Polyp-like Lesions Research Articles

Endometrial Polyp-Like Lesions Arising From Adenomyosis: Report of 5 Cases.

Endometrial Polyp-Like Lesions Arising From Adenomyosis: Report of 5 Cases.

Activation of STAT6 by intranasal allergens correlated with the development of eosinophilic chronic rhinosinusitis in a mouse model.

Eosinophilic chronic rhinosinusitis (ECRS) is a chronic inflammatory disease characterized by prominent eosinophilic infiltration along with a T-helper-2 (Th2) response. It has been well documented that signal transducer and activator of transcription 6 (STAT6) is a nuclear transcription factor that mediates Th2-type immunity and is implicatory of STAT1 and STAT3 in the pathogenesis of allergic airway diseases. However, little is known about the association between STATs and ECRS. Here, we explored the relationship between STAT1, STAT3, and/or STAT6 and eosinophilic inflammation accompanied by Th2-type immunity in a mouse model of ECRS. An ovalbumin (OVA)-staphylococcal enterotoxin B (SEB)-induced ECRS murine model was first established. The mucosal histological alterations were determined using hematoxylin and eosin staining. The number of eosinophils in peripheral blood was measured using a blood cell analyzer. The cytokine (IL-4, IL-5, IL17 A and IFN-γ) expression levels in the sinonasal mucosa and total and OVA-specific IgE from serum were measured using ELISA. Then, the protein levels of STAT1, STAT3, STAT6, phosphorylated STAT1 (p-STAT1), p-STAT3, p-STAT6, T-box expressed in T-cells (T-bet), GATA binding protein 3 (GATA-3), and retinoic acid receptor-related orphan receptor γ (RORγt) in the sinonasal mucosa were examined by immunohistochemical staining or Western blotting. Local administration of OVA combined with SEB (OVA + SEB) induced multiple polyp-like lesions, accompanied by prominent eosinophilic infiltration in the sinonasal mucosa. The OVA- and OVA+SEB-treated groups showed significantly higher eosinophil counts from peripheral blood and total and OVA-specific IgE levels from serum than those in the PBS- and SEB-treated groups. The levels of p-STAT6 were markedly increased by OVA + SEB exposure, as well as GATA-3, IL-4, and IL-5, but did not affect STAT6, p-STAT1, p-STAT3, T-bet, RORγt, IFN-γ, or IL-17A. Furthermore, an eosinophil count in the sinonasal mucosa showed a positive correlation with the level of p-STAT6 in the ECRS mouse model. Signal transducer and activator of transcription 6 signaling could be activated in the OVA+SEB-induced ECRS model and might be a crucial signal transducer in the development of Th2-skewed ECRS.

Therapeutic Effects of Intranasal Tofacitinib on Chronic Rhinosinusitis with Nasal Polyps in Mice.

The Janus kinase/signal transducer and activator of transcription (JAK-STAT) pathway play a key role in immune modulation, especially in the polarization of T helper cells. JAK inhibitors reduce inflammation by inhibiting the phosphorylation of STAT. We investigated whether a JAK inhibitor, tofacitinib, can reduce inflammation in a mouse model of chronic rhinosinusitis with nasal polyps (CRSwNP). An eosinophilic CRSwNP model was induced using 4-week-old BALB/c mice. The therapeutic effects of topical tofacitinib were compared with the effects of triamcinolone acetonide (TAC). Polyp formation and eosinophilic infiltration were assessed by histology. Levels of phosphorylated STAT (pSTAT), eosinophil cationic protein, and eotaxin were measured by immunohistochemistry. Gene expression levels of GATA-3 was measured using quantitative PCR. The production of cytokines in sinonasal tissues, including interleukin IL-4, IL-5, IL-12, and interferon-γ, were measured using enzyme-linked immunosorbent assays (ELISA). Topical tofacitinib administration significantly reduced the number of polyp-like lesions and the degree of eosinophilic infiltration, with an efficacy comparable with that of systemic TAC administration. Similarly, the levels of pSTAT6, eosinophil cationic protein, and eotaxin decreased with tofacitinib treatment. Tofacitinib decreased the gene expression level of GATA-3. Lastly, tofacitinib significantly decreased IL-4 and IL-5 production to a similar extent as that by systemic or topical TAC administration. Tofacitinib, but not TAC, significantly increased the production of interferon-γ. Topical tofacitinib administration may be an effective treatment for eosinophilic CRSwNP by inhibiting phosphorylation of STATs. N/A. Laryngoscope, 131:E1400-E1407, 2021.

