Polypoid Lesions Research Articles

Case Report: Massive Hemoptysis From a Spontaneously Regression Inflammatory Bronchial Polyp

BackgroundBronchial inflammatory polyps are usually treated by surgical operation or with steroids and/or antibiotics, and it is quite rare that such polys spontaneously disappear without any treatment. This report shows a rare case with a bronchial inflammatory polyp which caused massive hemoptysis but spontaneously disappeared without any treatment.Case PresentationA 66-year-old man with type 2 diabetes mellitus and a history of cough and asthma suddenly developed massive hemoptysis while smoking and was brought to an emergency room in our institution. In bronchoscopy on admission, a polypoidal elevated lesion was observed in the left upper lobe bifurcation. Pulsatile hemorrhage from a polypoidal elevated lesion was observed upon stimulation of passage of the bronchoscope. Bronchoscopy performed 25 days after discharge showed no evidence of active bleeding and a tendency toward reduction of the elevated lesion. In bronchoscopy performed 106 days after the initial hospitalization, the bronchial inflammatory polyp completely disappeared.ConclusionsWe should bear in mind the possibility of spontaneous disappearance of bronchial inflammatory polyps causing some serious symptoms such as massive hemoptysis and repeated bloody sputum. Finally, we should select the best therapy for bronchial inflammatory polys based on each patient's background and conditions in clinical practice.

Short-term results for brolucizumab in treatment-naïve neovascular age-related macular degeneration: a Japanese multicenter study.

To investigate short-term treatment outcomes of intravitreal brolucizumab (IVBr) for treatment-naïve neovascular age-related macular degeneration (AMD) in a Japanese multicenter study. Retrospective case control study METHODS: The subjects were 58 eyes of 57 patients with neovascular AMD (43 men and 14 women, mean age 74.6years) of whom 43 eyes of 42 patients completed initial loading of 3 monthly IVBr injections and were followed for more than 3 months. Best-corrected visual acuity (BCVA) changes, anatomical outcomes, and complications were investigated. Of the 43 eyes that completed loading doses, the AMD subtype was type 1 and type 2 macular neovascularization (MNV) in 51%, polypoidal choroidal vasculopathy (PCV) in 42%, and type 3 MNV in 7%. At 3months after initiating treatment, BCVA significantly improved (P = 0.002) and central retinal thickness significantly decreased (P < 0.0001). At 3months, complete retinal and subretinal fluid resolution was achieved in 91% of all eyes and complete regression of polypoidal lesions was achieved in 82% of PCV eyes. Iritis occurred in 8 eyes of 8 patients (14%), but resolved using topical or subtenon corticosteroid injection without visual loss in all cases. IVBr for treatment-naïve neovascular AMD was effective in the short-term, achieving significantly improved BCVA, good retinal fluid resolution, and a high rate of polypoidal lesion regression. However, iritis was noted in 14% of patients which may limit use of this drug.

Unusual presentation of extra-nodal double-hit follicular lymphoma: a case report

BackgroundTo the best of our knowledge, this case represents the first report of an extranodal double-hit follicular lymphoma (DH-FL) as an intestinal polypoid lesion.Case presentationA 72-year-old woman presents with constipation. Colonoscopy reveals a sessile polypoid lesion of the colon bearing morphological, immunohistochemical and molecular hallmarks of DH-FL. Complete clinical staging and bone marrow biopsy showed no signs of disseminated disease. The patient, after two years of follow-up is still free of disease confirming the indolent behaviour of this limited lesion.ConclusionsA synoptic view at all the features of the patient and not merely at the molecular hallmarks of a disease are essential to establish the correct clinical approach.

