Moderate Epithelial Dysplasia Research Articles

Quantitative assessment Cyclooxygenase – 2 immunohistochemical expression in different grades of oral epithelial dysplasia

Oral leukoplakia (OLP) is one the most common potentially malignant disorders account 0.2 to 4.9% of malignant transformation and dysplastic lesions vary from 3-6% this rate of malignant conversion depends on the different grades of epithelial dysplasia. Recent literature suggests that increased levels of COX-2 in potentially malignant disorders and malignant tumors show prominent genetic evidence in tumorigenesis. Assessment of Cyclooxygenase-2 – 2 (COX-2) immunohistochemical expression in different grades of oral epithelial dysplasia. Materials and Methodology A total of forty formalin-fixed, paraffin-embedded tissue blocks were obtained from departmental archives which are histopathological diagnoses of different grades of oral epithelial dysplasia each grade ten samples was included. Stained with COX-2 and positive cells were counted and tabulated for statistical analysis. Results Comparison between genders in oral leukoplakia males was more when compared with females. The mean age in mild epithelial dysplasia was more when compared with moderate and severe epithelial dysplasia. Expression of COX-2 was increased from mild to severe epithelial dysplasia increases. The mean number of positive cells was increased. A comparison of all groups was not statistically significant (p≥0.05). Conclusion: Oral leukoplakia (OLP) is one the most common potentially malignant disorders which accounts for 0.2 to 4.9% of malignant transformation. COX-2 can be used for early detection and prognostic makers in different grades of oral epithelial dysplasia. Keywords: Cyclooxygenase, Expression, Oral leukoplakia, Potentially malignant transformation

Tubular-villous adenoma against the background of ulcerative colitis (clinical case)

A clinical case of the development of tubular-villous adenoma with moderate epithelial dysplasia (high grade) is described, taking into account the presence of foci of squamous metaplasia in the epithelium of the glands. The pathology presented in the article according to ICD-O has code 8263/2.Description of the clinical case. The patient had an initial colonoscopy in 2020 and was diagnosed with chronic ileitis and colitis with moderate and in some areas high inflammation activity, which is most characteristic of nonspecific ulcerative colitis. The patient was treated by a gastroenterologist. In December 2021, she had a follow-up colonoscopy with the histological material sampling. Endoscopic conclusion: ulcerative colitis, total lesion, exacerbation phase.Results and discussion. When the device was inserted into the rectum at a distance of 13 cm, a neoplasm was visualized, the mucosa was pale, shiny, when trying to pass the device through the narrowing of the contact-vulnerable mucosa, with instrumental palpation, the formation was displaced by a conglomerate, a polyfragmentary biopsy was taken. In the study of histological preparations of the recto-sigmoid junction, a tubular-villous adenoma with moderate epithelial dysplasia (high grade) is determined, taking into account the presence of foci of squamous metaplasia in the epithelium of the glands. According to the literature, with ulcerative colitis affecting almost the entire colon for more than 10 years, there is an increased risk of colon cancer formation (10 %), which increases by 2–5 % annually. The possibility of malignancy is present in 10–20 % of patients with ulcerative colitis for more than 20 years. Other researchers describe the identified low-grade dysplasia as progressing to high-grade dysplasia and carcinoma in 29–54 % of cases.Conclusions. The study of patients with this pathology should be carried out against the background of thorough preparation of the large intestine with modern preparations using high-tech verification methods and polyfragmental biopsy with a qualified assessment of biopsy specimens.

