Multiple Polyps Research Articles

Analysis of Immunohistochemical Expression of BRAF (V600E) Mutation in Serrated Colorectal Polyps: A Study from Tertiary Hospital in Oman.

Colorectal cancer (CRC) is considered one of the most common cancers in the world. Serrated polyps were found to be precursor lesions for CRC. BRAF mutation (V600E) has been strongly linked to the development of these lesions. No previous study concerning BRAF immunohistochemical expression in serrated polyps- was done in Oman. The primary objective of our study was to assess the prevalence of BRAF (V600E) mutation in serrated colorectal polyps in the Omani population. The secondary objectives were to assess the prevalence of serrated polyps and their characteristic features: type, site and size as well as the relationship between BRAF (V600E) mutation and polyp type, site and size. Ninety-one hyperplastic polyps (HP) (76.5%), 24 sessile serrated lesions (SSL) (20.2%) and 4 cases of tubular adenomas with low grade dysplasia (3.4%) were studied for BRAF (V600E) immunohistochemical expression. No case of traditional serrated adenoma (TSA) was present. Control cases of craniopharyngioma and papillary thyroid carcinoma were included. BRAF (V600E) IHC was positive in 63 of the HP polyps (69.2%), 13 SSLs (54.2%) and none of the adenomatous polyps. The majority of positive polyps (75.0%) were ≤5 mm in size, 17.9% were 5-10 mm and 7.1% were ≥10 mm in size. The majority of BRAF (V600E) positive polyps (68.1 %) were in the distal colon and 31.9 % were in the proximal colon. The majority of positive cases for BRAF (V600E) were showing multiple polyps (61.8 %). None of the tubular adenomas showed any BRAF (V600E) positivity. Serrated polyps are now well known for their potential to develop CRC. Immunohistochemistry is an easy and reproducible way to detect BRAF (V600E) mutation. Our study showed there is high prevalence (64.3%) of BRAF mutation in serrated polyps in the Omani population. The majority of these polyps- were HP and SSL; and ≤5 mm in size and located in the distal colon.

Association of soy intake and cooking methods with colorectal polyp and adenoma prevalence: findings from the extended Lanxi pre-colorectal cancer cohort (LP3C).

Limited research has explored the association between dietary soy products and colorectal polyps and adenomas, with insufficient attention given to cooking methods and subtypes of polyps. This study aimed to comprehensively assess the relationship between soy intake, its cooking methods, and the risk of colorectal polyps and adenomas within a high-incidence population of colorectal cancer (CRC) in China. Data were derived from 14,903 participants aged 40-80 years, enrolled in the extended Lanxi Pre-colorectal Cancer Cohort (LP3C) between March 2018 and December 2022. This cross-sectional study is based on the participants' baseline information. Long-term dietary information was collected through a validated food frequency questionnaire (FFQ), and colorectal polyps and adenomas were identified through electronic colonoscopy. Employing multivariate logistic regression, results were expressed as odds ratios (ORs) with their corresponding 95% confidence intervals (95% CIs). 4,942 cases of colorectal polyps and 2,678 cases of adenomas were ascertained. A significant positive association was found between total soy intake and the occurrence of polyps/adenomas. Considering cooking methods, a notable increase in polyp risk was associated with the consumption of fried soys while no association was detected for boiled or marinated soys. Furthermore, total soy intake demonstrated associations with large and multiple polyps, polyps Yamade-typed less than II, and polyps across all anatomical subsites. Within the high-risk CRC population in China, increased soy product intake was linked to a higher risk of polyps, primarily attributed to the consumption of fried soys. This suggests that modifying cooking methods to avoid fried soys may serve as a preventive strategy for colorectal polyps.

HGG-01. DURABLE RESPONSE TO IMMUNOTHERAPY IN AN ADOLESCENT PATEINT WITH CONSTITUTIONAL MISMATCH REPAIR DEFICIENCY CMMRD AND SYNCHRONOUS THREE PRIMARY MALIGNANCIES