One-year results of treat-and-extend regimen with intravitreal brolucizumab for treatment-naïve neovascular age-related macular degeneration with type 1 macular neovascularization

We evaluated 1-year outcomes of loading phase treatment followed by maintenance treatment using a treat-and-extend (TAE) regimen with intravitreal brolucizumab for neovascular age-related macular degeneration (nAMD) associated with type 1 macular neovascularization (MNV). We analyzed 68 eyes of 65 consecutive patients with treatment-naïve nAMD associated with type 1 MNV. Forty-five eyes (66.2%) completed the 1-year treatment with intravitreal brolucizumab. In those cases, best-corrected visual acuity (BCVA) showed significant improvement, while there were significant reductions in foveal thickness and central choroidal thickness, after the initial brolucizumab injection, which were maintained until the last visit. The average total number of injections over 1 year was 6.4 ± 0.6. The average intended injection interval at the last visit was 14.0 ± 2.9 weeks. Moreover, 17of 23 eyes (73.9%) with polypoidal lesions showed complete regression of these lesions after the loading phase treatment. Although intraocular inflammation (IOI) was observed in 15 of 68 eyes (22.1%) within 1 year, amelioration in response to combination therapy with topical and subtenon injection of steroids, without visual decline, was obtained. These results indicate that loading phase treatment followed by the TAE regimen with intravitreal brolucizumab might improve BCVA and ameliorate exudative changes in eyes with treatment-naïve nAMD associated with type 1 MNV. Moreover, intravitreal brolucizumab can potentially reduce the treatment burden of nAMD. Prompt steroid therapy might be efficacious for ameliorating brolucizumab-related IOI without visual decline.

One-year outcomes of intravitreal brolucizumab injections in patients with polypoidal choroidal vasculopathy

To evaluate the 1-year visual outcomes and anatomic responses of Japanese patients who received intravitreal brolucizumab (IVBr) injections for polypoidal choroidal vasculopathy (PCV). This was a retrospective study of 17 treatment-naïve eyes with PCV that were treated with IVBr. We evaluated the best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT) and number of injections for 1 year. The eradication of polypoidal lesions was also evaluated using by indocyanine green angiography during the 1-year follow-up. Non-infectious intraocular inflammation developed in two (11.8%) eyes; 15 eyes were assessed at the 1-year follow-up examination. The mean BCVA improved significantly from 0.28 at baseline to 0.13 (P < 0.05) at 1 year. The CMT and CCT decreased significantly after 1 year. The mean number of injections was 6.4 ± 0.13. The rate of complete resolution of polypoidal lesions at 1 year was 93.3%. A dry macula was achieved in 13 eyes (86.6%) after the loading phase and in 11 eyes (73.3%) at 1 year. The IVBr injections appeared to be effective for improving both functional and anatomic outcomes in Japanese patients with PCV, with a high regression rate of polypoidal lesions.

ASSOCIATION OF FLOW SIGNALS WITHIN POLYPS ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY WITH TREATMENT RESPONSES AFTER COMBINATION THERAPY FOR POLYPOIDAL CHOROIDAL VASCULOPATHY.

To evaluate the changes of blood circulation within the polypoidal lesions by OCT angiography in eyes with polypoidal choroidal vasculopathy after combination therapy with aflibercept and photodynamic therapy. A total of 46 eyes from 46 patients who underwent the combination therapy for polypoidal choroidal vasculopathy were followed for more than 6 months. OCT angiography, covering an area 6 mm2 × 6 mm2 including the macula, were performed at baseline, 2 weeks, and 3 months and 6 months post-treatment. The subretinal fluid resolved within 3 months after treatment in 44 eyes (95.7%), and 27 eyes (58.7%) showed no recurrence, with no additional treatment. Seventeen eyes (37.0%) showed recurrence, and two eyes (4.3%) showed poor response. On OCT angiography at 2 weeks after treatment, flow signals were detected in 3 of 27 eyes (11.1%) without recurrence and in 8 of 19 eyes (42.1%) with recurrence or poor responses. A detectable flow signal at 2 weeks was significantly associated with recurrence or poor response (P = 0.032). Persistent flow signals within polyps on OCT angiography at 2 weeks after combination therapy suggest less effectiveness of the initial treatment.

