Polypoid Lesions Research Articles

Pathological features of pyloric gland adenoma of the gallbladder in comparison with gastric subtype of intracholecystic papillary neoplasm

Background and aimsPyloric gland adenoma (PGA) of the gallbladder is a polypoid, preinvasive epithelial neoplasm composed of uniform back-to-back, pyloric glands in a tubular configuration. Intracholecystic papillary neoplasm (ICPN), another preinvasive grossly visible neoplasm of the gallbladder, is subdividable into four subtypes, including gastric subtype. In this study, PGA was reappraised referring to gastric subtype of ICPN (gICPN). Materials and methodsPGA and gICPN pathologically defined by WHO 2019 classification were surveyed in a total of 104 cases of gallbladder epithelial neoplasms of our Hospital (2002 January to 2021 May) and were pathologically and immunohistochemically compared. ResultsPGA (7 cases) was characterized by i) a well-demarcated, polypoid lesion and ii) packed tubular components resembling pyloric glands. gICPNs (14 cases) were subdivided into i) pyloric gland predominant (2 cases), ii) foveola predominant (6 cases) and iii) mixed foveola and pyloric gland type (6 cases). gICPNs were also divided into a solitary, polypoid lesion with well demarcation from the surrounding mucosa (5 cases) and a conglomerated polypoid and granular lesions with poor demarcation (9 cases). PGA shared gross and histologic features with solitary, polypoid gICPNs, and PGA could be regarded as solitary gICPN predominantly composed of pyloric glands. Nuclear expression of β-catenin was found in 6 of 7 PGA, but absent in gICPN, including solitary, polypoid gICPN. ConclusionPGA could correspond to a solitary gICPN mainly composed of pyloric glands, but may undergo a different molecular pathway from gICPN.

Endoscopic transcecal appendectomy: a new endotherapy for appendiceal orifice lesions.

Background Endoscopic transcecal appendectomy (ETA) has been reported as a minimally invasive alternative procedure for lesions involving the appendiceal orifice. The aim of this case series study was to evaluate the feasibility, safety, and effectiveness of ETA for lesions at the appendiceal orifice. Methods This retrospective study included consecutive patients with appendiceal orifice lesions who underwent ETA between December 2018 and March 2021. The primary outcome was technical success. The secondary outcomes included postoperative adverse events, postoperative hospital stay, and recurrence. Results 13 patients with appendiceal orifice lesions underwent ETA during the study period. The median lesion size was 20 mm (range 8–50). Lesions morphologies were polypoid lesions (n = 5), laterally spreading tumors (n = 4), and submucosal lesions (n = 4). Technical success with complete resection was achieved in all 13 cases. There were no postoperative bleeding, perforation, or intra-abdominal abscess. The median length of hospital stay after ETA was 8 days (range 6–18). There was no tumor recurrence during a median follow-up of 17 months (range 1–28). Conclusions ETA is feasible, safe, and effective for complete resection of appendiceal orifice lesions. Larger, multicenter, prospective studies are needed to further assess this technique.

Polypoid Lesion on the Palm: Answer.

Polypoid Lesion on the Palm: Answer.

T and genetic variations between Asian and Caucasian polypoidal choroidal vasculopathy

PurposeTo compare phenotypic and genetic variations in polypoidal choroidal vasculopathy (PCV) between Caucasian and Asian patients.MethodsWe analysed phenotypic and genotypic data from two sites, Association for Innovation and Biomedical Research...

Inverted colonic diverticulum mimic colon polyp: A case report and review

AbstractInverted colonic diverticula (ICD) are infrequent colonoscopy findings and usually can be misdiagnosed as colon polyps. Further endoscopic intervention including biopsy or polypectomy is dangerous and might lead to severe complications. We report a case of inverted colonic diverticulum mimic colon polyp, characteristics with Aurora rings surrounding the lesion and these rings were enhanced by narrow‐band imaging. Besides, the polypoid lesion was reverted to a typical diverticular appearance after direct water jet. Endoscopists should be aware of the possibility of ICD and be familiar with the endoscopic characteristics and maneuvers for different diagnoses of ICD from colon polyps to avoid unnecessary dangerous intervention.

