IN THE STRUCTURE OF GASTRI C POLYPS

A study of the diagnostic value of tissue eosinophil infiltration in the structure of polyps of the human gastrointestinal tract and surrounding tissues was carried out. We investigated intestinal biopsies from 189 patients aged 40–90 years with polyps, cancer, metastases. This retrospective study allows us to note the possibility of using eosinophils in the development of criteria for early malignancy and a promising outcome of neoplasms in the mucous membrane. Eosinophils are important players in intercellular interactions within the polyp structure and the tissues around it. The complete absence of eosinophils in the tissue of malignant polyps indicates the malignancy of the neoplasm. We revealed relationship between apoptosis and eosinophilic infiltration; both of them affect the outcome and prognosis of polyp development. Apoptosis induction by eosinophils and programmed cambium necrosis in tumor progression need to be further researched.

Endoscopic management of colorectal polyps: From benign to malignant polyps.

Colorectal cancer (CRC) is the third most common cancer worldwide and the second leading cause of cancer related death in the world. The early detection and removal of CRC precursor lesions has been shown to reduce the incidence of CRC and cancer-related mortality. Endoscopic resection has become the first-line treatment for the removal of most precursor benign colorectal lesions and selected malignant polyps. Detailed lesion assessment is the first critical step in the evaluation and management of colorectal polyps. Polyp size, location and both macro- and micro- features provide important information regarding histological grade and endoscopic resectability. Benign polyps and even malignant polyps with superficial submucosal invasion and favorable histological features can be adequately removed endoscopically. When compared to surgery, endoscopic resection is associated with lower morbidity, mortality, and higher patient quality of life. Conversely, malignant polyps with deep submucosal invasion and/or high risk for lymph node metastasis will require surgery. From a practical standpoint, the most appropriate strategy for each patient will need to be individualized, based not only on polyp- and patient-related characteristics, but also on local resources and expertise availability. In this review, we provide a broad overview and present a potential decision tree algorithm for the evaluation and management of colorectal polyps that can be widely adopted into clinical practice.

Algorithm combining virtual chromoendoscopy features for colorectal polyp classification.

Background and study aims Colonoscopy is considered the gold standard for decreasing colorectal cancer incidence and mortality. Optical diagnosis of colorectal polyps (CRPs) is an ongoing challenge in clinical colonoscopy and its accuracy among endoscopists varies widely. Computer-aided diagnosis (CAD) for CRP characterization may help to improve this accuracy. In this study, we investigated the diagnostic accuracy of a novel algorithm for polyp malignancy classification by exploiting the complementary information revealed by three specific modalities. Methods We developed a CAD algorithm for CRP characterization based on high-definition, non-magnified white light (HDWL), Blue light imaging (BLI) and linked color imaging (LCI) still images from routine exams. All CRPs were collected prospectively and classified into benign or premalignant using histopathology as gold standard. Images and data were used to train the CAD algorithm using triplet network architecture. Our training dataset was validated using a threefold cross validation. Results In total 609 colonoscopy images of 203 CRPs of 154 consecutive patients were collected. A total of 174 CRPs were found to be premalignant and 29 were benign. Combining the triplet network features with all three image enhancement modalities resulted in an accuracy of 90.6 %, 89.7 % sensitivity, 96.6 % specificity, a positive predictive value of 99.4 %, and a negative predictive value of 60.9 % for CRP malignancy classification. The classification time for our CAD algorithm was approximately 90 ms per image. Conclusions Our novel approach and algorithm for CRP classification differentiates accurately between benign and premalignant polyps in non-magnified endoscopic images. This is the first algorithm combining three optical modalities (HDWL/BLI/LCI) exploiting the triplet network approach.

Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium

Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium

Biliary Tract Malignancies Related to Gallbladder Polyps, Primary Sclerosing Cholangitis, and Choledochal Cysts.

Biliary Tract Malignancies Related to Gallbladder Polyps, Primary Sclerosing Cholangitis, and Choledochal Cysts.