Incidental finding of a large polypoidal gallbladder mass diagnosed as papillary adenocarcinoma - A case report.

Introduction and importanceLesions which project from the gallbladder wall into its lumen are known as gallbladder polyps. Nearly 5% of all adults have gallbladder polyps, the majority are pseudo-polyps with no neoplastic potential. Although gallbladder polyps are commonly found in cholecystectomy specimen, only a very few gallbladder polyps present as carcinoma in a polypoid lesion.Case presentationA 48 years old male patient came for a routine health checkup and ultrasonography (USG) of abdomen showed incidental finding of a polypoid lesion measuring 43 × 28 mm in the gallbladder. Computed tomography scan revealed a soft tissue mass of similar size almost filling the lumen of the gallbladder and showed notable enhancement in post-contrast images. The mass was concluded to be suggestive of gallbladder carcinoma. Extended radical cholecystectomy was performed and histopathological examination of the polypoid lesion showed papillary adenocarcinoma with tumor staging of T2b.Clinical discussionThe prevalence of polypoid lesions of the gallbladder are reported to be 2–12% of all cholecystectomy specimens. Gallbladder polyps are one of the common USG findings in general population. It is difficult to differentiate between the benign and malignant polypoid lesions of the gallbladder solely depending on imaging studies. A size larger than 10 mm is the best indicator of malignancy. The most common malignant gallbladder polyp is adenocarcinoma.ConclusionIn majority of the cases, gallbladder polyp is an incidental finding. Even though most of the gallbladder polyps are benign in nature, cholecystectomy is the treatment of choice if the suspicion for malignancy is high.

Congenital Urethral Polyp as Cause of Urinary Retention in the Pediatric Population. Presentation of a Rare Case

Urethral polyps (UPs) constitute a rare congenital disease in the pediatric population. They are benign lesions that are associated with a great variety of symptoms including dysuria, decreased urine stream, urinary retention, urinary tract infections, vesicourethral reflux, and even enuresis. The aim of this study was to present one case of a UP in a 20-month-old boy. The boy was referred to the emergency department of a pediatric hospital due to acute urinary retention. The performed ultrasound detected an increased bladder wall and the presence of a bladder diverticulum. In addition, in the voiding cystourethrogram, a filling defect in the posterior urethra was noticed. The performed urethrocystoscopy detected one polypoid lesion of about 1 cm in length which was excised using an 11F resectoscope. The patient was followed up for 6 years without recurrence or additional symptoms.

An Unexpected Finding on Screening Colonoscopy in a Patient With Chronic Myelogenous Leukemia

