Management Of Neoplastic Lesions Research Articles

Histopathological spectrum of gastrointestinal lesions - In a tertiary care centre

Gastrointestinal (GI) pathology is one of the largest sub- specialities in pathology. Histopathological evaluation of GI lesions is the gold standard for providing essential diagnostic and prognostic information to the clinicians for the best timely management of each patient. : This is an unicenter retrospective and prospective study of 510 patients with GI lesions over a period of 2 years from July 2021 to June 2023. Biopsies and resected specimens of gastrointestinal tract were fixed in 10% formalin. Those specimens were then processed in automatic tissue processor. Routine Haematoxylin and Eosin stain and special stains, including immunohistochemical stains were done, whenever indicated. Then slides were examined and data generated from observation and was used for statistical analysis. Out of total 2462 histopathological specimens received in 2 years, over 21% of specimens were GIT lesions of them 510 were GI specimens. Gall bladder was the most common specimen received [34.3%] followed by appendix specimens [18.6%] and gastric biopsies [13.9%]. Non neoplastic GI lesions [89.3%] were the most common followed by neoplastic lesions [10.7%]. Males outnumbered female patients having M: F ratio1.3:1. The peak incidence of non neoplastic lesions are found in the age group of 21-40 years and that for neoplastic lesions found in the age group of 50-70 yrs. Chronic cholecystitis was the most common GI pathology [34.3%] followed by appendicitis [18.1%]. Adenocarcinoma was the most common histopathological malignancy [52.7%] followed by squamous cell carcinoma [47.2%]. Most common lesion in the oesophagus and oral cavity was squamous cell carcinoma whereas adenocarcinoma was most common in colo-rectum. This study enables the overview of the spectrum of histopathological lesion encountered in the surgical pathology department and also reiterates that the histopathological evaluation is a valuable diagnostic tool for definitive and early diagnosis of GI lesions which has an impact on management of neoplastic lesions.

Colorectal neoplasia surveillance in inflammatory bowel disease

Performing colorectal neoplasia surveillance in persons with inflammatory bowel disease (IBD) that is both clinically effective and cost effective is among the greatest challenges facing endoscopists who care for this population. While heightened colorectal cancer (CRC) risk has long been recognized among persons with IBD, this risk has been declining over time, with recent reports suggesting no more than a 1.5–2-fold higher risk compared to age and sex matched members of the general population. Nonetheless, given that CRC still occurs at a higher rate in this population, current surveillance strategies are inadequate for some persons. Conversely, 80–90% of persons with IBD had no neoplastic lesions identified during colonoscopy surveillance, suggesting that many persons with IBD are unnecessarily exposed to the risks of colonoscopy, with society bearing these excess costs.
 The purpose of colorectal neoplasia surveillance is to reduce the burden of CRC and CRC-related death in the IBD population. Societal guidelines recommend initiating colorectal neoplasia screening with colonoscopy in all persons with colorectal IBD involving at least the rectosigmoid (or at least 1/3 of the colorectum if accompanied by discontinuous inflammation) at 8–10 years following disease diagnosis and continuing lifelong surveillance every 1–5 years. Major factors influencing surveillance frequency include historical disease severity, extent of colorectal inflammation, chronic post-inflammatory changes, family history of CRC, history of colorectal neoplasm, primary sclerosing cholangitis, prior colonoscopy findings, and adequacy of prior surveillance. All guidelines further recommend targeted sampling or resection of suspicious visible abnormalities, and some societies continue to recommend extensive non-targeted biopsies to detect “invisible” neoplasia, particularly if other adjunctive optical modalities, such as dye-spray chromoendoscopy (DCE) or virtual chromoendoscopy (VCE), are not performed, or if the mucosa is poorly visualized, such as in areas of significant inflammation, post-inflammatory polyposis, or poor bowel preparation. Most societies now advocate for DCE or VCE as primary screening tools for IBD neoplasia surveillance or, at a minimum, as alternative modalities to traditional white light colonoscopy with non-targeted biopsies where resources and expertise exists.
 However, there are no prospective studies demonstrating a reduction in the incidence of CRC or of death from CRC with current surveillance strategies in persons with IBD. Furthermore, observations from large retrospective studies are also conflicting. A Cochrane analysis of 3 studies in persons with UC did not find a significant mortality benefit for current surveillance strategies. Considering that IBD afflicts many persons at a young age, is rising in prevalence in Canada and globally, and requires intensive lifelong surveillance , the amount of endoscopy resources directed toward IBD surveillance is potentially enormous. Increasing demands on colonoscopy resources from expansion of population-based CRC screening programs and an aging population are likely to challenge the ability to continue to provide intensive surveillance to all persons with IBD. Optimizing delivery of limited colonoscopy resources will thus be essential to maintain effective CRC prevention programs in this population.
 Current standards for neoplasia surveillance in IBD have been recently updated. Shah and Itzkowitz authored a comprehensive review that includes epidemiology, pathogenesis, and management of colorectal neoplasia, along with a chart that compares surveillance recommendations put forward by multiple societies. The present review will highlight new evidence influencing neoplasia surveillance and provide practical approaches for surveillance and management of neoplastic lesions in the IBD population.