Abstract BACKGROUND Familial Cancer Syndrome FCS is of particular concern in Saudi Arabia due to the high rates of consanguinity. Constitutional mismatch repair deficiency Syndrome (CMMRD) is an autosomal recessive FCS with a wide spectrum of malignancies Caused by Biallelic germline mutations in one of 4 mismatch repair genes (MLH1, PMS2, MSH2, and MSH6). METHODS we report 13 yr. Saudi boy, previously healthy with multiple café-au-lait (CAL) macules, and Consanguineous parents with a positive family history of Malignancy. presented with progressive headache, vomiting, abdominal pain, weight loss, and microcytic anemia. MRI Brain showed a Large left hemispheric necrotic mass, MRI abdomen: Circumferential gastric body wall thickening Distal transverse colon intraluminal polypoid mass, and liver hypodense lesion. He had a Resection of the brain tumor and Upper GI endoscopy + colonoscopy with polypectomy: which showed an Ugly gastric ulcer, and multiple colonic polyps. RESULTS Brain tumor molecular pathology: Gliosarcoma WHO grade 4 with negative IHC expression in PMS2 protein, hypermutant tumor with somatic PMS2 ATRX, TP53, NFI, and PIK3R1 genes mutation. stomach biopsy confirmed invasive gastric adenocarcinoma and Colonic polyp biopsy: Tubulovillous adenoma. Genetic testing Detect pathogenic Biallelic germline PMS2 mutation. He received adjuvant focal Brain radiation therapy 59.4Gy/33 F concurrent with immunotherapy (PD-1) inhibitor Nivolumab. Follow-up Abdominal imaging showed excellent response to immunotherapy with no significant residual lesion. MRI of the brain showed surgical bed multi-cystic lesions with thick nodular enhancement suggestive either of radiation necrosis vs. progressions/pseudoprogression. repeated MRI confirmed further progression of the enhancing surgical cavity lesion which was unresectable. CTLA-4 Inhibitor ipilimumab was added to Nivolumab to optimize therapy. UpToDate our patient is clinically stable on Maintenance Nivolumab with no side effects. CONCLUSION Our case confirms immunotherapy’s efficacy for treating CMMRD-related cancers, which can improve survival while reducing toxicity from less effective conventional therapies.

Adenocarcinoma in multiple adenomatous polyps: An analysis of demographic and socioeconomic factors.

e15619 Background: Adenocarcinoma in multiple adenomatous polyps (AMAP) is a form of gastrointestinal cancer characterized by adenomatous polyps in the gastrointestinal mucosa and distinct lesions found outside the intestines. A rare form of cancer, AMAP can be traced back to mutations in the APC gene, with higher rates of mutation correlating with worse prognosis. There is an association with familial adenomatous polyposis, which can lead to colorectal cancer in patients as young as 15. Examining demographic statistics on AMAP from the National Cancer Database (NCDB) sheds light on this rare form of colorectal cancer, unlocking new possibilities for diagnostics and treatment. Methods: A retrospective cohort analysis identified 193 patients with AMAP from the 2004-2020 NCDB using ICD-O-3 Code 8221 to identify them. Demographic factors such as age, sex, treatment type, and Charles/Deyo score were explored with descriptive statistics. Linear regression analysis was utilized to study incidence trends. Results: A total of 193 cases of histologically confirmed AMAP were retrieved from the 2004-2020 NCDB with a slight decline in incidence rates during this time (R² = 0.39). The majority of patients were male (55%), White (86%), privately insured (46%), and resided in metropolitan areas with a population size of at least one million (60%). Most patients also comprised the top two income quartiles based on median household income (64%). The mean age at diagnosis was 56.5 years (SD = 19.15, range = 15 - 90). The top primary sites affected were the Colon (26%), Sigmoid Colon (16%), and Rectum (11%). Furthermore, most patients were treated surgically (88%) with the average tumor size of 35.3 mm (SD = 20.5, range = 5.0 - 77.0). More patients received chemotherapy (28%) than radiation therapy (10.4%), with few patients receiving hormone therapy (0.5%) and none receiving immunotherapy. Over half (51%) of the patients were categorized as experiencing Stage 0 and Stage 1 cancer according to the NCDB Analytic Stage Group. The vast majority of patients (74%) had no comorbidities (Charlson-Deyo = 0) and did not receive any palliative care (97%). Conclusions: Our NCDB analysis on AMAP is a novel examination that provides insight into various demographics to better understand the disease. The majority of patients were males with adenocarcinoma lesions most commonly diagnosed in the colon and rectal areas, consistent with previous studies on multiple adenomatous polyps. Our analysis revealed that the majority of patients diagnosed with AMAP tend to be White, privately insured, reside in metropolitan areas, and hail from the top two quartiles of median household income. Additional research is required to gain a greater understanding of the demographic and socioeconomic factors that are important for accurate diagnosis, effective treatments, and improved outcomes.

