Polypoid Lesions Research Articles

Gastric polyps: a retrospective cohort analysis of 23,668 endoscopies indicates changing epidemiological and phenotypic characteristics.

Growing adoption of endoscopic procedures in clinical practice has gradually increase the detection rate of gastric polypoid lesions. To identify the epidemiologic characteristics of gastric polyps as well as changes of these parameters during a 15-year period. We reviewed all the upper endoscopies archived in our database reporting a polypoid lesion from 2003 to 2018. Demographic data, indication for endoscopy, morphological characteristics of polyps, histology, and presence of Helicobacter pylori were collected. We compared the abovementioned data between 2 periods: 2003-2010 and 2010-2018. A total of 989 (4.2%) patients from 23,668 reviewed were identified to harbour a polypoid lesion. Mean patient age was 63.2 years, with 58.8% being female. Most polyps (65.2%) were less than 5 mm in diameter and located in the fundus. Hyperplastic polyps (HPs) were the predominant type (28.6%) while fundic gland polyps (FGPs) were found in 24.1% of patients. Adenomas were the least common type (2.7%). Other pathology was identified in 43.3%. Comparison between the 2 periods revealed a rise of FGPs against HPs with a concomitant shift of location from antrum to fundus and an increase in the number of polyps per patient. FGPs and HPs were the most common polyps found in our cohort, with a change of their pattern during the 15 years. It is imperative to acknowledge the distinct characteristics of gastric polyps so as to properly assess the malignant potential that some of them, or their surrounding gastric mucosa, harbour.

Atypical localization of metastatic melanoma in the gastrointestinal tract.

Although most melanomas are diagnosed in early stages of the disease, a significant percentage show metastases from the beginning or during follow-up. The most common route is lymphatic, while hematogenous spread is less frequent. The most common site for metastases is the skin itself, although they can also occur in other organs, including the digestive tract, where the small intestine is the most frequently affected organ (2). We present the case of a 48-year-old woman with a history of superficial spreading melanoma of the cervical region, surgically treated 7 years prior and in remission, who presented with painless jaundice of 48 hours duration, without fever or other infectious focus. Upon arrival at the Emergency Department, she had a direct bilirubin of 7.9 mg/dL and a CRP of 140 mg/L. An abdominal ultrasound was performed, revealing biliary tract dilation without apparent cause, with secondary, apparently tumoral involvement of the gallbladder. During hospitalization, the study was completed with an abdominal CT scan, visualizing hyperdense lesions with a polypoid appearance in the gallbladder, in addition to the aforementioned intra- and extrahepatic biliary tract dilation. The cause was then identified as a hyperdense mass in the duodenum affecting the papilla, along with two other small hypervascular polypoid lesions in the second portion of the duodenum. With these findings, an ERCP was performed, revealing a papilla with a "pregnant" appearance, compatible with ampulloma, in addition to duodenal pseudopolyps of nonspecific appearance. The anatomopathological analysis was compatible with duodenal metastases from melanoma. Melanoma is the cancer with the highest mortality rate, and the gastrointestinal tract is a typical location for metastases, only surpassed by the skin itself and the lungs, especially the small intestine, although not the duodenum, where they are found in only 12% of cases (4). In this case, the diagnosis was complicated by the endoscopic appearance of the lesion, as the characteristic features are pigmented, blackish lesions typical of melanoma. As seen in the image, these lesions had an erythematous and pseudo-inflammatory appearance, so for diagnosis and treatment, it was essential to consider the history of the disease to perform an adequate anatomopathological diagnosis.

Destructive foreign body granuloma: A case report

External auditory canal polyps are predominantly inflammatory processes but occasionally indicate more severe pathology. Prolonged conservative management may postpone accurate diagnosis and appropriate therapeutic intervention. This case report presents a 37-year-old woman, previously healthy with a normal ear, who underwent a right myringotomy with the insertion of a pressure-equalizing tube in one hospital after an upper respiratory tract infection. However, due to the pandemic era, she lost follow-up for 2 years and subsequently presented to another hospital with worsening hearing and persistent otorrhea. The attending physician found a large polypoid lesion occupying her right external ear canal. A computerized tomography scan revealed an irregular enhancement mass involving the right ear canal, the middle ear cavity, and mastoid air cells with multiple destruction of the skull base and intracranial involvement in the right middle cranial fossa. The possibility of malignancy was raised, prompting the patient to seek evaluation in a third hospital. A right tympanomastoidectomy was performed, and during a posterior tympanotomy, a pressure-equalizing tube was discovered in her middle ear. The pathological results confirmed the presence of foreign body granuloma. Following surgery, the patient’s otorrhea improved.