Question: A 64-year-old woman presented for screening colonoscopy. Her only medical history included chronic myelogenous leukemia (CML) diagnosed 1 year prior that was improving and in the chronic phase with dasatinib 50 mg/d. She denied taking any other medications. The patient denied having any prior colonoscopies or any family history of colorectal cancer. She also denied any melena or hematochezia. She did report weight loss, which she attributed to her CML. On colonoscopy, multiple small polyps were seen throughout the colon ranging from 3 to 6 mm that were too numerous to count (Figure A). The polyps were friable and seemed to have mucous caps. A few of these polyps were removed from the transverse and sigmoid colon for pathological analysis (Figure B and C). What is the diagnosis? Look on page 58 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Inflammatory reactive polyposis caused by dasatinib is a rare phenomenon and has only been described once in the Japanese literature.1Kobayashi M. Ikezawa K. Yamaura M. et al.[Inflammatory reactive polyposis caused by dasatinib: a case report].Nihon Shokakibyo Gakkai Zasshi. 2018; 115 ([In Japanese]): 977-984PubMed Google Scholar Our patient had polyps with mucoid discharge similar in appearance to those described in the Japanese paper. It was determined that the patient’s polyposis was caused by inflammation that was triggered by dasatinib. Four months after discontinuing dasatinib in the Japanese patient, a repeat colonoscopy revealed significant improvement in the polypoid lesions. In the case of our patient, we did not advise discontinuing dasatinib because she was on a low dose and did not tolerate other therapies for CML. The patient remained asymptomatic on follow-up. To our knowledge, this is the first case of dasatinib-induced inflammatory polyposis described in the English literature. Cases of hemorrhagic colitis secondary to dasatinib already exist. With dasatinib becoming a widely used therapy for Imatinib resistant CML, it is prudent to monitor for complications. Dasatinib is taken orally, making the gastrointestinal tract particularly vulnerable to complications. It is important to be aware of the inflammatory effects of dasatinib and this warrants further laboratory and clinical studies.2Nakamura S. Kino I. Akagi T. Inflammatory myoglandular polyps of the colon and rectum. A clinicopathological study of 32 pedunculated polyps, distinct from other types of polyps.Am J Surg Pathol. 1992; 16: 772-779Crossref PubMed Scopus (63) Google Scholar It is unknown if prolonged polyposis owing to dasatinib is a benign process or may eventually result in malignancy3Fei F. Yu Y. Schmitt A. et al.Dasatinib inhibits the proliferation and function of CD4+CD25+ regulatory T cells.Br J Haematol. 2009; 144: 195-205Crossref PubMed Scopus (60) Google Scholar The mechanism of polyposis has also not yet been elucidated and it is necessary to accumulate more cases to further our understanding. Therefore, it is important to offer screening colonoscopies to these patients at regular intervals.

Beyond borders: A case report of small bowel obstruction secondary to undiagnosed florid endometriosis.

Introduction and importanceEndometriosis is a gynecological condition referring to the presence of endometrial tissue outside the endometrium with the potential of progressing to malignancy. It mostly affects pelvic organs; however, it has been described beyond the pelvis. In 10% of cases it occurs in the bowel, mostly rectum and sigmoid. Involvement of the small bowel is rare. Here we report endometriosis of the terminal ileum and appendix in a patient with no previous diagnosis of endometriosis.Case presentationWe describe a case of a 39-year-old-female who presented with abdominal pain, nausea and vomiting to the emergency department. This was on background history of intermittent abdominal pain every 2 weeks for the previous 5 months. Further investigation with computed tomography (CT) of the abdomen and pelvis showed small bowel dilatation with a polypoidal lesion obstructing the terminal ileum. On colonoscopy, no intraluminal lesions were identified in the terminal ileum. The patient underwent right hemicoloectomy. Histopathological results revealed endometriosis. The patient had uneventful recovery post-operatively and at her follow-up review at 4 weeks and 2 months from surgery.DiscussionThe presentation of endometriosis of the bowel is highly variable and difficult to diagnose pre-operatively. Due to lack of specific diagnostic measures, surgical resection and histology can be the only reliable way for first-time endometriosis diagnosis presenting as small bowel obstruction.ConclusionExtra-pelvic endometriosis should be considered as the cause of small bowel obstruction in the absence of other causes of bowel obstruction in young female patients.

Development and Validation of a Preoperative Nomogram for Predicting Benign and Malignant Gallbladder Polypoid Lesions.