“Vaai Ganam” - a screening program for early detection of oral potentially malignant disorders and oral cancer among truck drivers in Chennai – a cross-sectional survey

Introduction: Truck drivers, though forming an integral part of a vital trade link for the Indian population, lack basic life insurance and health care benefits offered by other organized sectors in Indian Industries. This paper aims to present the initial findings of the “VaaiGanam” program which proposes to identify tobacco use and the prevalence of Oral potentially malignant disorders (OPMDs) among truck drivers who are stationed or passing via Chennai and provide cessation services by behavioral therapy. Methods: This cross-sectional study was conducted by a dental screening team who were involved in data collection and screening of the 747 truck drivers who fulfilled the inclusion and exclusion criteria between Jan to Oct 2022. After data collection, oral examinations were done and suspicious lesions were sought for expert opinion. A standard punch biopsy was taken from those lesions requiring confirmation. Results: Among the 747 subjects who participated in this program, 704 (94.2%) were current users of various tobacco products, with 235 (31.4%) preferring smoking and the rest 469(62.8%) using smokeless tobacco products. Oral mucosal lesions were recorded in 49 (6.5%) of the study population, mostly among tobacco users. Punch/incisional biopsies were taken among 17 of the 49 subjects and oral dysplasia was histopathologically confirmed in 9 (mild epithelial dysplasia = 5; moderate epithelial dysplasia = 4) subjects. Conclusion: Truck drivers with tobacco and substance abuse are at high risk of developing oral cancer and hence this study emphasizes the importance of periodic oral cancer screening programs for this vulnerable population to identify potentially malignant oral lesions at an early stage.

ACTINIC CHEILITIS: A CLINICOPATHOLOGICAL RETROSPECTIVE ANALYSIS OF 110 CASES

OBJECTIVE To characterize actinic cheilitis in a sample of patients from a single Brazilian institution. STUDY DESIGN The records were retrospectively reviewed for all actinic cheilitis cases diagnosed from 1995 to 2019. The sociodemographic variables (age, sex, race), topographic aspects, and histopathological features were collected. RESULTS This study evaluated 110 patients, including 90 (81.82%) males, with a mean age of 61.43 years. Clinically, the lesions mainly appeared as plaques (48.18%). All slides were reviewed, with moderate epithelial dysplasia being the most frequent (41.94%), followed by mild (20.16%), severe (14.52%), and no dysplasia (8.87%). Fourteen cases were diagnosed as micro-invasive carcinoma (11.29%) and 4 cases as SCC (3.23%) CONCLUSION The present study showed that most cases presented significant histological alterations, including epithelial dysplasia, micro-invasive carcinoma, and carcinoma, thus proving the importance of clinical and histological evaluations of actinic cheilitis. To characterize actinic cheilitis in a sample of patients from a single Brazilian institution. The records were retrospectively reviewed for all actinic cheilitis cases diagnosed from 1995 to 2019. The sociodemographic variables (age, sex, race), topographic aspects, and histopathological features were collected. This study evaluated 110 patients, including 90 (81.82%) males, with a mean age of 61.43 years. Clinically, the lesions mainly appeared as plaques (48.18%). All slides were reviewed, with moderate epithelial dysplasia being the most frequent (41.94%), followed by mild (20.16%), severe (14.52%), and no dysplasia (8.87%). Fourteen cases were diagnosed as micro-invasive carcinoma (11.29%) and 4 cases as SCC (3.23%) The present study showed that most cases presented significant histological alterations, including epithelial dysplasia, micro-invasive carcinoma, and carcinoma, thus proving the importance of clinical and histological evaluations of actinic cheilitis.