Adult colocolic intussusception originating in a colonic GIST.

We report the case of an 86-year-old male who was admitted for intestinal subocclusion, in whom an abdominal computed tomography (CT) scan and colonoscopy revealed a colocolonic intussusception with an underlying and heterogeneous mass, failing to rule out a neoformative lesion. A left hemicolectomy procedure was carried out with regional lymphadenectomy (because of the potential neoplastic origin) through laparoscopy, and the patient had a favourable postoperative course. Pathology described 45cm of an intestinal segment, with intussusception and with a 12x7x6 cm ulcerated polypoid lesion. Lesion was revealed as high grade GIST, pathological state of pT4, N0 and free margins. The patient was treated with adjuvant Imatinib. The presentation of a colonic GIST as a colocolic intussusception causing intestinal subocclusion is an extraordinary case, and in our patient, early diagnosis with abdominal CT and free margin surgery were key for successful management.

Histological changes of endocervical polypoid lesions in women at reproductive age

Abstract Background: Endocervical polyps (ECP) are fragile benign protrusions commonly affecting 2%–5% of women during the reproductive age. Aim: This study aimed to identify the histopathological changes of clinically identified endocervical polypoid lesions during the reproductive age to detect any premalignant or malignant transformation if present. The objective is to assist the clinicians to decide whether the cervical polyps should be excised or not. Materials and Methods: Sixty specimens of the resected cervical polyps were obtained from Al-Salaam Teaching Hospital in Mosul city during the period from June 2021 to February 2022, women diagnosed to have cervical polyps on per speculum examination were given a time to be operated on with exclusion of pregnant, postmenopausal women, those on hormone replacement therapy, and those below 20 years. After polypectomy, fixation of biopsies in 10% buffered formalin was done followed by processing and staining with hematoxylin and eosin for histological examination. Chi-square test was used for interpretation of the histological findings. Results: The study revealed that 52% of the enrolled women were in the range of 40–49 years of age. Squamous metaplasia and benign microglandular hyperplasia were detected equally in 25% of the study group. Nabothian cyst was observed in 8%, whereas leiomyoma presenting as cervical polyp in 6%. Fortunately, no malignant changes were reported in the examined 60 cases and the only serious lesion was cervical intraepithelial neoplasia (CIN) observed in 2% of the examined polyps. Conclusion: we conclude as the incidence of malignant transformation of endocervical polyp is low in women in reproductive age and the only critical lesion is in situ intraepithelial neoplasia (CIN), it is proposed to follow an expectant management without interference and those patients can be only followed up to improve their health.

Intraductal Papilloma of the Breast: A Case Report

Intraductal papilloma of the breast is a rare benign tumour. The polypoid lesions arising from the nipple surface include papillomas and fibroepithelial stromal polyps. These lesions must be distinguished from malignant nipple lesions, such as Paget’s disease of the nipple or malignant breast conditions involving the nipple. Solitary papillomas (solitary intraductal papillomas) are single tumours that often grow in the large milk ducts near the nipple. They are a common cause of clear or bloody nipple discharge, especially when it comes from only one breast, and can be felt as a small lump behind or next to the nipple. Papillomas may also be found in small ducts in areas of the breast farther from the nipple. Multiple papillomas, which are growths that are less prone to generate nipple discharge, were present in this case. In papillomatosis, there are very small areas of cell growth within the ducts, but they aren’t as distinct as papillomas are. In order to distinguish between these disorders, a thorough clinical examination and imaging are essential. This case report describes a 36-year-old female who presented with swelling from the left nipple. Sonography of the left breast revealed a dilated duct in the left retro-areolar region with a focal isoechoic component within the duct {American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS 4B)}. The patient underwent core excision of the duct, and histopathological analysis confirmed the diagnosis of papilloma with changes of adenosis without atypia.