A narrative review of endoscopic therapies in Barrett’s esophagus

: Endoscopic therapy has largely replaced esophagectomy in the management of neoplastic lesions [high grade dysplasia (HGD) and early cancer] in patients with Barrett’s esophagus (BE). This change has improved the cost of treatment and decreased patient’s morbidity while maintaining comparable efficacy to surgery. A multitude of endoscopic techniques (resective and ablative) exist to completely eradicate the Barrett’s segment. Resective modalities such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are mostly used for visible or nodular Barrett’s lesions. Ablative modalities, such as radiofrequency ablation (RFA), cryoablation, and argon plasma coagulation (APC), are used to treat flat Barrett’s lesions. These resective and ablative modalities can be used alone or in combination to yield high rates of eradication. While more head to head trials are still needed to compare current modalities, the choice of technique can depend on several factors including the lesion morphology, Barrett’s segment length, the circumferential BE extent, side effect profile of treatment, availability of tools, as well as the physician’s expertise. In this review, we discuss when BE lesions can and should be treated endoscopically, provide an overview and comparison of the available endoscopic treatment modalities, updated research on upcoming technologies, and how these therapies can be positioned to treat BE in different clinical settings.

Histopathology of Sinonasal and Nasopharyngeal Neoplastic Lesions in a Tertiary Care Center of Western Nepal: A Descriptive Cross-sectional Study.

Sinonasal and nasopharyngeal regions harbor diverse clinical conditions including many non-neoplastic and neoplastic lesions presenting with nasal obstruction, facial pain and swelling, rhinorrhea, epistaxis, and other oral, ear, and orbital symptoms. Histopathology of excised lesions is the mainstay for the definitive diagnosis and management of neoplastic lesions. The aim of this study is to find out the prevalence of neoplastic lesions among sinonasal and nasopharyngeal masses. This was a descriptive cross-sectional study conducted among sinonasal and nasopharyngeal masses in the Department of Pathology of a tertiary care center of western Nepal with primary data of 20 years from January 2001 to May 2020. Ethical approval was taken from the Institutional Review Committee. Convenience sampling method was used. Data management and statistical analysis were done using Statistical Package for Social Sciences. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage. Out of 395 sinonasal and nasopharyngeal lesions, 134 (33.92%) (29.26-38.58 at 95% Confidence Interval) were neoplastic lesions. The malignant lesions were found to be 60 (44.77%). Inverted papilloma was the most common benign lesion comprising 28 (20.89%) of cases, and squamous cell carcinoma and nasopharyngeal carcinoma were the most common malignant lesions comprising 12 (8.95%) cases each. This study observed a variety of neoplastic lesions. The most common benign lesion was nasal polyp and squamous cell carcinoma and nasopharyngeal carcinoma were the most common malignant lesions.