Use of endoscopic sleeve to achieve full-thickness endoscopic resection of malignant polyp under direct vision.

Use of endoscopic sleeve to achieve full-thickness endoscopic resection of malignant polyp under direct vision.

Predictors of lymph node metastases in patients with malignant adenomatous polyps of the colon

BackgroundWe sought to describe predictors of lymph node positivity in patients with malignant colon polyps to identify low risk patients who may potentially avoid radical surgery. DesignThe National Cancer Database (2010–2015) was queried for all patients with malignant colonic polyps who underwent formal colonic resection. Univariate and multivariate methods were used to determine independent predictors of lymph node metastasis. Results14,663 patients were identified. Lymph node disease was present in 9% of patients. High-grade disease, LVI, PNI, younger age, and left sided location were univariate predictors of lymph node disease. High-grade disease (OR 1.84), left sided location (OR 1.31), LVI (OR 5.79), and PNI (OR 1.70) were independent predictors, while elderly age (OR 0.64) was protective (all p-values <0.001). Elderly patients with low grade disease of the right/transverse colon without LVI/PNI had a 4.4% risk of lymph node disease. High grade, left-sided tumors with LVI, non-elderly age, had a 30% risk. ConclusionNon-elderly age, left-sided location, LVI, PNI and high-grade histology are independent predictors of lymph node metastasis in malignant colonic polyps.

Decision making in the management of adults with malignant colorectal polyps: An exploration of the experiences of patients and clinicians.

A diagnosis of colorectal polyp cancer presents a treatment dilemma. The decision between segmental resection versus endoscopic surveillance is difficult due to a lack of good quality clinical evidence for either option. The aim of this study was to understand the decision making experiences of both clinicians and patients when faced with such a diagnosis. Qualitative, semi-structured interviews were undertaken with 10 clinicians involved in the care of patients diagnosed with polyp cancer and five patients who had experience of a diagnosis of polyp cancer. All clinicians and patients were from four hospital trusts across the north of England. Interviews were audio-recorded, transcribed verbatim and analysed using the principles of interpretative phenomenological analysis. Analysis of the interview transcripts evidenced that clinicians and patients were supportive of a shared approach to treatment decision making in the context of a diagnosis of colorectal polyp cancer. Uncertainty, influences and information were among the themes identified to be preventing this happening at present. This study identified themes which were common to both groups. These were complexity of the risk information, lack of patient information resources, and system factors and time. This research study has evidenced several factors such as uncertainty, complexity of risk information and influences on decisions which are preventing patients being involved in treatment decisions following a diagnosis of colorectal polyp cancer. Recommendations for improvements in practice, including a framework to assist treatment decision making in the future, are highlighted.

Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis.

Background and aims: Postmenopausal endometrial polyps are commonly managed by surgical resection; however, expectant management may be considered for some women due to the presence of medical co-morbidities, failed hysteroscopies or patient’s preference. This study aimed to identify patient characteristics and ultrasound morphological features of polyps that could aid in the prediction of underlying pre-malignancy or malignancy in postmenopausal polyps. Methods: Women with consecutive postmenopausal polyps diagnosed on ultrasound and removed surgically were recruited between October 2015 to October 2018 prospectively. Polyps were defined on ultrasound as focal lesions with a regular outline, surrounded by normal endometrium. On Doppler examination, there was either a single feeder vessel or no detectable vascularity. Polyps were classified histologically as benign (including hyperplasia without atypia), pre-malignant (atypical hyperplasia), or malignant. A Chi-squared automatic interaction detection (CHAID) decision tree analysis was performed with a range of demographic, clinical, and ultrasound variables as independent, and the presence of pre-malignancy or malignancy in polyps as dependent variables. A 10-fold cross-validation method was used to estimate the model’s misclassification risk. Results: There were 240 women included, 181 of whom presented with postmenopausal bleeding. Their median age was 60 (range of 45–94); 18/240 (7.5%) women were diagnosed with pre-malignant or malignant polyps. In our decision tree model, the polyp mean diameter (≤13 mm or >13 mm) on ultrasound was the most important predictor of pre-malignancy or malignancy. If the tree was allowed to grow, the patient’s body mass index (BMI) and cystic/solid appearance of the polyp classified women further into low-risk (≤5%), intermediate-risk (>5%–≤20%), or high-risk (>20%) groups. Conclusions: Our decision tree model may serve as a guide to counsel women on the benefits and risks of surgery for postmenopausal endometrial polyps. It may also assist clinicians in prioritizing women for surgery according to their risk of malignancy.