PurposeThe purpose of this study was to develop and validate a preoperative nomogram of differentiating benign and malignant gallbladder polypoid lesions (GPs) combining clinical and radiomics features.MethodsThe clinical and imaging data of 195 GPs patients which were confirmed by pathology from April 2014 to May 2021 were reviewed. All patients were randomly divided into the training and testing cohorts. Radiomics features based on 3 sequences of contrast-enhanced computed tomography were extracted by the Pyradiomics package in python, and the nomogram further combined with clinical parameters was established by multiple logistic regression. The performance of the nomogram was evaluated by discrimination and calibration.ResultsAmong 195 GPs patients, 132 patients were pathologically benign, and 63 patients were malignant. To differentiate benign and malignant GPs, the combined model achieved an area under the curve (AUC) of 0.950 as compared to the radiomics model and clinical model with AUC of 0.929 and 0.925 in the training cohort, respectively. Further validation showed that the combined model contributes to better sensitivity and specificity in the training and testing cohorts by the same cutoff value, although the clinical model had an AUC of 0.943, which was higher than 0.942 of the combined model in the testing cohort.ConclusionThis study develops a nomogram based on the clinical and radiomics features for the highly effective differentiation and prediction of benign and malignant GPs before surgery.

A Small Colonic Pedunculated Polypoid Lesion in the Context of Diverticulosis: The Ring-a-bell Sign.

A Small Colonic Pedunculated Polypoid Lesion in the Context of Diverticulosis: The Ring-a-bell Sign.

Histopathological Study of Gastric Polypoid Lesions in Patients Referred to Shahid Sadoughi Hospital in Yazd from 2011-2016

Introduction: The aim of this study was to evaluate the histopathology of gastric polypoid lesions in the patients and its relationship with gender, age and the size of the lesion in the patients referred to Yazd Shahid Sadoughi Hospital in Yazd City.&#x0D; Methods: This was a descriptive cross-sectional study. Sampling method was census; the records of all the patients with diagnosis of polypoid gastric lesions during the years 2011-2016 were examined. Among these, the information of 102 patients with a diagnosis of gastric polypoid lesion in the pathology examination, including the type of lesion, anatomical location and size along with gender and age was recorded in SPSS software version 16. Data analysis were run through Chi – square test, t test and ANOVA.&#x0D; Results: In this study, 52% of the patients were in the age group of 50-69 years. The most frequency was related to the female sex (67.6%), the most common lesions were hyperplastic polyp (56.9%) and polypoid gastritis (17.6%).The most common location of lesions was antrum (35.3% ) and the lowest prevalence was fundus (11.8%). Most polypoid lesions of the stomach were 5-9 mm in size. The results showed that different types of lesions differed significantly in size (P=0.019) and there was no significant relationship between age group and type of lesion (P=0.418), sex and type of lesion (P=0.053).&#x0D; Conclusion: From the results of this study, it is concluded that the most common type of gastric polyoid lesion is hyperplastic polyp and the most common location is the antrum. The largest polyp is inflammatory fibroid polyp.&#x0D;

Gastrointestinal: Endoscopic ultrasound of rectal subepithelial lesion mimicking gastrointestinal stromal tumor.