Evolution of Polypoidal Lesions after Treatment of Polypoidal Choroidal Vasculopathy.

PurposeTo evaluate the status and evolution of polypoidal lesions during the course of treatment of patients with symptomatic macular polypoidal choroidal vasculopathy (PCV).DesignComparative cohort study of randomly selected patients from a multicenter, randomized controlled clinical trial.ParticipantsThirty randomly selected patients from the EVEREST II study who were treated with combination ranibizumab and verteporfin photodynamic therapy (n = 15) or ranibizumab monotherapy (n = 15).MethodsAll patients were randomized at baseline and treated with a standardized treatment protocol. Indocyanine green angiography (ICGA) images were graded at the central reading center at baseline and months 3, 6, 12, and 24. Polypoidal lesions present at baseline were overlaid on ICGA images at subsequent visits to determine if these remained perfused or had regressed completely. New polypoidal lesions occurring at subsequent visits were similarly tracked to detail the evolution of each polypoidal lesion.Main Outcome MeasuresComplete polypoidal lesion regression over time.ResultsComplete polypoidal lesion regression was higher in the combination therapy group compared with the monotherapy group at all visits (month 12, 12 of 15 patients [80%] vs. 5 of 14 patients [35.7%]; P = 0.016). Persistence of baseline polypoidal lesions was lower in the combination therapy group: 1 of 15 patients (6.7%) versus 7 of 14 patients (50%) in the monotherapy group at month 12. Recurrences of polypoidal lesions that had regressed completely at an earlier time point were uncommon: 0% in the combination therapy group and 1 patient each at months 6 and 12 in the monotherapy group. Fewer new polypoidal lesions (arising after the baseline visit) were found in the combination therapy group at all visits (combination therapy: 2 of 15 [13.3%] vs. monotherapy: 4 of 14 eyes [28.6%] at month 12). Total polypoidal lesion area was significantly smaller in the combination therapy group compared with the monotherapy group throughout the study (0.013 mm2 vs. 0.110 mm2; P < 0.01 at month 12).ConclusionsCombination therapy was associated with higher rates of complete polypoidal lesion regression and fewer persistent polypoidal lesions compared with monotherapy. Closed polypoidal lesions rarely reopened, regardless of the treatment.

Antrochaonal Polyp in a 4 Years Old Child

Antrochoanal polyp (ACP) is a benign, solitary polypoidal lesion arises from the maxillary antral mucosa that traverses through the ostium to the choana extending in a variable extent to the naso/oropharynx. It is usually unilateral and appears mainly in adults and rarely in children. It should be on differential diagnosis of any patients with nasal obstruction and chronic nasal discharge. Nasal endoscopy, computed tomography (CT), cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) are the main diagnostic techniques. Complete endoscopic surgical removal from the antral portionis recommended to prevent recurrence. Here a 4-year-old child of antrochoanal polyp that underwent functional endoscopic sinus surgery (FESS) with complete clearance from the maxillary antrum is presented. Bangladesh J Otorhinolaryngol 2021; 27(2): 188-193

An Unusual Gastric Polyp: Brunneroma.

ABSTRACTBrunneromas or polypoid hamartomas are benign lesions arising from Brunner glands. They are usually benign lesions with low potential for malignancy. They are usually located in the duodenum and manifest with different unspecific symptoms, such as abdominal pain, nausea, or bloating. Other more serious manifestations are also reported in the literature that are related to the size of the lesion. Usually, they are treated with endoscopic resection, with some lesions requiring surgical intervention. We present a case of a gastric antral polypoid lesion that was consistent with Brunneroma on histology.