Detection Rate of Colorectal Polyps in Symptomatic Candidates of Colonoscopy: When Should We Do a Total Colonoscopy?

BACKGROUND The incidence of colorectal cancer is increasing in the northeast of Iran. Colorectal polyps are among the proposed risk factors noted, especially in the elder population. This study was designed to study the diagnosed cases of intestinal polyps detected from 2011 to 2016 in the northeast of Iran. METHODS The population consisted of symptomatic candidates referred to the colonoscopy center in Gorgan city. Based on the available colonoscopy and pathology reports, 1706 cases were enrolled after the exclusion of cases without sufficient data. RESULTS Among 1709 (55.5% males and 44.5% females) cases, 1405 cases with 1912 polyps were detected. Among them, 345 (25%) aged less than 50 years. Tubular adenoma (N = 826, 43.2%) and hyperplastic polyps (N = 519, 27.1%) were the top two histological findings. Out of 1405 patients with polyps, 660 (39.6%) polyps were detected in proximal colon (15.6% in proximal and 24% in both proximal and distal). Malignancies were detected in 13.2% (0.8% malignant polyps and 12.4% malignant masses). CONCLUSION A considerable number of colorectal adenomas in proximal colon and in patients younger than 50 years old, suggesting to schedule colorectal cancer screening from at least 10 years younger and continuing colonoscopy up to the proximal area.

Histopathological and Immunohistochemical Evaluation of CDX2 and Ki67 in Colorectal Lesions with their Expression Pattern in Different Histologic Variants, Grade, and Stage of Colorectal Carcinomas

Background:A variety of colorectal lesions are surgically treated encompassing both benign and malignant polyps and colorectal cancer (CRC). CRC is the third most common cause of death in developed countries. Over the last decade, CDX2 has been linked to CRC progression, with reduced expression of the protein associated with more advanced tumor stage, vessel invasion, and metastasis.Aims and Objectives:To analyze the histopathology and immunohistochemistry (IHC) of CDX2 and Ki67 with their expression pattern; in different lesions of colon and rectum with special reference to various grade/stage/histological variants of CRC and to find out whether they can be used as possible predictive marker.Materials and Methods:The study conducted was hospital based, both retrospective and perspective type comprising colorectal samples of total 367 cases (N) within a period of 2½ years. Surgical samples were collected, then grossed, processed, stained with routine hematoxylin and eosin stain in our department followed by IHC of CDX2 and Ki67 in only 60 randomly selected cases (n = 60).Results:Out of total 367 cases, 265 cases were prospective study and 102 cases were retrospective study (240 cases were colonic lesions, and 127 are rectal lesions). The samples included were both from colonoscopy biopsy (small) 319 cases and 48 colectomy specimen (large). Mean age of the study participants was 49.62 years with a standard deviation of 17.34 years and predominantly male, but the difference was not statistically significant (P > 0.05). Colon (238 cases, 64.9%) as a whole affected more than rectum and left sided tumors more than the right side. All 60 cases were found to be positive for CDX2 expression (i.e., 100%); majority (n = 38) being carcinoma cases possessing high score and was statistically significant (P = 0.008, using Chi-square test) indicating strong association, whereas Ki-67 showed an increased index from noneoplastic to neoplastic cases.Conclusion:These markers can be used as future predictive biomarkers which will precisely evaluate risk group, prognosis, and response to therapy hence can be used as target therapy reducing irrational treatment.

The evaluation of colon polyps and factors affecting malignancy of polyps

The evaluation of colon polyps and factors affecting malignancy of polyps