Somatic STK11 mosaicism in a Turkish patient with Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder, caused by germline variants in the serine/threonine kinase 11 (STK11) gene. However, mosaic variants in STK11 gene have been rarely described. A 25-year-old woman diagnosed with PJS due to multiple hamartomatous polyps in the gastrointestinal tract was referred to our clinic. In the molecular diagnosis, the patient was evaluated using the STK11 gene sequence analysis and multiplex ligation-dependent probe amplification (MLPA) method, which suggested no pathogenic variant to account for the clinical picture. Given that the clinical findings of the patient were consistent with those of PJS, the raw data from next-generation sequencing (NGS) were re-examined for mosaicism which led to the detection of a novel mosaic c.920 + 1G > T variant in STK11 gene with a rate of 23% (1860x). Deep read-level NGS was performed on buccal mucosa and polyp samples to determine mosaicism levels in other tissues. Variant frequencies were 29% (710x) and 31% (1301x), respectively. Mosaicism should be considered in cases with clear clinical diagnostic criteria, such as PJS, where the pathogenic variant cannot be detected by sequence analysis and MLPA methods. Identification of mosaicism in these patients is very important as it can have an impact on patient follow-up and genetic counseling for relatives.

Polyp segmentation based on implicit edge-guided cross-layer fusion networks

Polyps are abnormal tissue clumps growing primarily on the inner linings of the gastrointestinal tract. While such clumps are generally harmless, they can potentially evolve into pathological tumors, and thus require long-term observation and monitoring. Polyp segmentation in gastrointestinal endoscopy images is an important stage for polyp monitoring and subsequent treatment. However, this segmentation task faces multiple challenges: the low contrast of the polyp boundaries, the varied polyp appearance, and the co-occurrence of multiple polyps. So, in this paper, an implicit edge-guided cross-layer fusion network (IECFNet) is proposed for polyp segmentation. The codec pair is used to generate an initial saliency map, the implicit edge-enhanced context attention module aggregates the feature graph output from the encoding and decoding to generate the rough prediction, and the multi-scale feature reasoning module is used to generate final predictions. Polyp segmentation experiments have been conducted on five popular polyp image datasets (Kvasir, CVC-ClinicDB, ETIS, CVC-ColonDB, and CVC-300), and the experimental results show that the proposed method significantly outperforms a conventional method, especially with an accuracy margin of 7.9% on the ETIS dataset.

The role of BMI, serum lipid profile molecules and their derivative indexes in colorectal polyps.

To investigate the role of body mass index (BMI), serum lipid profile molecules and their derivative indexes in colorectal polyps. A total of 352 individuals who underwent colonoscopy at our center were included in this retrospective analysis. Of these, 247 patients without evident abnormalities (control group), while 105 patients diagnosed with colorectal polyps (patient group). Serum lipid profile molecules and their derivative indexes were then compared between the two groups. The patient group exhibited significantly higher levels of total cholesterol (TC) and apolipoprotein B (ApoB) compared to the control group (p<0.05). In males, the patient group displayed elevated levels of ApoB and ApoB/ApoA1 ratio compared to the control group (p<0.05). Additionally, the triglycerides (TG) and TG/high-density lipoprotein-cholesterol (HDL-C) ratios were significantly higher in the multiple polyps group than in the single polyp group (p<0.05). Furthermore, the HDL-C and HDL-C/ApoA1 ratio levels were higher in the adenomatous polyp group when compared to the non-adenomatous polyp group (p<0.05). Multiple logistic regression analysis indicated that total cholesterol (TC), TG, low-density lipoprotein-cholesterol (LDL-C), TC/HDL-C ratio, TG/HDL-C ratio and LDL-C/HDL-C ratio were risk factors for the occurrence of colorectal polyps (p<0.05). ROC curve analyses revealed that TC, ApoB, and ApoB/ApoA1 ratio were associated with colorectal polyps. No significant difference in BMI between the two groups (p>0.05). The incidence and progression of colorectal polyps are linked to serum lipid molecules and their derivative indexes. Dyslipidemia may increase the risk of colorectal polyps, potentially leading to colorectal cancer (CRC).