Filiform polyposis in a 20-year-old patient with ulcerative colitis – a rare occurrence

Abstract Introduction/Objective Filiform polyposis (FP), also referred as inflammatory polyposis or pseudopolyposis, is an uncommon benign entity usually diagnosed in patients with history of Crohn’s disease, ulcerative colitis, interstitial tuberculosis or histiocytosis X. It is characterized by multiple finger-like mucosal projections/pseudopolyps seen more commonly in transverse and descending colon. Pathogenesis of FP is uncertain but it is hypothesized to be reactive process to chronic inflammation leading to formation of fingerlike projections. The term filiform polyposis was coined in 1974 by Appleman HD and his collegues to describe numerous long slender worm-like (filiform) colonic lesions seen in radiographs. Herein, we are going to present a case of FP diagnosed in a 20-year-old male with history of medically refractive ulcerative colitis. Methods/Case Report The patient is a 20-year-old male, with a history of medically refractive ulcerative colitis on systemic steroids and vedolizumab. He underwent sigmoidoscopy and colonoscopy which reveals multiple pedunculated, polypoid lesions, ranging from 0.5 to 3 cm in length with white tips (cap of purulent mucous). Patient underwent total abdominal colectomy with end ileostomy. The specimen received by our deparment consist of a segment of right colon (63 cm in length, 3.5 cm in diameter) with attached ileum (3 cm in length, 2 cm in diameter) and appendix (6 cm in length, 0.8 cm in diameter). The part of the right colon is constricted/strictured measuring 24 cm in length, 2 cm in diameter. Opening reveals numerous (&amp;gt;100) pedunculated, finger-like polypoid lesions measuring from 0.3 cm to 2 cm in length. The lesions involve the entire right colon including distal colonic surgical margin. Appendix and ileum are not involved by the lesion and grossly unremarkable. Microscopic evaluation of the lesions reveal acute and chronic inflammatory cells, granulation tissue, areas of necrosis and reactive changes with focal mucosal atrophy consistent with chronic ulcerative colitis. Results (if a Case Study enter NA) NA Conclusion Filiform polyposis (FP) is an uncommon benign entity commonly seen in association with Inflammatory Bowel Diseases. Diagnosing FP requires comprehensive gross and microscopic examination as well as review of clinical history and imaginig studies. Because of its uncommon nature, we recommend to report this entity to raise awareness and to educate the pathologists who have not diagnosed it before.

Clinical and imaging features of carcinosarcoma of the uterus and cervix

AimThe purpose of our study was to analyze the clinical and imaging features of uterine carcinosarcoma (UCS) and cervical carcinosarcoma (CCS), and to explore the diagnostic and staging accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) examinations.Methods41 patients including 37 with UCS and 4 with CCS from July 2011 to September 2020 were enrolled in the study. Of the 37 UCS cases, 7 had CT images, 27 had MRI images, and 3 had both CT and MRI images. The Clinical data, CT or MRI imaging findings were analyzed. Diagnosis and staging accuracy of CT and MRI images were also analyzed.ResultsCarcinosarcoma usually occurs in postmenopausal women (40/41), with the typical clinical symptom being vaginal bleeding (33/41). The CA125 degree was significantly different between the two invasion depth groups (p = 0.011). Most uterine carcinosarcomas showed unclear boundaries, uneven density, low or equal signal on T1WI, high or mixed signal on T2WI, uneven high signal on diffusion-weighted image (DWI), and mild enhancement. The diagnostic accuracies of CT and MRI for carcinosarcoma were 0% and 3.33%, respectively. The diagnostic accuracy for malignant tumors on CT and MRI was 50% and 83.33%, respectively.ConclusionsCarcinosarcoma lesions presented with huge mass filling in the cavity, and some presented with small polypoid lesions or endometrial thickening. Evaluation of lymph node metastasis is a significant challenge for imaging staging.