Recurrence and Carcinogenetic Rates of Colorectal Polyps.

to determin the recurrence rate of benign recto-colonic polyps in a 5-year interval, and compare the development rate of intrapolypoid carcinomatous lesions in polypectomized versus nonpolypectomized subjects. a group of 77 patients diagnosed with recto-colonic polypoid lesions during the period 2014-2019 underwent colonoscopy at the time of study initiation and then annually during a five-year interval. Results: The recurrence rate of polyps increased annually from 5 to 12.5%; the highest rate was noted in the last two years. The five-year cumulative risk of neoplastic lesions was 73% in patients without polypectomy and 20% among those with endoscopic resection (p 0.05). Comparing the recurrence rate of benign lesions (60%) in patients without neoplastic findings with the recurrence rate of adenomas in patients with benign lesions (40%), a higher risk of recurrence was found in the first category, and seemed to be influenced by the personal history of pre-existing adenomatous lesions. an increased risk of colorectal polyps recurrence was reported during five year follow up; moreover, during the first three years an increased risk of malignant transformation was observed among cases in which endoscopic resection was not feasible when compared to those in which complete excision was feasible.

Primary Rectal Perineurioma: A Rare Incidental Finding

Abstract Perineurioma is a rare benign peripheral nerve sheath tumor which can occur intraneurally or uncommonly in the extraneural soft tissues. The majority of the perineuriomas of the gastrointestinal tract occur distal to the splenic flexure as polypoid pedunculated or sessile lesions. Lesions are often discovered incidentally during routine colonoscopy for cancer screening. Diagnosis is mainly histological with the majority of the cases showing mucosal/submucosal bland spindle cell proliferation with expression of perineurial markers. We report a rare case of rectal perineurioma in a 42-year-old female who presented with the complaint of intermittent episodes of painless rectal bleed associated with defecation. A pedunculated polypoid lesion in the rectum measuring 12 mm in greatest dimension was seen on colonoscopy. The patient underwent endoscopic mucosal resection of the mass. Microscopically, the lesion showed proliferation of spindle cells with oval-to-spindle nuclei, bland chromatin, and moderate amount of pale to eosinophilic cytoplasm with indistinct cell borders. Overlying mucosa showed hyperplastic crypt epithelium. Spindle cells were positive for epithelial membrane antigen and CD 34 and negative for S100, with low Ki-67 marked cycling cell population (<1.0%) and negative Progesterone receptor (PR) and CD 117, these features confirming the diagnosis of perineurioma.

Diagnostic and Therapeutic Role of Electrocautery Snare Use in Endobronchial Polypoid Lesions

IntroductionElectrocautery with a snare probe offers a tool for the treatment of endobronchial polyps. The aim of this study was to demonstrate the efficacy of the snare probe in patients undergoing rigid bronchoscopy due to central airway obstruction. MethodsThis retrospective descriptive study included patients who underwent rigid bronchoscopy with an electrocautery snare probe for the diagnosis and/or treatment of endobronchial polyps in an interventional pulmonology unit. ResultsThe mean age of the 47 patients (38 men) with endobronchial polypoid lesions was 61.5 years. Six lesions (12.8%) were located in the trachea, 6 (12.8%) in the right main bronchus, 11 (23.4%) in the left main bronchus, and 24 (51.1%) in the lobar bronchi. Twenty-eight lesions (59.5%) were malignant. Prior to the procedure, 6 (12.8%) patients had grade 1 obstruction, 6 (12.8%) had grade 2 obstruction, 15 (31.9%) had grade 3 obstruction, and 20 (42.6%) had grade 4 obstruction. In terms of airway obstruction after the procedure, grade 1 was present in 46 (97.9%) patients and grade 2 was present in 1 (2.1%) patient. No major complication developed in 93.6% of the patients. During a mean follow-up period of 48 months, 85.1% of the patients did not experience recurrence. ConclusionOur results demonstrate that the snare probe can be used to effectively and reliably establish airway patency in patients with central airway obstruction due to endobronchial polypoid lesions.