Multiple airborne allergen-induced eosinophilic chronic rhinosinusitis murine model.

Several murine models have been established to mimic human eosinophilic chronic rhinosinusitis (ECRS). However, in most of these models, ECRS was induced using ovalbumin, which does not cause sinusitis in humans. Thus, we aimed to develop a more clinically relevant murine model of ECRS using multiple airborne allergens. We also investigated the effects of exposure duration of the allergens on ECRS development. C57BL/6 mice were intranasally administered multiple airborne allergens (house dust mite, Aspergillus fumigatus, Alternaria alternata, and protease from Staphylococcus aureus) three times weekly for 4, 8, 12, and 16 consecutive weeks. Histopathological changes, the levels of cytokines and chemokines in the nasal lavage fluid, and immune cells of the blood and spleen were analyzed. The mice administered multiple allergens showed significantly increased eosinophil infiltration, epithelial thickening and disruption, and subepithelial collagen deposition from 8weeks compared to the control group. Goblet cell hyperplasia, polyp-like lesions, and blood eosinophils, as well as the levels of interleukin-5 and eotaxin in the nasal lavage fluid were considerably increased in the ECRS group from 12weeks compared to those of controls. Instillation of allergens for 16weeks exacerbated the eosinophil infiltration and eotaxin increase in the nasal lavage fluid. We successfully established a new murine model of ECRS using more clinically relevant multiple airborne allergens. Prolonged exposure to airborne allergens for 12weeks or more, corresponding to the definition of human ECRS, strongly induced eosinophil infiltration as well as epithelial remodeling.

Therapeutic effects of intranasal cyclosporine for eosinophilic rhinosinusitis with nasal polyps in a mouse model.

Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) is a principally type 2 T helper cell (Th2)-mediated inflammatory disease. Systemic corticosteroids currently represent the most effective treatment for CRSwNP, but their long-term use is constrained due to their detrimental side effects. Long-term use of topical steroids is safe, but their efficacy is often limited. Topical cyclosporine has proven to be safe and effective for Th2-mediated diseases such as allergic conjunctivitis. It was hypothesized that topical cyclosporine would be an effective novel drug for the treatment of CRSwNP; its therapeutic efficacy was assessed using a previously established mouse model. After induction of eosinophilic CRSwNP in four-week-old BALB/c mice according to previous protocols, the therapeutic effects of intranasal cyclosporine were evaluated and compared with those of triamcinolone acetonide (TAC). Histopathologic changes were evaluated using hematoxylin and eosin for polyp formation and Sirius red staining for eosinophilic infiltration. The production of cytokines in sinonasal tissues, including tumor necrosis factor (TNF), interleukin (IL)-2, interferon (IFN)-γ, IL-4, IL-5, IL-13, and IL-17A, was measured using a cytometric bead array. The number of polyp-like lesions was reduced significantly only by systemic TAC, but the degree of eosinophilic infiltration was decreased significantly by topical cyclosporine, the potency of which was similar to that of topical or systemic TAC. Except for IFN-γ, the majority of measured cytokines were reduced significantly by topical cyclosporine, although their effects on IL-2 and IL-13 were less potent than those of systemic TAC. Topical cyclosporine might be an effective drug for the management of CRSwNP.

The Effect of Smoking on Eosinophilic Rhinosinusitis with Nasal Polyp in Mouse Model

Objectives: Chronic rhinosinusitis with nasal polyp is a clinically common disease, and cigarette smoking is a major risk factor for airway inflammation. However, little is known about the effects of smoking on eosinophilic rhinosinusitis (ERS) with nasal polyp. A histopathologic and molecular study was performed to investigate the effects of smoking using mouse model of ERS with nasal polyp. Methods: Mice were divided into 4 groups: control group, smoking group, ERS group, and ERS + smoking group (N = 8, each). Histopathologic changes were investigated using several special stainings: Hemotoxylin and eosin for overall inflammation and polyp-like lesions, Sirius red for eosinophils, Toluidine blue for mast cells, Alcian blue for secretory goblet cells, and Masson’s trichrome for collagen fiber. Serum IgE levels and systemic cytokines were determined using enzyme-linked immunosorbent assay. The expression of vascular endothelial growth factor (VEGF) and HIF-1a were evaluated by immunohistochemical staining. Results: Smoking enhanced the degree of polyp-like lesions, eosinophil infiltrations, goblet cell deposition, and subepithelial fibrosis in ERS model. Total and OVA-specific IgE levels were increased in both ERS groups, however, smoking had no additive effect on them. The systemic cytokines (IL-4, IL-6, IL-17, and IFN-γ) were also elevated significantly by smoking. Smoking enhanced VEGF expression in nasal epithelial cells, suggesting underlying mechanism of increased polyp formation. Conclusions: Smoking exposure had additive effects on experimental ERS. It resulted from increased local and systemic inflammation, and airway remodeling. Increased VEGF might be its underlying mechanism.