A 60-year-old man presented with anorexia, weight loss, and constipation for 3 months. On peri-rectal examination, a bulge was palpated in the rectum. He underwent colonoscopy, which showed large subepithelial lesion (SEL) starting from anorectal junction extending proximally till rectosigmoid junction obliterating the lumen without complete obstruction (Fig. 1a). Contrast-enhanced computed tomography of the pelvis showed a large lobulated heterogeneous enhancing soft tissue lesion within the rectum (Fig. 1b). Endoscopic ultrasound (EUS) was performed, which showed a large well defined lobulated hetero-echoic lesion (70 × 63 mm) with multiple cystic spaces in peri-rectal area (Fig. 1c). Possibility of rectal malignant gastrointestinal stromal tumor (GIST) was considered looking at CT and EUS image. To confirm our diagnosis, EUS-guided fine needle aspiration (FNA) was performed. During FNA, dark brownish fluid was aspirated (Fig. 2a). Possibility of bleed within tumor was considered because of dark brownish fluid aspiration; however, black pigments were noticed on slide preparation (Fig. 2b). Histopathological examination showed pleomorphic cells with abundant brownish pigment with multinucleation suggestive of malignant melanoma (Fig. 2c). Patient was advised for surgery and referred to the surgeons. Malignant melanoma is an extremely rare and aggressive tumor of the rectum. It accounts for 0.5–4% of all anorectal malignancies and < 1% of all melanomas. It is most common site of primary gastrointestinal melanoma followed by stomach, small intestine, and colon. Patients usually present in the fifth or sixth decade, and it is more common in female patients. Anorectal melanomas usually appear as ulcerated polypoidal lesions rather than SEL. EUS is an important diagnostic tool in diagnosis and differentiation of SEL. There is lack of characterization of anorectal melanoma on EUS because of rarity of tumor. Yonal et al. described the EUS morphological features of esophageal melanoma as iso to hypoechoic solid tumor mass with variable areas of internal hyper-echogenicity and anechoic cystic spaces, similar to the findings from our case. Morphological features of some SELs are confusing; therefore, EUS FNA plays an important role in differentiation of SELs. Therapy in anorectal melanomas is dictated by the local staging of disease and also the presence of lymph node and distant metastases. Multidisciplinary approach is required depending on the stage of tumor. Surgery has been the mainstay of treatment for anorectal melanoma. Although these tumors are usually radio-resistant and chemo-resistant, combination of chemotherapy and immunotherapy remains a therapeutic option for advanced metastatic disease. Overall, 5-year survival is only 3–22%, and survival in recurrent or metastatic disease is less than 10 months. Although a rare entity, anorectal melanoma can mimic GIST and may be a differential during the evaluation of rectal SEL. Early diagnosis of tumor is of paramount importance for favorable prognosis.

Clinical analysis of 44 cases of atypical polypoid adenomyoma of the uterus

BackgroundAtypical polypoid adenomyoma (APA) is a rare intrauterine polypoid lesion that occurs predominantly in premenopausal women. Although APA was previously considered a benign lesion and treated conservatively, an increasing number of cases show that APA has a high rate of recurrence or residual disease and that it precedes the development of carcinoma. The clinical management of APA remains to be established. The aim of this study was to analyse the clinicopathological features of APA and discuss its diagnosis and prognosis.MethodsForty-four patients with APA were admitted to Beijing Obstetrics and Gynecology Hospital from 2005 to 2019, and their clinical and histopathologic features were evaluated. B-ultrasound was performed, and all the patients (n = 44) underwent hysteroscopy. Endometrium excision was performed by means of the four-step diagnosis and treatment method. Hysteroscopic transcervical resection (TCR) was performed in 5 patients with APA-H and 11 with APA-L. Except for one patient who underwent transcervical endometrial resection, all the patients underwent hysterectomy and salpingectomy or salpingo-oophorectomy. Data from a median follow-up of 42 months (ranging from 3 to 174 months) were available for these patients.ResultsPathological diagnosis were made according to the degree of abnormality of the APA surface glands, resulting in APA-L in 36 patients and APA-H in 8 patients. Among these patients, 28 (25 APA-L and 3 APA-H) were treated conservatively. The effect of the four-step diagnosis and treatment method as an APA therapy was excellent. During the follow-up, no evidence of recurrence was found.ConclusionsFor patients with intracavitary lesions > 1 cm, the hysteroscopic four-step diagnosis and treatment method and pathological diagnosis are the basis of clinical treatment. More than 30% of APA surface glands have complex structures characterized by branching and budding or other high-risk factors, such as endometrial hyperplasia, which are indications for hysterectomy. For patients who desire to become pregnant or to preserve the uterus, hysteroscopy with complete excision of the lesions should be the preferred treatment method. The patients should be treated and followed up closely with regular hysteroscopy and endometrial biopsy.

SMALL AS WELL AS LARGE COLORECTAL LESIONS ARE EFFECTIVELY MANAGED BY ENDOSCOPIC MUCOSAL RESECTION TECHNIQUE.

