Polypoid Carcinoma Research Articles

The possibility of nonpolypoid carcinogenesis in the large intestine as inferred from frequencies of DNA aneuploidy of polypoid and crater-shaped carcinomas.

DNA ploidy patterns were studied by cytofluorometry in 60 cases of crater-shaped invasive carcinoma and 30 cases of polypoid tumor (severe dysplasia or submucosally invasive carcinoma located in the pedunculated, semipedunculated, or sessile polyp) of the large intestine. The data were compared with 20 cases of intramucosal differentiated (or intestinal type) adenocarcinoma of the stomach, with special reference to their macroscopic shape and frequency of DNA aneuploidy. DNA aneuploidy was found in 77% of the crater-shaped carcinomas and in 17% of the polypoid tumors of the large intestine. The frequencies were significantly different and the frequency gap amounted to 60%. However, 18 of 20 (90%) gastric adenocarcinomas were nonpolypoid in shape, whereas two (10%) were polypoid. DNA aneuploidy was found in 50% of the gastric adenocarcinomas and 56% of the nonpolypoid gastric adenocarcinomas. This value did not differ from the values reported previously for the submucosally invasive and advanced crater-shaped intestinal type adenocarcinomas of the stomach. Biologic characteristics of adenocarcinomas of the large intestine can be compared with those of intestinal type adenocarcinomas of the stomach, because intestinal type gastric adenocarcinoma is surrounded mostly by intestinalized mucosa and considered to arise from the epithelium under induction or progression of intestinal differentiation. Therefore, we inferred that the frequency gap in DNA aneuploidy between the crater-shaped and polypoid tumors of the large intestine implies that in the large intestine approximately 60% of the crater-shaped invasive carcinomas develop from the small nonpolypoid carcinomas.

Coexpression of Cytokeratin and Vimentin in a Polypoid Bronchogenic Squamous Cell Carcinoma of the Lung

AbstractA 71 year old male presented with the symptoms, physical findings, radiographic, and bronchoscopic picture of a bronchogenic neoplasm with obstructive pneumonia. The initial biopsy with corresponding immunohistochemistry revealed a poorly differentiated neoplasm with an antigenic profile of sarcoma. The subsequent partial pneumonectomy revealed a polypoid squamous cell carcinoma with immunohistochemical, histological, and electron microscopic confirmation. The discrepancy between the initial biopsy interpretation and final results was addressed. (The JHistotechnol 10:273, 1987.)

Practical aspects of endoscopic management of malignant polyps.

World experience now overwhelmingly supports the policy of conservative management by endoscopic snare polypectomy of "focal" cancer in polyps (malignancy in adenomas and polypoid carcinomas), providing that the polyp is pedunculated and that endoscopic and histological criteria are favorable. Invasion to within 2-3 mm of the snare-resection line is acceptable, providing that the advancing tumour margin is well-circumscribed. Unfavourable characteristics include poorly differential tumour, involvement of stalk vessels, and sessile configuration. This management policy applied to 90 patients between 1971 and 1981 resulted in successful 5-year follow-up of the 74 patients treated by polypectomy alone. Among the 16 patients managed surgically, no local lymph nodes were involved in any case, although 4 patients were found to have residual local tumour at the polypectomy site.

Esophagogastric polyps: radiographic and endoscopic findings.

Radiographic, endoscopic, and pathological findings were correlated in 20 patients with polypoid esophagogastric lesions. In 16 patients, pathological examination showed chronic inflammatory change and epithelial hyperplasia; the polyp was located on the gastric side of the squamocolumnar junction, usually in association with a prominent gastric fold, and probably represented a localized form of gastritis. In the other 4 patients, the lesion was adenocarcinoma. An inflammatory esophagogastric polyp may be differentiated from polypoid carcinoma when adequate radiographs are available and specific diagnostic criteria are followed. Endoscopic biopsy is recommended if the lesion does not fulfill the criteria of an inflammatory esophagogastric polyp.

Diagnosis and management of gastric polyps: study of fifteen cases with review of the literature.

FIFTEEN patients with gastric polyps were studied. In only 7 cases could symptoms be directly attributed to polyps. Endoscopic polypectomy was performed in 5 patients without complications. Three patients with polyp diameter 3.5 cm or greater required surgical polypectomy. Biopsy specimens were not representative of excised polyps in 4 of 8 cases. At least some adenomatous polyps have malignant potential but hypoplastic polyps are benign. Examination of the excised polyp is required for accurate histological typing and detection of polypoid carcinoma.