Cigarette smoke promotes eosinophilic inflammation, airway remodeling, and nasal polyps in a murine polyp model.

Exposure to cigarette smoking (CS) is a major risk factor for airway inflammation. However, little is known about the effects of CS exposure on eosinophilic rhinosinusitis with nasal polyps (ERSwNPs). Histopathological and molecular studies were performed to investigate its effects using a murine model of ERSwNPs. Mice were assigned to one of the following four groups (n = 8 for each group): control group, CS exposure (CS group), ERSwNP (ERS group), and ERSwNPs exposed to CS (ERS + CS group). Histopathological changes were investigated using various stains, including hematoxylin and eosin for inflammation and polyp-like lesions, Sirius red for eosinophils, toluidine blue for mast cells, Alcian blue for goblet cells, and Masson's trichrome stain for collagen fibers. mRNA expression of cytokines from nasal mucosae was measured. Serum IgE and systemic cytokine levels were measured by enzyme-linked immunosorbent assays. The expression of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor (HIF) 1-alpha was evaluated by immunohistochemical staining. The ERS + CS group showed more severe symptoms, increased the number of polyp-like lesions, infiltration of eosinophils, goblet cell hyperplasia, and subepithelial fibrosis, compared with the ERS group. Additionally, mRNA expressions of IL-4 and IL-17A were up-regulated in ERS + CS group and higher levels of IL-4, IL-6, IL-17A, and interferon gamma from splenocytes were observed significantly in the ERS + CS group compared with the ERS group. In the ERSwNP murine model, exposure to CS enhanced the expression of VEGF and HIF-1-alpha in nasal epithelial cells. Chronic exposure to CS aggravated eosinophilic inflammation and promoted airway remodeling and nasal polyp formation in a murine model of ERSwNPs. The underlying mechanism might involve up-regulated expression of VEGF and HIF-1-alpha.

A patient with Cronkhite-Canada syndrome whose entire digestive tracts was examined endoscopically

A 60-year-old woman was referred to our hospital with nausea, vomiting, taste disorder, alopecia, onichodystrophy and epigastric pain. Laboratory examination showed under-nutritionand abdominal computed tomography showed a thickened stomach wall. Endoscopic examination of the entire digestive tract showed multiple salmon roe-like polyp in the stomach, duodenum, ileum, and colon. Pathologically, biopsy specimens from the polyp-like lesions and mucosa revealed edematous change of the intestitium and cystic dilatation of the glands. We diagnosed the patient as having Cronkhite-Canada syndrome because of the polyposis associated with abnormalities of the ectoderm. Prednisolone therapy was initiated at 40 mg per day, with tapering of the dose subsequently. The clinical symptoms, laboratory data and polyposis improved with the prednisolone therapy. The prognosis of patients with Cronkhite-Canada syndrome treated with prednisolone is favorable, however, it has been reported recently that Cronkhite-Canada syndrome is associated with a risk of carcinogenesis. Therefore, it is necessary to conduct periodic screening of the entire digestive tract even after mucosal improvement.

The “Double-Layer Sign”

Polypoidal choroidal vasculopathy (PCV), a disease of the choroidal vascular network, presents clinically with polyp-like reddish orange lesions, as well as retinal pigment epithelial (RPE) and/or neurosensory retinal detachments. Optical coherence tomography (OCT) is a useful diagnostic tool that provides cross-sectional and volumetric imaging of posterior segment microstructure. Typical OCT findings in PCV may reveal a classic hyperreflectivity in the choroidal layers known as the "double-layer" sign. This sign is indicative of an abnormal choroidal vascular network. Indocyanine green angiography is also useful for the diagnosis of PCV and clearly identifies the polyp-like lesions arising from the choroidal vasculature. A 53-year-old African American woman presented with complaints of gradually decreasing vision in the left eye (OS). Clinical examination revealed moderately reduced acuity OS with a small central scotoma found on Amsler grid testing. Dilated fundus examination revealed a hemorrhagic RPE detachment with suspicion of a choroidal neovascular membrane in the foveal region of the OS. Exudative leakage appeared circumferentially around the macula OS. Optical coherence tomography of the OS also revealed two highly reflective layers: one at the level of the RPE and another beneath the RPE ("double-layer" sign). The patient was referred to a retina subspecialist for angiography and treatment consideration. It is important to distinguish PCV from other variants of choroidal neovascularization. The polyp-like lesions found in the PCV are a unique and classic characteristic. Proper diagnostic workup includes stereoscopic posterior fundus evaluation and imaging studies, including OCT and indocyanine green angiography.