Endoscopic mucosal resection (EMR) is an easy-to-use treatment option for superficial colorectal lesions, including lesions ≥20 mm. To evaluate the effectiveness of EMR. We evaluated 430 lesions removed by EMR in 404 patients. The lesions were analyzed according to their morphology, size, location, and histology. Lesions <20 mm were resected en bloc, whereas lesions ≥20 mm were removed by piecemeal EMR (p-EMR). Adverse events and recurrence were assessed. Regarding morphology, 145 (33.7%) were depressed lesions, 157 (36.5%) were polypoid lesions and 128 (29.8%) were laterally spreading lesions, with 361 (84%) lesions <20 mm and 69 (16%) ≥20 mm. Regarding histology, 413 (96%) lesions were classified as neoplastic lesions. Overall, 14 (3.3%) adverse reactions occurred, most commonly in lesions removed by p-EMR (P<0.001) and associated with advanced histology (P=0.008). Recurrence occurred in 14 (5.2%) cases, more commonly in lesions removed by p-EMR (P<0.001). EMR is an effective technique for the treatment of superficial colorectal lesions, even of large lesions.

Bifocal intracholecystic tubulopapillary neoplasm: A rare and distinct tumor of the gallbladder.

Intracholecystic papillary‐tubular neoplasms are rare precancerous and polypoid lesions of the gallbladder, found in nearly 0.4% of cholecystectomy specimens. They follow the adenoma‐carcinoma sequence. About half the cases are associated with invasive carcinoma. Their diagnosis relies on histopathological examination with extensive sampling of the surgical specimen.

A168 UTILITY OF FOLLOW-UP PANCOLONIC DYE SPRAY CHROMOENDOSCOPY FOR THE DETECTION AND TREATMENT OF DYSPLASTIC LESIONS IDENTIFIED DURING HIGH-DEFINITION WHITE-LIGHT ENDOSCOPY IN PATIENTS WITH COLONIC INFLAMMATORY BOWEL DISEASE

Abstract Background Patients with inflammatory bowel disease (IBD) involving the colorectum are at higher risk for the development of flat and poorly delineated dysplastic lesions. Pancolonic dye spray chromoendoscopy (DCE) can represent an adjunct to white light endoscopy (WLE) that enhances detection and delineation of such lesions. Aims We evaluated the utility of follow-up DCE for lesion detection and treatment in patients with IBD who had visible (polypoid or flat lesions) or invisible (identified in non-targeted biopsies) dysplasia detected during high-definition (HD)-WLE. Methods We retrospectively studied patients with colonic IBD from The Ottawa Hospital who underwent DCE by a trained endoscopist, as follow-up for dysplasia detected during HD-WLE, over a 7-year time period (2013–2020). We collected demographic and disease-specific variables. Results Twenty-four patients were included (mean age 56.7±13.8 years, 50.0% male, 70.8% ulcerative colitis, mean disease duration 18.0±11.0 years, 70.8% moderate or severe disease activity historically, and 41.7% remote history of dysplasia). Seventeen (70.8%) patients were referred following detection of invisible dysplasia; the remainder (29.2%) were referred for surveillance of poorly defined visible dysplastic lesions. For those referred following detection of invisible dysplasia, DCE identified visible dysplasia at the same site in 8/17 (47.1%) patients, at a different site in 6/17 (35.3%) patients, and no dysplasia in 3/17 (17.6%) patients. DCE identified 1.39±1.50 new visible dysplastic lesions per patient that were not identified on index HD-WLE. DCE upgraded the highest grade of dysplasia and diagnosed colorectal cancer in 2/24 (8.3%) patients, which was missed on index HD-WLE. Endoscopic resection was successful in 23/34 (76.7%) dysplastic lesions identified on DCE. However, DCE was unable to facilitate lesion resection in three patients due to advanced lesion characteristics. Follow-up data was available for 17/24 (70.8%) patients (mean 0.88±0.58 years). Of these patients, 7/17 (41.2%) developed subsequent dysplasia, including 4/17 (23.5%) at a site of prior invisible dysplasia, 2/17 (11.8%) at sites of prior visible dysplasia, and 1/17 (5.88%) at a different site. One of these patients developed high-grade dysplasia requiring resection. Conclusions In this study, DCE is a valuable tool for dysplasia detection and treatment in persons with colonic IBD who have ill-defined dysplasia identified during HD-WLE. Given some patients developed dysplasia following DCE in our cohort, it is important to maintain close follow-up and obtain biopsies around sites of prior invisible and visible dysplasia. Further studies are required to validate our findings. Funding Agencies None