Surgical Treatment of Early Gastric Cancer

In Japan, R2-gastric resection which consists of gastrectomy, omentectomy and complete removal of Group 1 and 2 regional lymph nodes has been generally accepted as the procedure of choice in the treatment of early gastric cancer during the past 20 years. As a result, surgical treatment for early gastric cancer patients has achieved a very good survival rate, 97.7% and 96.2% 5 and 10 years, respectively, after surgery. To determine a new rationale for surgical treatment for early gastric cancer, the relationship between various prognostic factors and postoperative prognosis in 1,200 patients with early gastric cancer was studied. The survival rate for patients with a single focus of cancer in the stomach was significantly higher than that for patients with multiple foci. The incidence of recurrence was very low (2.8%) as a whole and most recurrence was found in patients who have had invasion into the submucosa with regional lymph node metastasis. The characteristic mode of recurrence was hematogenous metastasis to the liver and lung. The majority of causes of death were non-malignant disease and multiple primary malignant neoplasms. As to the survival rate in relation to the extent of lymph node dissection, no significant difference in survival rate was observed among the three procedures R0-, R1- and R2-resection in single cancer regardless of cancer invasion through the gastric wall. The survival rate for intramucosal carcinoma without lymph node metastases and with Group 1 lymph node metastases in both single and multiple cancer was 100%. In addition, 125 patients with intramucosal polypoid cancer (types I and IIa according to the macroscopic classification of early gastric cancer) showed no lymph node metastasis and had 100% survival. Therefore, from the present study a new rationale for surgical treatment for early gastric cancer is recommended as follows: 1) In general, R1-resection is indicated for intramucosal carcinoma and R2-resection for submucosal carcinoma. 2) Local resection of the tumor or R0-resection with preservation of the regional lymph nodes is thought to be sufficient for an intramucosal polypoid carcinoma less than 2.0 cm in diameter.

Experimental Cancer of the Bowel in the Nb Rat

An animal model of bowel cancer, induced by 1,2-dimethyl hydrazine, has been developed in the Nb rat. Invasive polypoid carcinomas of the colon were noted in nine rats surviving 29 weeks after the carcinogen was first administered. Two of these nine rats also developed duodenal carcinomas. Because dosage schedules are known from previous experiments with the Nb rat, this animal model may be useful for evaluating the effects of cytotoxic drugs on experimental bowel cancer.

Cholangiographic evaluation of bile duct carcinoma.

Cholangiograms and clinical histories of 82 patients with biopsy-proved bile duct carcinoma were reviewed. The carcinomas were classified according to morphologic type and anatomic location, and these were correlated with surgical and pathologic findings and clinical outcome. Ulcerative colitis and antecedent inflammatory disease of the biliary tree, particularly primary sclerosing cholangitis, seem to predispose to the development of bile duct carcinoma. Focal stenotic lesions were the most common morphologic type (62/82). Polypoid carcinomas and diffuse sclerosing carcinomas were less common and of about equal frequency. Prognosis was best for patients with polypoid carcinomas and worst for those with diffuse sclerosing carcinomas. In 69 cases (84%), the tumors involved the intrahepatic or proximal extrahepatic ducts, making curative resection difficult or impossible. Patients with carcinomas limited to the more distal extrahepatic bile ducts had a longer average survival and a higher probability of surgical cure. Proper management of patients with bile duct carcinoma requires a complete and accurate cholangiographic evaluation of the morphology, location, and extent of the disease.

Surgical pathology of endoscopically removed malignant polyps of the colon and rectum.

Fifty-six endoscopically removed malignant polyps of the colon and rectum were studied to assess criteria for adequacy of therapeutic polypectomy. Features examined were: 1) tumor grade; 2) lymphatic invasion; 3) tumor extent (head, stalk, margin); 4) sessile versus pedunculated; 5) size; and 6) type of background adenoma. Thirty-four patients underwent colon resection while the remaining 22 malignant polyps were followed for a mean of 4.5 years. Five (8.9%) malignant polyps metastasized to lymph nodes while three cases showed metachronous liver metastases. Pathologically, malignant polyps were grouped into 28 long stalk (LS), 21 short stalk (SS), and seven sessile types, with a lymph node metastatic rate of 0%, 19%, and 14%, respectively. Only one of six malignant polyps with lymphatic invasion had any lymph node metastases (16.5), while 66% of grade III cancers had lymph node metastases. In those 24 cases with tumor at or near the resection margin (17 SS and seven sessile cases), the incidence of lymph node metastases or local recurrence was 25%. The incidence of lymph node metastases or local recurrence was 0% among the 28 LS polyps and the four SS polyps with tumor limited to the head. Two of seven polypoid carcinomas (28.5%) metastasized; however, both had positive resection margins. There was no difference in size between metastasizing and nonmetastasizing malignant polyps. Of the 36 cases where histological criteria indicated polypectomy inadequate, the incidence of lymph node metastases or local recurrence was 17%. There were no metastases or recurrences where polypectomy was considered histologically adequate. LS polyps may be treated by polypectomy alone, except in those cases with grade III cancer, lymphatic invasion, or tumor at the resection margin. SS polyps with cancer limited to the head may be treated similarly to LS polyps, while all other SS polyps and sessile polyps should undergo resection postpolypectomy.