Prevalence of diverse colorectal polyps and risk factors for colorectal carcinoma in situ and neoplastic polyps

BackgroundMost colorectal cancers originate from precancerous polyps. This study aimed to determine the prevalence of colorectal polyps with diverse pathological morphologies and to explore the risk factors for colorectal carcinoma in situ (CCS) and neoplastic polyps.MethodsInpatients admitted from January 2018 to May 2023 were screened through the hospital information system. Polyps were classified according to pathological morphology. The prevalence of polyps was described by frequency and 95% confidence interval. Univariate and multivariate logistic regression analyses were used to explore the risk factors for CCS and neoplastic polyps.ResultsIn total, 2329 individuals with 3550 polyps were recruited. Among all patients, 76.99% had neoplastic polyps and 44.31% had advanced adenomas. Tubular adenoma had the highest prevalence at 60.15%, and the prevalence of CCS was 3.86%. Patients with a colorectal polyp diameter ≥ 1.0 cm or number ≥ 3 were 8.07 times or 1.98 times more likely to develop CCS than were those with a diameter < 1.0 cm or number < 3, respectively (OR 8.07, 95%CI 4.48–14.55, p < 0.0001; and OR 1.98, 95%CI 1.27–3.09, p = 0.002). The risk of CCS with schistosome egg deposition was also significantly increased (OR 2.70, 95%CI 1.05–6.98). The higher the levels of carbohydrate antigen (CA) 724 (OR 1.01, 95%CI 1.00–1.02) and CA211 (OR 1.16, 95%CI 1.03–1.32) in patients with colorectal polyps were, the greater the risk of CCS. When colorectal neoplastic polyps were analyzed, we discovered that for each 1-year increase in age, the risk of neoplastic polyps increased by 3% (OR 1.03, 95%CI 1.02–1.04), p < 0.0001. Patients with a polyp diameter ≥ 1.0 cm had a 2.11-fold greater risk of neoplastic polyps compared to diameter < 1.0 cm patients (OR 3.11, 95%CI 2.48–3.92), p < 0.0001. In addition, multiple polyps and CA199 levels are risk factors for neoplastic polyps.ConclusionMore than 3/4 of colorectal polyp patients have neoplastic polyps. Patients are more inclined to develop CCS and neoplastic polyps if they have large polyps (> 1.0 cm) or multifocal polyps. The levels of the tumor markers CA724 and CA211 show some potential usefulness for predicting CCS and may be exploited for early identification of high-risk populations.

Alexithymia, emotion regulation and autistic traits in Familial adenomatous polyposis

IntroductionFamilial adenomatous polyposis (FAP) is a condition characterised by multiple polyps inside the colon or rectum, leading to colorectal cancer in all patients who do not perform prophylactic colectomy and a higher risk of cancer in other organs. Nevertheless, it has been reported that 14-48% of patients do not comply with regular endoscopic surveillance, which seems to be related to the lower levels of emotional distress observed in these patients. Also, APC gene polymorphisms have been described as being related to neurodevelopmental disorders, such as autism.ObjectivesTo study the prevalence of alexithymia, autistic traits and emotion regulation strategies in patients with FAP.MethodsWe conducted a cross-sectional study of patients with a genetic or clinical FAP diagnosis and assessed for alexithymia, autistic traits and emotion regulation using psychometric tests - Toronto Alexithymia Scale - 20 items (TAS-20), Autism-Spectrum Quotient Test (AQ) and Emotion Regulation Questionnaire (ERQ), respectively. The control group were patients with Lynch Syndrome. Statistical analysis was performed using SPSS vs.26.ResultsWe recruited a total of 20 patients (10 with FAP vs 10 with Lynch Syndrome). Nine patients were male (45%) versus 11 female (55%). The mean age was 53,35 years (SD 18,4). Half the sample presented a low educational level (equal or inferior to 4th grade).The overall prevalence of alexithymia was 65%, with an 80% prevalence in FAP patients and 50% in Lynch Syndrome. TAS-20 total score was higher in FAP patients (69,0 vs 60,7; p=0,68). Externally-oriented thinking subscale score was statistically higher in FAP patients (p=0,024).The overall prevalence of autistic traits was 25%, and the mean AQ score was higher in FAP (23,4; SD 4.97) compared to Lynch Syndrome patients (20,2; SD 5.57), but there were no statistically significant differences between the diagnoses (p=0,192).A moderate positive correlation exists between Total AQ and Total TAS (r=0.51; p=0.020).Concerning the scores obtained on the ERQ scale, most participants (14; 70%) use Expressive Suppression as a regulation strategy. Patients with Lynch Syndrome had higher scores than those with FAP, both in the Cognitive Reappraisal (4.22; SD 1.58 vs 4.28; SD 0.90) and Expressive Suppression (4.58; SD 1.08 vs 5.15; SD 1.03) domains.The average AQ score for patients who mostly use expressive suppression is significantly higher than for those who use cognitive reappraisal (23.86 (3.63) vs 17.00 (6.6); p=0.039).ConclusionsThe preliminary results of this study point to high levels of alexithymia and autistic traits in this population, and a higher tendency to regulate emotions by expressive suppression.The main limitation of the study was the small sample size, which reduced the power of the study to find statistically significant differences. Also, in future studies, a different control group should be considered.Disclosure of InterestNone Declared