ORAL LICHEN PLANUS AND ORAL LICHENOID LESION: A COMPARISON BETWEEN CLINICAL CASES

This study describes two cases, comparing oral lichen planus (OPL) and oral lichenoid lesion (OLL). Case 1 presents a 48-year-old black female, complaining of mouth sores for 8 months. Upon examination, multiple white and red striated plaques were observed at various oral sites. The diagnostic hypothesis was OLP, and a biopsy was performed. The histopathological report was suggestive of OPL, where the epithelium was atypical. Case 2 presents a 69-year-old white female, complaining of white patches found bilaterally on the tongue. A biopsy was performed due to the diagnostic hypothesis of leukoplakia. Histopathology revealed moderate epithelial dysplasia, showing inflammatory infiltration with a lichenoid pattern. Correlation with clinicopathology and follow-up were imperative for the final diagnosis of OLL. Similar clinical and histopathological features of OPL and OLL make their precise diagnosis complex. Thus, careful observation of clinicopathological and follow-up criteria are critical for the differential diagnosis of these lesions. This study describes two cases, comparing oral lichen planus (OPL) and oral lichenoid lesion (OLL). Case 1 presents a 48-year-old black female, complaining of mouth sores for 8 months. Upon examination, multiple white and red striated plaques were observed at various oral sites. The diagnostic hypothesis was OLP, and a biopsy was performed. The histopathological report was suggestive of OPL, where the epithelium was atypical. Case 2 presents a 69-year-old white female, complaining of white patches found bilaterally on the tongue. A biopsy was performed due to the diagnostic hypothesis of leukoplakia. Histopathology revealed moderate epithelial dysplasia, showing inflammatory infiltration with a lichenoid pattern. Correlation with clinicopathology and follow-up were imperative for the final diagnosis of OLL. Similar clinical and histopathological features of OPL and OLL make their precise diagnosis complex. Thus, careful observation of clinicopathological and follow-up criteria are critical for the differential diagnosis of these lesions.

Assessment of Oral Lesions With Tobacco Usage: A Cross-Sectional Clinicopathological Study in Sri Ganganagar, Rajasthan, India.

Background Tobacco usage in the form of smoking or chewing has increased the risk of oralpotentiallymalignant disorders (OPMDs) and oral cancer. These deleterious habits are also related to changes in dentition and the oral mucosa. Aim The aim of our study was to evaluate the oral changes associated with tobacco usage among residents of Sri Ganganagar. Materials and methods This study was conducted among the residents of Sri Ganganagar, Rajasthan, India, using stratified cluster random sampling, prestructured questionnaires, and detailed oral examination. A total of 100 patients with a previous history of tobacco usage were enrolled in this study after obtaining informed consent. Age- and gender-matched controls were also evaluated to correlate the findings. Clinical details were documented, including the Oral Hygiene Index-Simplified (OHI-S), Decayed-Missing-Filled Teeth (DMFT) index, Community Periodontal Index (CPI), loss of attachment, dental findings, and oral mucosal changes. Suspicious lesions were stained with toluidine blue, and a biopsy was performed for histopathological evaluation. The tabulated results were statistically analyzed using theStatistical Package for the Social Sciences (SPSS) version 21.0 (IBM SPSS Statistics, Armonk, NY, USA)for significance. Results Attrition, abrasion, and erosion of teeth were more frequent in tobacco users than in controls. Smoker's palate, tobacco pouch keratosis, and leukoplakia were commonly noted mucosal lesions. The mean values of the parameters of the DMFT score (3.560), CPI score (2.190), and loss of attachment score (0.542) were higher among tobacco users, and it was statistically significant (P value < 0.05). Out of 100 patients, 17 had suspicious lesions. It included seven cases of oral submucous fibrosis (OSMF), two cases of tobacco pouch keratosis, and eight cases of leukoplakia. Toluidine blue staining and biopsy were performed. Histopathological examination of suspicious lesions revealed hyperkeratosis, various grades of epithelial dysplasia, and differing inflammatory responses. Out of 17 biopsied cases, there were two cases of hyperkeratosis with severe epithelial dysplasia, four cases of hyperkeratosis with moderate epithelial dysplasia, two cases of hyperkeratosis with mild dysplasia, two cases of superficially invasive squamous cell carcinoma, five cases of advanced OSMF, and two cases of moderately advanced OSMF. Conclusion Tobacco usage produces visible changes in dentition and latent alterations in the oral mucosa. Suspicious lesions should always be referred for histopathological examination to identify oral potentially malignant disorders and oral cancerso that prompt treatment could be initiated. Patient education is mandatory to avoid the usage of tobacco in any form.