Localised sinonasal amyloidosis presenting with unilateral hearing loss: a case report and review of the literature

Localised sinonasal amyloidosis is a rare occurrence with only twenty-nine documented cases in literature. This report follows the case of a 79-year-old gentleman with an atypical presentation of headaches and unilateral (right-sided) hearing loss. The patient initially underwent magnetic resonance imaging of his internal auditory meatus which was normal. Flexible nasoendoscopy was performed which identified a right middle meatus discharging possible polypoidal lesion. A computed tomography scan of his sinuses was performed which identified a large soft tissue lesion projecting into the upper nasal airway arising from the nasal recess, with the appearance suspicious for a polyp. Subsequently, the patient underwent functional endoscopic sinus surgery to manage right maxillary sinusitis and further examine the right-sided polypoidal mass lesion that was obstructing the maxillary antrum. Maxillary sinus biopsy revealed a diagnosis of sinonasal amyloidosis while tests for systemic amyloidosis were negative.

Seven-year outcomes of combined treatment of anti-vascular endothelial growth factor with photodynamic therapy for polypoidal choroidal vasculopathy; according to polypoidal lesion regression

PurposeTo evaluate the long-term prognosis of polypoidal choroidal vasculopathy (PCV) treated with anti-vascular endothelial growth factor (anti-VEGF) combined with verteporfin photodynamic therapy (PDT), according to polypoidal lesion regression.MethodsThis study retrospectively reviewed the data of 33 naïve eyes with PCV treated with anti-VEGF combined with verteporfin PDT and followed-up for at least 7 years. The collected data included demographic profile, best-corrected visual acuity (BCVA), central foveal thickness (CFT), PED volume, and presence of submacular hemorrhage. Regression of polypoidal lesion was determined using indocyanine green angiography and optical coherence tomography. All eyes were divided into regression or persistent groups, based on the polypoidal lesion regression one year after the initial combined treatment.ResultsBCVA improvement was maintained for 3 years in the regression (p = 0.001) and 1 year in the persistent (p = 0.006) groups, respectively. The mean BCVA of the regression group was better than that of the persistent group over 7 years, but the difference was significant only at 1 year (p = 0.037). The number of eyes which maintained BCVA less than or equal to 0.3 logMAR at 7 years was 11 eyes (64.7%) in regression group and 4 eyes (25.0%) in persistent group (p = 0.022).ConclusionsRegression of the polypoidal lesion at 1 year after the initial combination treatment was associated with favorable long-term visual prognosis, particularly in terms of maintaining good visual acuity.

Endometrial stromal tumor presenting as multiple endometrial polyps with limited infiltration; a novel presentation

Abstract Introduction/Objective The 2020 WHO classifies endometrial stromal tumors into endometrial stromal nodule (ESN), low-grade endometrial stromal sarcoma (LGESS), high-grade endometrial stromal sarcoma, and undifferentiated sarcoma. Minimal irregularity of the interface is allowed in ESN (up to 3 foci of <3 mm). In a small number of cases, the irregular interface exceeds the acceptable criteria for ESN but relatively limited compared to most LGESS. These cases are classified as endometrial stromal tumor with limited infiltration. These tumors may recur, and it is best managed as LGESS. Methods/Case Report We report a case of endometrial stromal tumor in a 42-year-old female who presented with abnormal vaginal bleeding. Imaging showed multiple fibroids. She underwent total abdominal hysterectomy and bilateral salpingectomy. On gross examination three endometrial polyps with sharp demarcation from the adjacent myometrium were identified (largest 4 cm). Histology revealed proliferation of uniform small cells with scant cytoplasm and round to oval nuclei with rare mitotic figures in a delicate network of arterioles. Immunostains showed positive staining for CD10 and estrogen receptor while negative for Caldesmon. These polyps were mainly confined to the endometrium with only small foci of irregular border with the myometrium. No vascular invasion, high grade cytologic atypia or necrosis were seen. The tumor showed JAZF1-SUZ12 gene fusion. This case was diagnosed as an endometrial stromal tumor with limited infiltration. Results (if a Case Study enter NA) NA Conclusion In conclusion, endometrial stromal tumors are commonly submucosal or intramural, we report a rare case that presented as multiple endometrial polyps, with very limited myometrium infiltration. To our knowledge, no cases have been reported so far. It is essential to be cognizant of this entity when dealing with polypoid lesions of the endometrium, they may recur and should be managed as LGESS.