Hyaluronidase-1-mediated glycocalyx impairment underlies endothelial abnormalities in polypoidal choroidal vasculopathy

BackgroundPolypoidal choroidal vasculopathy (PCV), a subtype of age-related macular degeneration (AMD), is a global leading cause of vision loss in older populations. Distinct from typical AMD, PCV is characterized by polyp-like dilatation of blood vessels and turbulent blood flow in the choroid of the eye. Gold standard anti-vascular endothelial growth factor (anti-VEGF) therapy often fails to regress polypoidal lesions in patients. Current animal models have also been hampered by their inability to recapitulate such vascular lesions. These underscore the need to identify VEGF-independent pathways in PCV pathogenesis.ResultsWe cultivated blood outgrowth endothelial cells (BOECs) from PCV patients and normal controls to serve as our experimental disease models. When BOECs were exposed to heterogeneous flow, single-cell transcriptomic analysis revealed that PCV BOECs preferentially adopted migratory-angiogenic cell state, while normal BOECs undertook proinflammatory cell state. PCV BOECs also had a repressed protective response to flow stress by demonstrating lower mitochondrial functions. We uncovered that elevated hyaluronidase-1 in PCV BOECs led to increased degradation of hyaluronan, a major component of glycocalyx that interfaces between flow stress and vascular endothelium. Notably, knockdown of hyaluronidase-1 in PCV BOEC improved mechanosensitivity, as demonstrated by a significant 1.5-fold upregulation of Krüppel-like factor 2 (KLF2) expression, a flow-responsive transcription factor. Activation of KLF2 might in turn modulate PCV BOEC migration. Barrier permeability due to glycocalyx impairment in PCV BOECs was also reversed by hyaluronidase-1 knockdown. Correspondingly, hyaluronidase-1 was detected in PCV patient vitreous humor and plasma samples.ConclusionsHyaluronidase-1 inhibition could be a potential therapeutic modality in preserving glycocalyx integrity and endothelial stability in ocular diseases with vascular origin.

Clinicopathological study of the polypoidal lesions of polypoidal choroidal vasculopathy.

To investigate the pathogenic features of the polypoidal lesions from the specimens of polypoidal choroidal vasculopathy extracted from human subjects. Seven specimens of polypoidal lesions extracted from five eyes of six patients (mean age, 60.16 ± 10.41years) of polypoidal choroidal vasculopathy were examined. The polypoidal lesions were obtained by surgical excision. Thereafter, a histopathological analysis of the specimens was performed. The polypoidal lesions were oval nodules located underneath the retinal pigment epithelium. A pathological study of the lesions revealed that Bruch's membrane schisis was observed in all specimens and they were all located in the Bruch's membrane. The Bruch's membrane schisis and serosanguineous materials constituted the main structure of the lesions in five of the seven specimens, with small vessels being observed in two specimens. One specimen was composed of two polypoidal lesions of different characteristics, and one specimen had a neovessel membrane complex with several polypoidal lesions. Inflammatory cells and blood vessels were observed in the polypoidal lesion of the specimen with neovessel membrane complex. Polypoidal lesions of polypoidal choroidal vasculopathy are abnormalities of the Bruch's membrane. The lesions are characterized by the Bruch's membrane schisis, which is filled with serosanguineous materials. The lesions are progressive and may contain inflammatory cells and blood vessels.