Histopathological and risk factor analyses of oral potentially malignant disorders and oral cancer in a proactive screening in northeastern Thailand

BackgroundLip and oral cavity cancer has been reported as the 10th most common cancer in Thailand. Recently, a screening program for oral potentially malignant disorders (OPMDs) and oral cancer was conducted in the northeastern Thailand which took into consideration a total of 371,911 people who resided in the provinces of Buriram, Chaiyaphum, Nakhon Ratchasima, and Surin.MethodsA total of 330,914 subjects were consecutively screened for risk factors of oral cancer by village health volunteers (VHVs) using a questionnaire (S1). Then, 186,710 subjects with one or more risk factors for oral cancer were referred for oral screening by dental auxiliaries or dentists at sub-district level hospitals (S2) where 86,941 subjects were subsequently screened. Afterwards, 1576 subjects with suspicious oral lesions for OPMDs or oral cancer attended local hospitals for further investigation and treatment. Oral medicine specialists, oral surgeons, and local dentists at the district level hospitals performed biopsies and the samples were sent for histopathological analysis. The objectives of the study were to report the histopathology findings from the biopsies obtained from these subjects and the associated risk factors.ResultsOut of 427 subjects who received biopsies, complete diagnostic results were obtained from 409 patients (462 specimens). The 5 most common histopathological results from these specimens were mild epithelial dysplasia (27.3%), fibroepithelial hyperplasia (14.5%), oral lichen planus/oral lichenoid reactions (11.5%), moderate epithelial dysplasia (8%), and acanthosis with or without hyperkeratosis (5%). Oral squamous cell carcinoma was detected in 14 subjects and 11 other forms of oral cancer were revealed. Among the analyzed risk factors, habitual betel quid chewing was established as a statistically significant risk factor associated with OPMDs and oral cancer.ConclusionThe most frequently observed histopathological results of clinically suspected oral cancer and OPMDs included mild epithelial dysplasia, fibroepithelial hyperplasia, oral lichen planus/oral lichenoid reactions, moderate epithelial dysplasia, and acanthosis with or without hyperkeratosis. Betel quid chewing habit was found to be associated with OPMDs and oral cancer.

EPIDEMIOLOGICAL SURVEY OF MALIGNANT AND PREMALIGNANT INJURIES OF THE HISTOPATHOLOGICAL DIAGNOSIS SERVICE OF A UNIVERSITY

<h3>Objectives</h3> Squamous cell carcinoma is the most frequent malignant lesion of the oral cavity. There are several premalignant lesions in the literature that present different levels of dysplasia, and the correct diagnosis is essential to prevent progression. The present study aimed to evaluate the incidence of malignant and premalignant lesions in the Histopathological Diagnostic Service of a university in southern Brazil. <h3>Study Design</h3> 1318 reports issued by the Histopathological Diagnosis Service between 2002 and 2020 were analyzed, establishing the prevalence of injuries with the presence of mild, moderate, and intense dysplasia and carcinomas. <h3>Results</h3> 82% of patients were male and the most prevalent site was the tongue (50%), followed by the alveolar ridge (20%) and palate (16%). Histopathologic diagnosis was squamous cell carcinoma for 38.93% of cases, followed by mild epithelial dysplasia and moderate epithelial dysplasia. Among patients diagnosed with cancer, 84% had a smoking habit. Smoking increased the chance of developing carcinoma in the oral cavity by 4 times. <h3>Conclusions</h3> Most patients who developed squamous cell carcinoma used tobacco. The study demonstrates the association with malignant lesions in the mouth and reinforces the importance of good anamnesis focusing on the history of tobacco use.