Polypoidal Choroidal Vasculopathy: Evaluation Based on 3-Dimensional Reconstruction of OCT Angiography

Three-dimensional (3D) reconstruction using swept-source OCT angiography (SS-OCTA) can provide insights into the nature and structure of polypoidal choroidal vasculopathy (PCV) and its component parts, the polypoidal lesion (PL) and the branching neovascular network (BNN). This study aims to describe novel observations of PCV using 3D reconstruction of SS-OCTA, and to compare these observations with similar images of type I macular neovascularization (MNV) typical neovascular age-related macular degeneration (nAMD). Clinical case series. Patients with PCV in either eye from clinical studies conducted in a tertiary retina center. Images with prespecified SS-OCTA imaging protocol were obtained and reconstructed in 3D. Forty neovascularization lesions (30 PCV and 10 typical nAMD) based on SS-OCTA were analyzed. The following 3 specific features were evaluated: (1) the pattern of flow signal within the PLs as either homogenous or showing internal vascular architecture; (2) the configuration of the BNN as hypermature, mature, or immature; and (3) the spatial arrangement of the PLs in relation to the BNN. Comparisons were made between PCV and typical nAMD. All PLs exhibited internal vascular architecture in the form of coil-like loops and none exhibited homogenous flow. Small focal nodules were present within this internal vascular architecture in 70% of PLs. Branching neovascular networks exhibited a hypermature/mature configuration (100 vs. 50%, P < 0.01) and were associated with thicker choroid compared with typical nAMD type 1 MNV (238.7 ± 104.3 vs. 155.6 ± 49.2, P= 0.02). The BNN and PL were located at distinct anteroposterior planes in 81% of the eyes. We identified proliferating vasculature in both the PL and the BNN. Comparison of the configuration suggests that the BNN represents a more chronic and inactive lesion than the PL. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Angioleiomyoma of the uterus presenting as an endometrial polyp: An uncommon occurrence of two cases with a literature review.

Angioleiomyoma is a benign neoplasm that arises from vascular smooth muscle cells. Angioleiomyoma of the endometrium is very uncommon. The differential diagnoses of this entity are myopericytoma, angiomyofibroblastoma, endometrial stromal tumor, and perivascular epithelioid cell tumor. 31-year-old and 45-year-old patients presented with heavy menstrual bleeding, lower abdomen pain, and dysmenorrhea. Perspeculum and radiological investigations showed an endometrial polyp. They underwent diagnostic hysteroscopy, polypectomy, and endometrial biopsy. Polypectomy specimens of both cases revealed polypoidal lesions lined by the endometrium. The core of the polyp was arranged in long intersecting bundles of spindle cells and interconnecting anastomotic patterns with many intervening thick-walled blood vessels. These spindle cells have oval and cigar-shaped nuclei, fine chromatin, and a moderate amount of eosinophilic cytoplasm, resembling smooth muscle cells. These smooth muscle cells of the vessel wall were merging with the adjacent walls of the blood vessel. There was no nuclear atypia or necrosis. The mitotic rate was 0-1/10 HPF. Focal areas of hyalinization and adipocytic components were noted in one case. The endometrial glands did not show intraepithelial or invasive neoplasia. On immunohistochemistry (IHC), these spindle cells were diffuse and strongly immunopositive for SMA and Desmin. CD34 highlighted the endothelial lining of the prominent thick-walled blood vessels. By correlating with histomorphology and IHC positivity, a diagnosis of angioleiomyomatous polyp of endometrium was rendered. We report two uncommon cases of angioleiomyoma of the endometrium and discuss the differential diagnosis and literature review.

Rhinosporidiosis of Nasal and Nasopharyngeal Subsite from Raichur District, Karnataka – Case Reports

Rhinosporidiosis is a mucocutaneous infection, primarily involving the nose. It rarely presents as a disseminated disease, with a polypoidal lesion of the mucous membrane of the nose and its subsite. Rhinosporidiosis affects commonly the mucous membrane of the nasopharyngeal subsite, conjunctiva and palate. The causative organism is Rhinosporidium seeberi and this disease is more prevalent in tropical countries.

Antrochoanal Polyp: A Case Report

Background: Antrochoanal polyp is a rare benign, non-ectopic polypoid lesion that arises from the maxillary antrum. The commonly affected age group ranges from ten to 15 years. It typically results in a unilateral lesion. However, it is rare to see this tumor in children less than 15 years of age. Methods: Case report: this report presented a case of an 8-year-old Saudi male patient who presented with a complaint of dysphagia, snoring, nasal discharge, and mouth breathing for several months. Results: Computed tomography showed complete opacification of the right maxillary sinus with extension to the right nasal fossa and nasopharynx through a widened maxillary infundibulum, which is suggestive of an antrochoanal polyp. Conclusion: Even though antrochonal polyps are frequently seen in children between the ages of ten and 15, it is important to remember that they can develop younger.