Juvenile polyposis syndrome (review)

Juvenile polyposis syndrome (JPS), a rare disease with an autosomal dominant mode of inheritance, which is characterized with the presence of multiple polyps in various parts of the gastrointestinal tract, mainly in the colon. The detection of adenomatous polyps in patients with JPS, in addition to juvenile ones, significantly complicates the differential diagnosis with familial adenomatous polyposis, in which it is necessary to perform a radical surgery — proctocolectomy. Only in 40-60% of cases, pathogenic variants of the SMAD4 and BMPR1A genes can be identified, each of which is characterized with its own clinical manifestations. Treatment options for patients with JPS include endoscopic and surgical; however, the decision-making algorithm, as well as the timing of postoperative follow-up, are not evaluated in Russian clinical guidelines. The rare occurrence of this syndrome, difficulties in endoscopic diagnosis and morphological verification, as well as limitations in determining the molecular genetics cause of the disease demonstrate the need for further research.

A Case of Multiple Gastrointestinal Polyps, Cutaneous Manifestations, and Nail Dystrophy.

A Case of Multiple Gastrointestinal Polyps, Cutaneous Manifestations, and Nail Dystrophy.

Peutz–Jeghers syndrome with polyps in the stomach, duodenum, and small and large intestine: a case report

BackgroundPeutz–Jeghers syndrome is a rare hereditary condition characterized by gastrointestinal polyps and pigmented oral lesions. The case contributes to a deeper understanding of Peutz–Jeghers syndrome and underscores the significance of interdisciplinary collaboration for accurate diagnosis and tailored therapeutic strategies.Case descriptionWe present a case of a 15-year-old Afghan female patient with multiple polyps throughout the gastrointestinal tract and mucocutaneous pigmentation. Despite previous medical visits and colonoscopies, her symptoms persisted. A multidisciplinary team discussed the case and recommended further investigations and interventions. A polypectomy was performed, confirming the presence of hamartomatous polyps. The patient was diagnosed with Peutz–Jeghers syndrome, but during the course of treatment she went through complications and was managed surgically as well.ConclusionTimely polyp removal and lifelong surveillance are crucial in managing Peutz–Jeghers syndrome. Further research and genetic analysis are needed to improve understanding and management of this rare disorder.

Lower Gastrointestinal Bleed in Children: Safety, Utility, and Yield of Colonoscopy: an Experience from a Large Tertiary Referral Endoscopy Center

Abstract Objective: There is paucity of data on lower gastrointestinal bleed (LGIB) in the pediatric population. We aimed to retrospectively review the endoscopy findings in patients younger than 18 years, presenting with lower gastrointestinal (GI) bleed and undergoing colonoscopy. Materials and Methods: Retrospective review of the endoscopy database at the department of gastroenterology at a tertiary care center from Western India was conducted between June 2017 until December 2021. Patients ≤18 years with LGIB, who underwent colonoscopy within 7 days of onset of bleed, were included in the study. Demographic details, endoscopic findings, and complications were noted. Results: In all, 55 patients were included in study (65% males; median age: 13 years [range: 1–18 years]). The most common endoscopic findings were polyps in 26 (47.2%) patients, colitis in 15 (27.2%) patients, solitary rectal ulcer syndrome (SRUS) in 6 (11.3%) patients, and hemorrhoids in 3 (5.4%) patients. Five (9%) patients had normal colonoscopy in whom the cause remained unidentified on further evaluation. However, no repeat episode was documented on a follow-up of 30 days. The most common location of a polyp was the rectum (64%). Two patients had multiple polyps (2 each). All the patients underwent a successful polypectomy. Pathology reported juvenile polyps in 25 biopsies. Four were diagnosed as inflammatory bowel disease (IBD), while 11 had acute infective colitis. Patients with infectious colitis as compared to IBD had higher incidence of fever (55 vs. 0%) and lesser incidence of previous similar events (22 vs. 66%). Those with polyps were younger than those without polyps (9.1 vs. 14.3 years; p = 0.000). Polyps were significantly more common in boys (84%; 22/26; p = 0.014) than in girls. No complications occurred in this cohort of patients. Conclusions: Polyps are the most common cause of LGIB in patients ≤18 years, followed by colitis. Polyps were more common in younger males.