PROGRESSION OF AN ERYTHROPLASIA IN THE BUCCAL MUCOSA: CASE REPORT

The objective of this study is to report a rare case of erythroplakia in the buccal mucosa, with progression to an erythroleukoplakia and severe epithelial dysplasia. A 60-year-old male patient, ASA II, smoker, and drinker for over 40 years, presented with bilateral lesions in the buccal mucosa. On intraoral examination, at the right buccal mucosa, a red plaque of rough consistency and sensitive to touch was observed, and on the left side it presented as a homogeneous and painless white plaque. The clinical diagnoses were erythroplakia and leukoplakia, respectively, and an incisional biopsy was performed in both lesions, which had a histopathologic diagnosis of moderate and mild epithelial dysplasia, respectively. After 2 months, progression to an erythroleukoplasic lesion was observed bilaterally. Surgical removal was performed, which evidenced a progression of degree of epithelial dysplasia to severe epithelial dysplasia. The patient is being followed up monthly.

ASSOCIATION OF FOXP3 WITH CLINICAL AND HISTOPATHOLOGICAL ASPECTS OF MALIGNANT TRANSFORMATION OF THE ORAL LEUKOPLAKIA

<h3>Objectives</h3> Oral leukoplakia (OL) is the most common potentially malignant lesion of the oral mucosa. Several factors are associated with increased risk of malignant transformation. The aim was to evaluate the expression of Foxp3+ cells in OL samples and their relationship with clinical and pathologic factors associated with the malignant transformation of OL. <h3>Study Design</h3> Twenty-five samples from patients diagnosed with OL were selected. Clinical data such as age, sex, and location were obtained from archives. The histopathologic degree was obtained, and immunohistochemistry was performed using anti-Foxp3. Ten fields from each slide were obtained and Foxp3+ cells were counted. The mean density was compared between groups and statistical analysis was applied. Normal oral mucosa (NOM) samples were used as control. <h3>Results</h3> Foxp3+ cells were increased in samples of smokers when compared to NOM samples (<i>P</i> < .05). Foxp3+ cells were increased in females (<i>P</i> < .05) and in OL samples with severe epithelial dysplasia when compared with samples of moderate epithelial dysplasia (<i>P</i> < .05). <h3>Conclusions</h3> The study suggests that the number of cells associated with modulation of immune response may be affected by clinical and histopathologic characteristics associated with malignant transformation of OL.

IHC expression of AKT in different grades of epithelial dysplasia: An in vitro study.

Akt, also known as protein kinase B, is a serine/threonine-specific protein-kinase which plays a key role in multiple cellular processes such as glucose metabolism, apoptosis, transcription and cell migration. The activation of Akt is one of the most frequent alterations observed in human cancer and tumour cells. Akt regulates cellular survival and metabolism by binding and regulating many downstream effectors, e.g., Nuclear Factor-kB, murine double minute 2(MDM2). To evaluate and compare immunohistochemical expression of Akt in normal epithelium and different histological grades of epithelial dysplasias. Forty paraffin-embedded tissue sections were used for the immunohistochemical study of which 10 cases of normal epithelium, 10 cases of each mild, moderate and severe epithelial dysplasia which were diagnosed by haematoxylin and eosin procedures. The tissue sections were immunohistochemically analysed for expression of Akt in different grades of epithelial dysplasia by using anti-Akt-1 monoclonal antibody. Statistical analysis was carried out using statistical package for social science (SPSS, V 10.5). The data were analysed using Chi-square test and P < 0.05 was considered statistically significant. An overall significant difference was observed when normal tissues were compared with epithelial dysplasia with a Chi-square value of 21.04, but there was no statistical significance between the three grades of epithelial dysplasias. In conclusion, this study suggests that Akt-1 overexpression can be one of the useful diagnostic markers for predicting the potential behaviour of oral dysplasias transforming into oral squamous cell carcinoma (OSCC).

Immunohistochemical expression of paxillin in potentially malignant disorders and squamous cell carcinoma patients.