Diagnosing Polypoidal Choroidal Vasculopathy using Color Fundus Photography, Optical Coherence Tomography and Optical Coherence Tomography Angiography.

To compare the diagnostic accuracy of differentiating polypoidal choroidal vasculopathy (PCV) from exudative age-related macular degeneration (AMD), using color fundus photography (CFP), optical coherence tomography (OCT), and swept-source optical coherence tomography angiography (SS-OCTA) without using fluorescein angiography/ indocyanine green angiography (FA/ICGA). Treatment-naïve eyes with exudative age-related macular degeneration (AMD) that underwent CFP, OCT, SS-OCTA, and FA/ICGA imaging before treatment were identified. Images of each patient were categorized into 2 sets (Set A: CFP+OCT; Set B: CFP+ SS-OCTA). In Set B, both the en face and cross-sectional B-scans were analyzed. Each set was reviewed by two graders, and it was determined whether the presumed diagnosis was PCV. Sensitivity, specificity, and area under the curve (AUC) for the diagnosis of PCV were assessed for each set by comparing diagnoses that included ICGA. The number of polypoidal lesions in each set was calculated and compared to ICGA. A total of 94 study eyes from 94 patients with AMD were included in the study, of which 66.0% were male, and the mean age was 71.8±9.0 years. The PCV diagnosis rate using ICGA was 45.7%. Sensitivity of sets A, B: 0.88, 0.93; specificity: 0.94, 0.96; positive predictive value: 0.93, 0.95; negative predictive value: 0.91, 0.94, AUC: 0.90 (95% confidence interval [CI]:0.83-0.97), 0.96 (95% CI:0.90-1.00). Set A detected polypoidal lesions 1.28±0.91, Set B detected polypoidal lesions 1.47±1.01, ICGA showed 1.51±0.86. In the interclass correlation coefficient analysis, the correlation between Set A and ICGA was ICC=0.76(95% CI:0.60-0.86, p<0.001), and the correlation between Set B and ICGA was ICC=0.84(95% CI:0.72-0.91, p<0.001). This study highlights that, without using ICGA, both CFP combined with OCT and CFP combined with SS-OCTA demonstrate high sensitivity, specificity, and AUC in diagnosing PCV. It is evident that SS-OCTA contributes to enhancing sensitivity, specificity, and AUC for PCV diagnosis.

Sinonasal Hamartoma and Chronic Laryngeal Edema Causing Severe Dyspnea.

Sinonasal hamartomas, according to the 5th edition of the World Health Organisation classification of head and neck tumours are divided into respiratory epithelial adenomatoid hamartoma (REAH), seromucinous hamartoma and chondromesenchymal hamartoma. Seromucinous hamartoma are benign proliferations of small eosinophilic glands surrounded by fibrous stroma and cuboidal cells. Hamartomas of the nasal cavity and paranasal sinuses are rare entities, clinically presenting as sinonasal polyposis. A 79- year-old female patient was referred to our emergency room due to severe dyspnea. Anterior rhinoscopy revealed unilateral greyish polypoid mass obstructing the middle, inferior and common nasal meatus. Systemic corticosteroids and oxygen therapy were administered under observation. Computerized tomographic imaging of the paranasal sinuses with contrast on all three planes showed an opacified polypoid mass in all meatus and the maxillary, anterior ethmoidal and sphenoidal sinus posteriorly extending to the choanae. On the coronal plane a widening of the olfactory clefts about 12mm was described. FESS visualized that the polypoid mass originated from the posterior septum and extended to all meatus anteriorly and to the choanae posteriorly. The polypoid lesion was endoscopically completely excised. Histopathological analysis revealed a seromucinous hamartoma. Seromucinous hamartoma are rare benign tumors of the sinonasal region with potential of malignant alteration. Unfortunately, they share symptoms and clinical appearance with other benign conditions of the sinonasal region. Therefore, it is even more important to consider them as a differential diagnose.