Gallbladder sinistroposition (left-sided) finding in laparoscopic cholecystectomy, a case report

A left-sided gallbladder (LSGB), also known as sinistropostition, is a rare anatomical variant with a reported incidence of 0.2-1.1%. It is defined as a gallbladder located on the left side of the falciform ligament, embedded in the third hepatic lobe, without situs inversus viscerum. A 37-year-old Latino man with a history of bilateral inguinal repair underwent a scheduled laparoscopic cholecystectomy due to multiple gallbladder polyps. Preoperative ultrasound reported a gallbladder of 60x20 mm, wall thickness of 1 mm, with polyps of up to 10 mm. Standard laparoscopic cholecystectomy trocar placement was used. Upon revision of the right hepatic lobe, there was an absence of the GB in the visceral side of segments IV, V, or VI. It was identified to the left of the falciform ligament with adhesions to the anterior and superior portions of the pylorus and lesser curvature. The subxiphoid trocar was adjusted to the left of the falciform ligament, and Calot’s triangle dissection was performed to obtain a critical view of safety. No other anatomical variants were identified. The procedure was performed safely with a satisfactory view of critical cholecystectomy steps and anatomy identification. After the procedure, the surgeon complained of right-hand pain and numbness due to a medial position of the subxiphoid trocar for dissection. The surgical approach of a LSGB in laparoscopic surgery should be individualized for each patient. A minimally invasive approach may be realized successfully when critical thinking by the surgeon is applied and always prioritizing the safety of the patient.

Síndromes de poliposis gastrointestinal

Colorectal polyposis syndromes are a heterogeneous group of entities that have the emergence of multiple polyps along the digestive tract in common. They can occur as a consequence of a germline mutation or sporadically. It is important to recognize them in order to establish appropriate management and monitoring in patients and their relatives who are at risk, given that they are associated with an increased incidence of colorectal cancer compared to the general population. The diagnosis of these diseases is based on a set of clinical and genetic criteria, in the event a mutation responsible for it is identified. In this regard, the recent emergence of multigene panels has made it easier to reach a diagnosis in daily clinical practice.

Rectal Malakoplakia Presenting as Multiple Rectal Polyps -A Case Report

Rectal Malakoplakia Presenting as Multiple Rectal Polyps -A Case Report

Preoperative multimodal ultrasonic imaging in a case of Peutz-Jeghers syndrome complicated by atypical lobular endocervical glandular hyperplasia: a case report and literature review

BackgroundPeutz-Jeghers syndrome (PJS), an autosomal dominant multiple cancerous disorder, is clinically characterized by mucocutaneous macules and multiple gastrointestinal hamartomatous polyps. Gastric-type endocervical adenocarcinoma (G-EAC), a special subtype of cervical adenocarcinoma with non-specific symptoms and signs, is known to occur in approximately 11% of female patients with PJS.Case presentationHere, we report a case of PJS in a 24-year-old female with multiple mucocutaneous black macules who complained of vaginal discharge and menorrhagia. Moreover, we first described the multimodal ultrasonographical manifestations of PJS-correlated G-EAC. The three-dimensional reconstructed view of G-EAC on 3D realisticVue exhibited a distinctive “cosmos pattern” resembling features on magnetic resonance imaging, and the contrast-enhanced ultrasound displayed a “quick-up and slow-down” pattern of the solid components inside the mixed cervical echoes. We reported the multimodal ultrasonographical characteristics of a case of PJS-related G-EAC, as well as reviewed PJS-related literature and medical imaging features and clinical characteristics of G-EAC to provide insight into the feasibility and potential of utilizing multimodal ultrasonography for the diagnosis of G-EAC.ConclusionsMultimodal ultrasound can visualize morphological features, solid components inside, and blood supplies of the G-EAC lesion and distinguish the G-EAC lesion from normal adjacent tissues. This facilitates preoperative diagnosis and staging of PJS-related G-EAC, thereby aiding subsequent health and reproductive management for patients with PJS.