Cell adhesion molecules are essential to maintain the integrity of stratified squamous epithelium but their expression has to be dynamic to aid the mobility and turnover of cells. Paxillin is one such multi-domain protein which integrates numerous signals from cell surface receptors, integrins and growth factors. It thus functions as a regulator of various physiological and pathological processes including tissue remodeling, cell motility, gene expression, matrix organization, cell proliferation, metastasis and survival. Hence, the assessment of paxillin expression in normal control, potentially malignant disorders and oral squamous cell carcinoma patients was carried out. The present retrospective study comprised of 20 each clinically and histologically confirmed case of normal control, potentially malignant disorders, and oral squamous cell carcinomas. All the slides were stained immunohistochemically using Paxillin antibody. The localization, staining intensity and percentage of positivity for paxillin expression was statistically significant among normal control and potentially malignant disorders, whereas oral squamous cell carcinoma showed a non-significant difference. Upon comparison of histopathological grading of potentially malignant disorders, mild versus severe and moderate versus severe epithelial dysplasia showed a statistical significant difference among all the parameters of paxillin expression. However, WDSCC & MDSCC a statistically significant difference among localization and staining intensity of paxillin. Paxillin may play an important role in pathogenesis of oral squamous cell carcinoma by altering the adhesive properties of the tumor cells interacting with the extracellular matrix which in turn affects their invasive behavior and histologic differentiation.

Prognostic significance of p53 expression in various grades of epithelial dysplasia

Background: Potentially malignant disorders in oral mucosa represent the morphological steps of epithelial transformation in the form of various grades of dysplasia. Only few cases of dysplasia evolve into carcinoma, and there is no specific markers invented which can predict the probability of progression. Oral carcinogenesis is a multistage course which constitutes a sequence of molecular events resulting in cell cycle dysregulation. p53 is the most commonly affected tumor suppressor gene. p53 mutation leads to uncontrolled proliferation of cancer cells as well as increased p53 protein. p53 overexpression has been suggested to be consistent indicator for the development of oral cancer. The objective of this study is to investigate p53 immunohistochemical expression in various grades of oral epithelial dysplasia (ED) and to estimate the correlations between their expression levels in various grades of dysplasia. Materials and Methods: This study is done at the Department of Oral Pathology and Microbiology, SPDC, Wardha. Total four groups were taken. Ten patients each of mild, moderate, and severe ED, i.e., total-30 patients and 10 control patients. The sample size required for the group was calculated by using the required formula. p53-positive cells were counted in 5 high power field (HPF) in all grades of ED and labeling index was measured. Results: Analysis of variance test was applied to see the differences in the p53 expression.It was found that-LI increases with the increasing grades of EDP53 expression observed in 5 HPF in all grades of ED yields this expression only in basal cell layer in normal oral mucosa, basal and parabasal cell layers in mild ED and basal, parabasal and suprabasal layers in moderate and severe grades of ED in focal areas.Conclusion: The increase in the p53 expression in epithelium correlates to various grades of EDs.

Topical mitomycin C treatment in corneal and conjunctival intraepithelial neoplasia: A case report

Corneal and conjunctival intraepithelial neoplasia is a slowly progressive ocular surface lesion with low malignant potential. Owing to the high recurrence rates, cryotherapy or topical chemotherapy is used with surgical treatment. In this paper, we report the histopathologic findings and treatment of a case of intraepithelial neoplasia that began in the conjunctiva and progressed to the cornea. A 75-year-old woman presented with complaints of redness, irritation and lacrimation in her left eye for around 1 month. Slit-lamp examination revealed a papilliform mass on the nasal conjunctiva along with involvement of the adjacent corneal epithelium. Conjunctival excisional biopsy showed a moderate epithelial dysplasia. Topical 0.04% mitomycin C was administered 4 times daily for 3 weeks. No recurrence was observed in the following 18 months.

Visual Analytics: A Method to Explore Natural Histories of Oral Epithelial Dysplasia.