Associations between vaginal microbiota and endometrial polypoid lesions in women of reproductive age: a cross-sectional study

Research Question: What are the different characteristics of vaginal microbial composition between patients with endometrial polypoid lesions and controls? Design: This cohort study compares the preoperative microbial compositions of vaginal samples in a cohort of 703 women with endometrial polypoid lesions (293 women diagnosed with polyps pathologically and 410 women diagnosed as not-polyps pathologically) and 703 women in the control group. Bacterial abundance, diversity, differential taxa, and microbial network structure were assessed using 16S rRNA gene sequencing. We also utilized predictive algorithms to determine the functional pathways of the vaginal microbiota within the cohort. Results: The control group exhibited a higher relative abundance of Lactobacillus crispatus in comparison to the polypoid lesions group (P = 0.0427). Vaginal microbiota beta diversity was found to be significantly different across the groups (P < 0.05). Leptotrichia and Cutibacterium were identified as being more abundant in the polyps group, while Fannyhessea, Acinetobacter, Achromobacter were more abundant in the not-polyps group. On the other hand, the control group exhibited higher abundance of Bifidobacterium, Achromobacter, and Escherichia/Shigella (FDR < 0.05). Furthermore, the polyps group and not-polyps groups displayed more complex co-occurrence networks than the control group. Conclusions: The results of our study provide compelling evidence supporting the associations between the vaginal microbiota and endometrial polypoid lesions, highlighting the potential correlation between a well-balanced vaginal microbial ecosystem and a healthy intrauterine environment.

FRI097 A Case Of Evolocumab-induced Transaminitis Revealing A Gastrointestinal Melanoma

Abstract Disclosure: C. Nava Suarez: None. J.V. Mayrin: None. J. Prater: None. W. Jiang: None. Introduction: Proprotein convertase subtilisin/Kexin type 9 (PCSK-9) inhibitors, like evolocumab, are anti-lipid drugs with potent lipid-lowering effect, potential cardiovascular benefits, and good tolerability. They are monoclonal antibodies directed against the PCSK-9 hepatic receptor decreasing serum LDL-cholesterol. Although PCSK-9 inhibitors are usually safe, transaminitis has been reported in the literature a few times. Little is known about the mechanism of action of this injury and many clinicians are not familiar with this complication. Currently, there are no guidelines for dose adjustment in patients with advanced liver disease, and conflicting data on their effect on patients with established liver disease is emerging. We report a case of acute and intermittent transaminitis with the use of evolocumab that lead to the discovery of malignant melanoma in the patient’s gallbladder and jejunum. Case: A 74-year-old male with a past medical history of dyslipidemia, type 2 Diabetes Mellitus, and cutaneous melanoma 9 years priorly presented for a routine follow-up. He had been on evolocumab for a year after developing statin-induced myalgias. His physical exam was unremarkable. Routine blood work revealed new onset transaminitis almost 5 times above the upper limit of normal with AST 174 IU/L and ALT 230 IU/L (40 IU/L and 44 IU/L respectively). The rest of his liver panel was unremarkable. A liver ultrasound showed a 5 cm hyperechoic polypoid lesion within the gallbladder. No signs of choledocholithiasis were seen, potentially explaining the lack of bilirubin elevation; hepatic steatosis without cirrhosis was also seen. Given its higher sensitivity, MRCP confirmed the gallbladder mass. Liver enzymes were trended for more than 80 days, and intermittent elevation of serum transaminases coincided with the administration of evolocumab with normalization of the transaminases in between episodes. An open cholecystectomy confirmed the diagnosis of malignant melanoma of the gallbladder with an incidental jejunal metastasis. Oncologic treatment was initiated. Serum transaminases normalized following discontinuation of evolocumab and remain normal. Conclusion: As this case illustrates, serial monitoring of transaminases can reveal the presence of liver injury after initiation of PCSK-9 inhibitors, and further investigation with specialized liver imaging should be considered to exclude other differential diagnoses. Currently, there is little known about the hepatotoxic effect of these drugs and researchers are currently looking for possible causes. Theoretical mechanisms of injury include autoimmune cross-reactivity like with other monoclonal antibodies or progression of chronic liver disease. Clinicians should be aware of this potential side effect even though it is not a common one, given that many patients who start treatment may have underlying liver disease. Presentation: Friday, June 16, 2023