Experimental cancer of the bowel in the Nb rat

An animal model of bowel cancer, induced by 1,2-dimethyl hydrazine, has been developed in the Nb rat. Invasive polypoid carcinomas of the colon were noted in nine rats surviving 29 weeks after the carcinogen was first administered. Two of these nine rats also developed duodenal carcinomas. Because dosage schedules are known from previous experiments with the Nb rat, this animal model may be useful for evaluating the effects of cytotoxic drugs on experimental bowel cancer.

Screening for Colorectal Cancer

A voluntary colorectal screening program was carried out in North Carolina to evaluate the public's willingness to perform a do-it-yourself bowel test, to educate the public on the importance of routine colorectal screening, and to assess the efficacy of a small-scale screening program in detecting colorectal cancer. A screening kit was requested by 1,204 individuals after hearing or reading about the program; 770 kits were returned. Of 29 (3.7%) positive test results, six were negative after retesting. Adequate follow-up was available for 18 of the remaining 23 positive results. Thirteen were due to anal bleeding, diverticulosis, or heavy ingestion of aspirin; five were considered false-positive results, since no evidence of disease could be found. No cases of polypoid tumors or carcinoma were detected. The main value of such a program in an area with a small population base is to increase the awareness of the public of the importance of routine screening for colorectal cancer.

Endoscopic analysis on the growth of early gastric carcinoma

Earliest endoscopic appearance and its subsequent changes were studied in 41 cases of early gastric carcinoma where gastrocamera photographs were available for detailed analysis over the period from three months up to 10 years. The earliest appearance of polypoid carcinoma was a small area of nodularity, and that of carcinoma with mucosal depression was patchy reddening. Both types of carcinoma were thought to occur initially as a lesion without mucosal elevation or depression (IIb). In carcinoma with shallow mucosal depression (IIc and IIc-+III), there were cases believed to have remained intramucosal for an extremely long period of several years, whereas, in polypoid carcinoma (IIa and I), the growth seemed to be more rapid. In the cases with ulcer within the carcinomatous lesion, healing of the ulcer was confirmed in 37%, and "malignant cycles" were observed in 21%. Malignant transformation of gastric ulcer was suggested in one case with linear ulcer.

Carcinomas of the Colon in Buffalo Strain Rats Given Intraperitoneal Injections of Methylazoxymethanol Acetate

Buffalo strain male and female rats were given methylazoxymethanol acetate (20% solution) intraperitoneally 20 mg/kg body weight weekly for 9 weeks, and killed 27 weeks later. Carcinomas of the large intestine, predominantly in the descending colon, developed in some of the rats. The incidence was higher in male than in female rats. Polypoid carcinomas were observed more often in male rats and sessile carcinomas with metastases in the female rats. Carcinomas were not observed in organs other than the large intestine.

Endoscopic polypectomy. Therapeutic and clinicopathologic aspects.

The problem of the malignant potential of neoplastic colonic polyps is being, in large measure, resolved by newly derived techniques. Now most polyps may be removed endoscopically using the fiberoptic colonoscope. The largest world experience is at the Beth Israel Medical Center in New York, where over 2000 polyps have been endoscopically removed without a single death and with but one complication requiring operative intervention. Laparotomy is now reserved for polyps not suitable for endoscopic resection or where a question of residual cancer exists. Experience with endoscopic resection has called for: 1) re-assessment of colonic polyps in terms of their malignant potential; and 2) clarification of the indications for laparotomy and bowel resection subsequent to or instead of endoscopic removal. Among all polypoid lesions 0.5 cm or greater in size in the Beth Israel series, a variety of pathologic types was encountered. If only the neoplastic polyps were considered, the incidence of "malignant change" was 10.5% for 855 polyps analyzed. There is, however, a need to clarify terminology and to differentiate between carcinoma in situ and invasive cancer whenever possible. Superficial cancers (carcinomas in situ) do not recur or metastasize and require no treatment other than polyp removal. When "invasive" cancer is present (4.5% of neoplastic polyps) or the lesion is a "polypoid carcinoma" each case must be individually evaluted. Criteria for diagnosis, gross morphological features suggesting cancerous change, and current management of "malignant" polyps are discussed. Colonoscopy is an important component of the followup program whether malignant polyps are resected endoscopically or by the transabdominal route.