Risk assessment and follow-up of oral potentially malignant disorders in patients with mild or moderate oral epithelial dysplasia is an ongoing challenge for improved oral cancer prevention. Part of the challenge is a lack of understanding of how observable features of such dysplasia, gathered as data by clinicians during follow-up, relate to underlying biological processes driving progression. Current research is at an exploratory phase where the precise questions to ask are not known. While traditional statistical and the newer machine learning and artificial intelligence methods are effective in well-defined problem spaces with large datasets, these are not the circumstances we face currently. We argue that the field is in need of exploratory methods that can better integrate clinical and scientific knowledge into analysis to iteratively generate viable hypotheses. In this perspective, we propose that visual analytics presents a set of methods well-suited to these needs. We illustrate how visual analytics excels at generating viable research hypotheses by describing our experiences using visual analytics to explore temporal shifts in the clinical presentation of epithelial dysplasia. Visual analytics complements existing methods and fulfills a critical and at-present neglected need in the formative stages of inquiry we are facing.

Epithelial Dysplasia at Excision Margins of Oral Squamous Cell Carcinoma: A Review on Relationship to Clinicopathological Parameters and Prognosis.

Background:Epithelial dysplasia (ED) at oral cancer excision margins is a frequent finding. Dysplastic epithelium at excision margins may not be similar to dysplasia in Oral potentially malignant disorders (OPMD) as malignant transformation has already taken place. Therefore, management of ED at excision margins should be different to that of OPMD. ED creates a dilemma in relation to further management of cancer patients, since there are no accepted guidelines. Therefore, the objective of this review is to analyze existing literature and to arrive at evidence based recommendations for the management of ED at excision margins. Methods:A comprehensive string was run on PubMed, Medscape and Medline. The final outcome included 113 studies. Finally, the most relevant 10 articles were critically assessed for inclusion and exclusion criteria against various parameters. Results and Conclusions: Severe and Moderate ED need re-excision in order to improve prognosis. There is not enough sound evidence for the management of Mild ED at excision margins of oral squamous cell carcinoma. Guidelines for the management of ED at excision margins should be formulated after comprehensive multi center studies using lager cohorts of patients.

Gastroesophageal reflux is associated with an increased risk of gastric cardiac polyps: a case-control study of 140 cases.

The pathogenesis of gastric cardiac polyps is not yet clear, and there is little research on their clinical and histopathologic characteristics and correlation with gastroesophageal reflux. Early detection and treatment of premalignant lesions in this area can prevent the development of cancer. We aimed to evaluate the clinical and histopathologic characteristics and risk factors of gastric cardiac polyps to improve the current understanding of the disease. Patients diagnosed with gastric cardiac polyps at the Third Affiliated Hospital of Sun Yat-Sen University between January 1, 2010, and December 31, 2019, were sought for the study. The exclusion criteria were missing clinical data, insufficient pathological reports, gastric malignancy, or a previous history of gastroduodenal surgery. Ultimately, 140 patients were included in the case group, while 140 patients diagnosed with chronic superficial gastritis from the same 10-year period were identified randomly and selected as a control group. The exclusion criteria for this group were the same as those for the case group. Patients in both groups were matched in age and gender to ensure comparability between the two groups. We evaluated and compared the demographic and clinical data and endoscopic impressions of each group and analyzed the endoscopic, histologic features of gastric cardiac polyps. Gastroesophageal reflux was significantly associated with a higher risk of gastric cardiac polyps after adjustment for other covariates [adjusted odds ratio (OR) =2.809; 95% confidence interval (CI): 1.178-6.697; P=0.020]. Most gastric polyps were single (97.9%), sessile (92.8%), and small polyps with a diameter less than 1 cm (88.6%). Most were located in the gastroesophageal junction region (65.0%) with a smooth surface (56.4%) or surface congestion (30.0%). Hyperplastic (inflammatory) polyps (88.0%) were the most common pathological type and comprised gastric-type foveolar epithelium, squamous epithelium, or admixture of the two epithelia, with a minority showing intestinal metaplasia, mild, or moderate epithelial dysplasia. Gastroesophageal reflux was associated with a significantly higher incidence of gastric cardiac polyps with a 2.8-fold increased risk. Most gastric cardiac polyps were found to be benign lesions and had a favorable prognosis in the clinic despite their malignant potential.