Periostin may play a protective role in the development of eosinophilic chronic rhinosinusitis with nasal polyps in a mouse model

Several genes have been reported to be upregulated in human nasal polyps in previous genetic analyses. Among these genes, periostin is known to be overexpressed in nasal polyps obtained from aspirin-sensitive patients. Using periostin-null mice, we investigated the role of periostin in a murine model of eosinophilic rhinosinusitis with nasal polyps. Animal study. Eosinophilic rhinosinusitis was induced in both periostin-null and wild-type mice according to previously established protocols. In brief, ovalbumin (OVA) was used for sensitization and prolonged intranasal stimulation. Staphylococcus aureus enterotoxin B was applied intranasally to develop polyplike lesions. To examine the inflammation and mucosal lesions, hematoxylin and eosin, Sirius red, and Giemsa staining were performed. There was no definite difference in the maximal mucosal thickness between periostin-null and wild-type mice. In contrast, some parameters of inflammation, including the number of polyplike lesions and mast cells, were aggravated in the periostin-null mice compared to wild type. Eosinophilic infiltration was aggravated in the OVA-stimulated periostin-null mice, compared to OVA-stimulated wild-type mice, whereas there was no apparent difference between wild-type and periostin-null mice challenged with additional S aureus enterotoxin B. The loss of periostin appears to enhance polyplike lesion formation and mast cell infiltration in a mouse model of eosinophilic rhinosinusitis with nasal polyps.

Aromatase inhibitor treatment of menorrhagia and subsequent pregnancy in a patient with familial hyperparathyroidism–jaw tumor syndrome

To describe the clinical management of menorrhagia in a woman with hyperparathyroidism-jaw tumor syndrome (HPT-JT). Case report. Large translation research hospital. A 26-year-old nulligravid woman with familial HPT-JT presented with life-long menorrhagia resistant to progesterone intrauterine device (IUD) therapy and a desire for fertility. Aromatase inhibitor therapy. Clinical response to therapy and pregnancy. Imaging demonstrated an enlarged endometrial lining and thickening of the junctional zone. At operative hysteroscopy, multiple atypical endometrial polyp-like lesions filled the entire uterine cavity and were removed. Histologic evaluation demonstrated the lesions to be adenomyomas with an abundance of aromatase expression. Postoperative treatment included an aromatase inhibitor. The patient's menorrhagia, which had previously been resistant to progesterone IUD therapy, resolved with the aromatase inhibitor. After 10 months of this treatment, the aromatase inhibitor was discontinued and a repeated hysteroscopy revealed a markedly improved uterine cavity. The patient subsequently became pregnant on her first natural cycle and delivered a healthy term infant. Aromatase inhibitors may represent a novel treatment for benign uterine pathology in HPT-JT.