Management of incidentally detected gallbladder polyps: a review of clinical scenarios using the 2022 SRU gallbladder polyp consensus guidelines.

Gallbladder (GB) polyps are a common incidental finding on sonography, but only a small fraction of polyps become GB cancer. The Society of Radiologists in Ultrasound (SRU) consensus committee recently performed an extensive literature review and published guidelines for GB polyp follow-up/management to provide clarity among the many heterogeneous recommendations that are available to clinicians. As these guidelines have become adopted into clinical practice, challenging clinical scenarios have arisen including GB polyps in primary sclerosing cholangitis (PSC), high risk geographic/genetic patient populations, shrinking polyps, pedunculated vs sessile polyps, thin vs thick stalked polyps, vascular polyps and multiple polyps. According to the SRU guidelines, clinicians should refer to gastroenterology guidelines when managing GB polyps in patients with known PSC. If patients at high geographic/genetic risk develop GB polyps, 'extremely low risk' polyps may be managed as 'low risk' and 10-14mm 'extremely low risk' or '7-14mm' low risk polyps that decrease in size by ≥ 4mm require no follow-up. Thin-stalked or pedunculated polyps are 'extremely low risk' and thick-stalked pedunculated polyps are 'low risk'. Sessile polyps are 'low risk' but should receive immediate specialist referral if features suggestive of GB cancer are present. Neither polyp multiplicity nor vascularity impact risk of GB cancer and follow up should be based on morphology alone.

Coral Tissue Regeneration and Growth Is Associated with the Presence of Stem-like Cells

Members of the Cnidaria phylum were studied for centuries to depict the source of their unprecedented regeneration capacity. Although adult stem cells (ASCs) have been recognized in tissue growth/regeneration in many hydrozoans, there has not been any evidence of them in the ancestral Anthozoa class. This study sheds light on the development of epidermal epithelium expansion, akin to blastema, during tissue regeneration after small circular incisions (each 2.77 mm2) and during the natural expansion of tissue across a flat surface in the scleractinian coral Stylophora pistillata. Regeneration was completed within 9 days in 84.5% (n = 64) of the assays. About 35% of the samples regrew a single polyp, 60% showed no polyp regrowth, and approximately 6% exhibited multiple new polyps. We further used histological staining, pH3, Piwi immuno-histochemistry, and qPCR for eight stemness markers: Piwi-1, Nanos-1, Nanos-1-like, Tudor-5, Tudor-7, Boule, Sox-2, and Myc-1. The results revealed the formation of an “addendum”, an epidermal epithelium in the growing edges (in regenerating and normal-growing fronts) inhabited by a cluster of small cells featuring dense nuclei, resembling ASCs, many expressing pH3 as well as Piwi proteins. Most of the stemness genes tested were upregulated. These results indicate the participation of ASCs-like cells in tissue regeneration and growth in scleractinian corals.

APOE genotype, eicosapentaenoic acid (EPA) supplementation and n-3 highly unsaturated fatty acid (HUFA) levels in patients with multiple colorectal polyps: A secondary analysis of the seAFOod polyp prevention trial

IntroductionWe examined the relationship between Apolipoprotein E (APOE) genotype and n-3 highly unsaturated fatty acid (HUFA) levels in participants of the seAFOod trial, who were undergoing colonoscopy surveillance after removal of colorectal polyps. MethodsBaseline and on-treatment (eicosapentaenoic acid [EPA] 2 g daily or placebo for 6 months) levels of n-3 HUFAs, and plasma 18-hydroxyeicosapentaenoic acid (HEPE), were analysed according to APOE genotype (based on polymorphisms rs429358 and rs7412) in 584 participants. ResultsBefore treatment, APOE2/2 individuals had lower levels, and APOE4/4 participants had higher levels, of n-3 HUFAs, including EPA, than APOE3/3 counterparts (P < 0.01 for the APOE2/2 versus APOE4/4 comparison). After EPA supplementation, n-3 HUFA levels were not significantly different when stratified by APOE genotype, although APOE4 carriers displayed lower plasma 18-HEPE levels than individuals without an APOE4 allele (P = 0.002). ConclusionsAPOE genotype is associated with differential n-3 HUFA and 18-HEPE levels in individuals with multiple colorectal polyps.