Cribriform-morular thyroid carcinoma

Along with classic papillary thyroid cancer, there are rare histological variants with special clinical features, and often physicians are not well informed about them. We present a clinical case of 25 years-old female, who was diagnosed with papillary thyroid cancer based on neck ultrasound and fine needle aspiration biopsy followed by thyroidectomy. The histological and immunohistochemical investigation (expression of cytokeratin-19, CD 56, thyroglobulin, β-catenin) were performed and cribriform-morular carcinoma was identified. It’s believed that this type of papillary thyroid cancer in the majority of cases is associated with familial adenomatous polyposis of the colon. This disease with an autosomal dominant type of inheritance is caused by the mutation of the APC suppressor gene and characterized by the presence of multiple adenomatous polyps in the colon with a 100% risk of malignancy and colon cancer. The patient underwent an additional examination with colonoscopy which revealed polyps in all parts of the colon ranging in size from 1 mm to 3.5 cm. We identified mutation in gene APC — p.S1104X and performed a preventive coloproctectomy. The histological examination verified tubular and tubulovillous adenomas with moderate epithelial dysplasia. During 6 years of follow-up of patient, structural and biochemical remission of thyroid cancer was observed.

Endoscopic submucosal tunnel dissection for a giant adenoma of the cecum (case report)

Endoscopic removal of giant adenomas of the cecum is associated with high risk of perforation and conversion to laparoscopic procedure. Endoscopic submucosal dissection for cecal adenomas had technical limitations due to the adjacent ileocecal valve and appendix opening, perpendicular operating angle. Case presentation of the possibility of successful removal of a large laterally spreading cecal adenoma by the method of endoscopic submucosal tunnel dissection (ESTD) never been described before for this tumor site and size. Patient 54 years old, an LST-G adenoma (5 cm in diameter, according to Kudo – IIIL, according to Sano – II) was detected in the dome of the cecum during colonoscopy. ESTD. The postoperative period without any unfavorable events; the patient was discharged on the 5th day after surgery. The morphological conclusion: tubulo-villous adenoma with moderate epithelial dysplasia, R0. ESTD is suitable for cecal giant adenomas.

Malignant transformation of oral leukoplakia: a follow-up study.

The main objective of the study was to identify the determinants that contribute to the malignant transformation of oral leukoplakia in a group of patients managed in secondary care. A secondary objective was to compare two dysplasia grading systems to determine their utility in assessing the prognosis. The cohort consisted of 93 patients diagnosed during the period 2009-2013. The variables recorded and analysed included age and sex, clinical presentation (colour) and severity of oral epithelial dysplasia (OED) scored by the WHO (2005) and the binary grading systems. The planned management included excision of high-grade dysplasia and observation of low-grade dysplasia lesions based on the WHO grading system. Patient factors were transcribed from the pathology records and updated using a questionnaire sent out to the whole group of patients. Data were analysed using χ2 test and Kaplan-Meier analysis (P < 0.05). Complete follow-up data were available for 93 patients. Malignant transformation occurred in 7 patients (7.5%) during a mean follow-up period of 30months. Among the surgically excised group (n = 51), a recurrence of oral leukoplakia was noted in 16 patients (31%). WHO OED grading (P = 0.02) and the presence of red areas (P = 0.012) were useful in predicting malignant transformation with severe epithelial dysplastic lesions and red and white mixed lesions showing higher rates. Leukoplakias (7.5%) transformed over a mean follow-up period of 30months. Dysplasia grading and the clinical appearance by colour (mixed white and red) were significant predictors of malignant transformation CLINICAL SIGNIFICANCE: Patients with erythroleukoplakia and those diagnosed with moderate or severe epithelial dysplasia require more intensive interventions as such lesions have a higher risk of developing a malignancy.