The effect of retinyl palmitate on healing of benign vocal fold lesions

The leading cause of vocal fold lesions such as nodules and polyps is phonotrauma, which causes microhematoma formation in the vocal fold cover that can initiate an inflammatory process. Vitamin A (Vit A) is essential for immunity, cellular differentiation and maintenance of respiratory epithelium. The aim of this study is to investigate the effect of Vit A (retinyl palmitate) on healing of vocal fold lesions, including vocal polyps and nodules. Eighteen patients with vocal fold lesions were included in the study. Of the patients, 13 had vocal polyps and 5 had vocal nodules. Patients received 90,000 IU oral Vit A in palmitate form daily for 2 months. In addition to Vit A treatment, only vocal hygiene recommendations were given to the patients, without any other medication or specific voice therapy. Pre- and post-treatment acoustic analysis [jitter % (jitt %), shimmer % (shim %), normalized noise energy (NNE), maximum phonation time (MPT), etc.] were performed. Lesion dimensions and stroboscopic findings were evaluated. Voice handicap index (VHI) was applied. Statistical analysis was performed between pre- and post-treatment measurements. Of the 18 patients, 8 had immature lesions (6 polyp-like lesions and 2 immature nodules) and 10 had mature lesion (7 polyps and 3 nodules). None of the patients showed complete healing. Partial response was seen in four patients with immature lesions. There were minimal changes in lesion dimensions, but this difference did not reach statistical significance. MPT of patients with immature lesions were close to significance level but overall MPT revealed no significant improvement (p = 0.051). Jitt %, shim % and NNE did not change significantly. In this study, the only statistically significant finding was VHI of the patients with immature lesions. Three of the patients complained of weight gain. Our data showed that Vit A at a given level of dose and duration seems to be ineffective in the treatment of benign vocal fold lesions. On the other hand, whether Vit A is effective on mature and immature lesions of vocal folds at higher doses and/or longer duration of treatment or not requires further studies.

Polyps of the small intestine

Polyps of the small bowel are rare compared to those of the colorectum. A correct histopathological diagnosis is crucial for the choice of subsequent treatment. This article reviews the most frequently found and some rare but distinct polyps and polyp-like lesions in the small intestine. Adenomas are the most commonly found polyps in the small intestine. Other polypoid lesions include Brunner gland hyperplasia, Brunner gland hamartoma, periampullary myoepithelial hamartoma and pyogenic granuloma. Adenomas are usually found in the distal portion of the duodenum, whereas, Brunner gland hamartoma and inflammatory polyps are noted in the proximal portion of the duodenum. The rare but distinct Peutz–Jeghers polyp and juvenile polyp are reviewed, including the associated hereditary autosomal dominant syndromes (i.e. Peutz–Jeghers and juvenile polyposis syndrome) of which these lesions are the phenotypic hallmarks. Finally, an extremely rare polyposis syndrome with unknown aetiology, i.e. Cronkhite–Canada syndrome, is described with documentation.

Pilzösophagitis

Oesophageal candidasis is in most cases an inflammation of the oesophagus caused by the yeast fungus Candida albicans. Colonisation is detectable in 20% of all healthy persons. For the actual infection of the epithelia an additional local or systemic disruption of the defence against infections must be present. Main symptoms include odynophagia, dysphagia, retrosternal pain, and in severe cases also fever. Endoscopy reveals amongst others velvety white-yellowish plaques, crumbly mucosa, ulcerations, polyp-like lesions, and also diffuse bleeding of the mucosa. Oesophageal candidasis can be diagnosed by endoscopic brushing or forceps biopsy. Therapy options include topical or systemically active medications which can be given orally or intranvenously. Which medication is chosen depends on the severity of the infection and the patient's immune status.

Polypoid endometrium on three‐dimensional saline contrast sonohysterography

Endometrial abnormalities are often diagnosed in women with a history of abnormal uterine bleeding. The differential diagnosis between focal and global endometrial lesions has been facilitated by the use of saline contrast sonohysterography, which has proved to be more effective than has non-enhanced B-mode transvaginal ultrasound1. The most common focal endometrial lesions are benign endometrial polyps. However, endometrial carcinoma may also present as a focal polypoid lesion within the uterine cavity. In premenopausal women, the differential diagnosis also includes submucous fibroids, which sometimes protrude into the uterine cavity, forming polyp-like lesions. Multiple endometrial polyps are found in approximately 20% of cases2. It is unusual, however, to find more than two to three polyps in individual cases. A large number of concomitant polyps, which is sometimes referred to as ‘endometrial polyposis’, are a rarity. Here, we present a case of polypoid endometrium, which resembled endometrial polyposis on transvaginal ultrasound examination. A 39-year-old woman attended for an ultrasound scan with a history of intermenstrual bleeding and primary infertility. Twelve years previously she had undergone a colposcopy and cervical biopsy, but her smear tests were normal following this. In 2001 she underwent a hysteroscopy and polypectomy. She continued to experience intermenstrual bleeding, but another hysteroscopy in 2003 revealed no endometrial abnormalities. She was in good general health and she was not on any regular medication. Her baseline hormone profile was normal. On ultrasound examination, a small subserous fibroid was noted, which was not affecting the uterine cavity. On B-mode examination, the endometrium appeared irregular and the midline echo was disrupted. On Doppler examination, the endometrium appeared poorly vascularized. The ovaries were normal. Three-dimensional saline contrast sonohysterography was performed, revealing more than 20 polypoid lesions arising from the endometrium (Figure 1). A Figure 1 Coronal section of the uterus obtained on three-dimensional saline contrast sonohysterography showing multiple polyp-like lesions within the endometrial cavity.