Inflammatory fibrous polyp (pseudotumor) of ileum.

Clinically and grossly, an inflammatory fibrous polyp of the ileum may resemble an ulcerated polypoid carcinoma and may produce intussusception or partial bowel obstruction. Only eight cases of this distinctive lesion have been reported in the literature; the findings in these cases and in three new cases discussed here.

Carcinosarcoma of the esophagus

A case of carcinosarcoma of the esophagus is presented with a review of the classic clinical endoscopic, radiologic, and histologic features. The polypoid pattern of growth of carcinosarcoma results in early obstruction. Local invasion or metastases occur late, if at all. The diagnosis of carcinosarcoma is suggested when biopsy or cytological washings of the pedunculated lesion reveals carcinoma, since pedunculated polypoid carcinoma of the esophagus is very unusual. This neoplasm, although rare, has a better prognosis than carcinoma of the esophagus. Early recognition based on the described characteristic features is emphasized.

Gastric polyps. Histologic types and their relationship to gastric carcinoma.

In a study of the relationship between gastric polyps and carcinoma, a series of 97 cases of gastric polyps were studied histologically and follow-up information obtained. Thirty-five per cent of the total series of gastric polyps were found as incidental findings in stomachs with gastric carcinoma. Polyps were subdivided by gross appearance into single polyps, multiple discrete polyps, or gastric polyposis; no significant difference in association with carcinoma was found for these gross types. Polyps could be subdivided microscopically into hyperplastic and adenomatous types. Hyperplastic polyps were relatively more common (76%), and were randomly distributed in the stomach. Adenomatous polyps were usually antral in location and were histologically similar to the adenomatous polyps of the colon. Marked epithelial atypia (in-situ carcinoma) was seen only in polyps of the adenomatous type. Adenomatous polyps were associated with carcinoma more frequently than hyperplastic polyps—59% and 28%, respectively. Follow-up information on a total of 40 patients who underwent surgery for gastric polyps without associated carcinoma showed that 3 developed subsequent polyps and only one developed a polypoid carcinoma. The initial polyps in these cases were multiple, greater than 2 cm in size, and, in each case, at least one was of the adenomatous type. The subdivision of polyps into 2 histologic types revealed the close morphological and statistical relationship of the adenomatous type of gastric polyp to gastric carcinoma. This relationship is otherwise obscured by the presence of the more numerous hyperplastic polyps. In almost all circumstances, simple polypectomy with a rim of uninvolved adjacent mucosa is sufficient treatment.

Polypoid Lesions of the Gastrointestinal Tract

ABSTRACT Here is a timely monograph which leads the clinician through the confusion created by opposing views on the significance of adenomatous polyps of the colon. The author has ably summarized, both succinctly and fairly, the opposing arguments and has in addition given an editorial statement of his own considered opinion. Presented in a well organized manner, the book is a valuable contribution which serves to clarify the clinical problem involved and which obviously represents a tremendous amount of review work.In this concise volume, the reader will gain an up-to-date and clearer understanding of the possible relationships between adenomatous polyps, papillary adenomas, and polypoid carcinoma. Equally well covered are all polypoid lesions found along the gastrointestinal tract, including multiple and familial polyposis, pseudoinflammatory polyps, carcinoid polyps of the rectum, lymphoid polyps, juvenile polyps, etc.Also of particular value, and well represented, is the surgical management of polypoid lesions of the

Polypoid and junctional squamous cell carcinoma of the tongue and larynx with spindle cell carcinoma

Polypoid and junctional squamous cell carcinoma of the tongue and larynx with spindle cell carcinoma

Polypoid and Junctional Squamous Cell Carcinoma of the Tongue and Larynx with Spindle Cell Carcinoma (Pseudosarcoma)

Polypoid and Junctional Squamous Cell Carcinoma of the Tongue and Larynx with Spindle Cell Carcinoma (Pseudosarcoma)