The color of dysplasia in ulcerative colitis

The color of dysplasia in ulcerative colitis

Reprogramming of intestinal differentiation and intercalary regeneration in Cdx2 mutant mice.

The homeobox gene Cdx2, a homologue of the Drosophila gene caudal, has been implicated in the control of cell differentiation in the intestinal epithelium. Recently, we showed that mice in which one allele of the Cdx2 gene had been inactivated by homologous recombination developed multiple intestinal polyp-like lesions that did not express Cdx2 and that contained areas of squamous metaplasia in the form of keratinizing stratified squamous epithelium, similar to that occurring in the mouse esophagus and forestomach. We have now examined colonic lesions from 98 Cdx2+/- mice and report that the lesions are composed of heterotopic stomach and small intestinal mucosa. We conclude that Cdx2 directs endodermal differentiation toward a caudal phenotype and that haploinsufficient levels of expression in the developing distal intestine lead to homeotic transformation to a more rostral endodermal phenotype, such as forestomach epithelium that does not express Cdx2 during normal development. Intercalary growth (epimorphic regeneration), which previously has never been described in mammals, then occurs, resulting in the ordered "filling in" of tissue types at the discontinuity between the gastric and colonic epithelia. This intercalary growth in a restricted space results in the formation of the polypoid lesions observed.

HISTOLOGICAL FINDINGS IN GASTRIC MUCOSA AND SHICHIJO'S REACTION

Shichijo's reaction, a biological test for diagnosis of gastric diseases, is known to give fairly high percentage of positivity in gastric cancer. The author performed gastric biopsy with 415 cases using a fiber-gastroscope, and compared histological findings in gastric mucosa with Shichijo's reaction. Surgical specimens were also examined in some cases. In thes subjects tested were included 33 cases of early gastric cancer. The findings obtained were as follows : 1) In the advanced gastric cancer, the positive group of Shichijo's reaction (inclusive of theintermediate type) accounted for 18 of the total 24 cases (75%), that was significantly higher than in benign gastric diseases : 23.3% in gastric ulcer, 16.5% in gastric polyp, and 15.4% in gastritis. These results were approximately equal to the previous reports.In the early gastric cancer, the positivity rate was 8 of 33 (24.2%), and many (21 of 33, i.e. 63.6%) gave type III and IV, the total cases of type III to IX of shichijo's reaction accounting for 29 of 33 cases (87.9%). In applying Shichijo's reaction as a screening test for gastric cancer in social wide examinations, it should therefore be better to include all the cases of type III to IX for detailed examination.3) Early gastric cancer, giving the intermediate and the positive type of Shichijo's reaction, frequently occurred in those of the protruding and the concaving type by the endoscopic classification (5 of 6 cases, i. e. 83.8%), whereas the negative type was frequently observed in those of the superficial flat type (22 of 25 cases, i. e. 88.8%).4) Pathohistological classification and developed sites of gastric cancer did not give any relation with types of Shichijo's reaction, but the depth of the cancer cell infiltration was related with the positivity; especially in cases with the muscular layer invaded the positivity rate was much high.5) Shichijo's reaction was not used as a supplementary method in differentiation of early gastric cancer from benign gastric diseases resembling it, since no differnce was od-served between them in any type of Shichijo's reaction.6) Relation- between stages of benign ulcer (which were assumed from histological findings of gastric biopsy specimens) and Shichijo's reaction was observed. It was found that the positivity was relatively higher in the almost healed and the scar stage ulcer.7) Some morphological classifications of polyp-like lesions and various gastritis had to definite relation with Shichijo's reaction, excepting the superficial nature of the former; in polyp-like lesions with rough surface, the positivity rate was higher than in those with smooth surface.

Polypoid lesions of the large intestine: differential diagnosis from true polyps.

Certain polyplike lesions of the anus and large intestine that project into the lumen of the bowel and resemble true polyps are encountered rather frequently on digital examination of the anus and rectum, on endoscopy of the lower portion of bowel and on x-ray studies of the colon. It is generally accepted that true polyps have malignant propensities while most polypoid lesions do not. For this reason the differential diagnosis is important. Features that assist in the differential diagnosis are consistency, location and appearance of the lesion.