1033 Endobronchial Sclerotic Neurofibroma: A Case Report of a Very Rare Benign Tumour

Abstract Introduction Endobronchial neurofibromas are exceedingly rare benign lesions most commonly originating at the trachea. Primary pulmonary tumours of neurogenic origin such as peripheral nerve sheath tumours (PNSTs) are extremely rare, accounting for less than 0.2% of all lung tumours. Intrathoracic PNSTs are usually benign and are commonly found in the posterior mediastinum as schwannomas with female preponderance. We present the first reported occurrence of the sclerotic variant of endobronchial neurofibroma and the approach used in its definitive investigation and management. Case Report A 69-year-old Caucasian male with a 66 pack-year smoking history and a background of alcohol induced liver cirrhosis, peripheral vascular disease and dilated cardiomyopathy presented with dyspnoea and fatigue with severe normocytic anaemia. Computed Tomography (CT) chest, abdomen and pelvis revealed an indeterminate nodule at the secondary carina projecting into the bronchus intermedius (BI). Fibreoptic bronchoscopy showed a polypoid lesion with a vascular appearance. Under general anaesthetic, combined fibreoptic and rigid bronchoscopy was used to remove the lesion with rigid forceps. Gross histological appearance showed an 8x6x5mm pedunculated lesion with a 2mm diameter short stalk and histology of a sclerotic neurofibroma with fibroblasts and collagen, positively staining for S100 and LP10. This patient is due for follow up in 6-month with a CT chest to ensure no tumour recurrence. Conclusions Endobronchial neurofibromas appear highly vascular and demand extra caution at bronchoscopic intervention. Prompt, experienced thoracic surgical and intervention pulmonology input should always be sought. Combined approach of fibreoptic and rigid bronchoscopy allows better control of potential bleeding and the airway.

Optical coherence tomography angiography analysis of aneurismal type 1 neovascularization in a cohort of white patients.

To evaluate the detection rate of aneurysmal type 1 neovascularization (AT1) in Caucasian patients using optical coherence tomography angiography (OCTA) and to describe OCTA characteristics of AT1 in a cohort of white patients. We conducted an observational retrospective study in 44 eyes of 43 patients with AT1. All patients underwent a complete ophthalmologic examination, including fundus imaging, indocyanine green angiography, optical coherence tomography, and OCTA. Branching vascular network (BVN) and polyp detection rates by OCTA were evaluated. Furthermore, we described BVN and polyp morphologies on en face OCTA and flow of polyps on B-scan OCTA. En face OCTA revealed BVN in 84.09% of cases and polypoidal lesions in 86.36% of cases. B-scan OCTA showed BVN and polyps in 95.45% and 93.18% of the patients, respectively. "Trunk" BVNs (51.35%) and "ring" polyps (47.37%) were the most frequent morphologies observed in our cohort, and "patchy hyperflow" (80.49%) signal was the most common visualized in our patients. Regarding OCT parameters, CT under polyps was higher in patients with positive detection of polyps on B-scan OCTA. OCTA is a possible diagnosis tool in Caucasian patients with AT1. To the best of our knowledge, this is the largest study performed in Caucasian patients regarding OCTA diagnostic abilities and features.

Polypoid invasive carcinoma of the gallbladder-Another challenging polypoid neoplasm.

Invasive gallbladder carcinoma generally presents as nodular-sclerosing growth. Recently, "polypoid invasive carcinoma (PICA)" showing grossly visible polypoid neoplasm and histologically invasive carcinoma with no adenomatous components was proposed as a neoplastic polyp of the gallbladder. We herein report five cases of PICA collected from 49 cases of invasive gallbladder carcinoma in comparison with another polypoid preinvasive neoplasm of gallbladder, intracholecystic papillary neoplasm (ICPN). Polypoid invasive carcinomas were composed of four males and one female with an average age of 74years. Polypoid lesions were sessile (height ranging from 6 to 10mm and the largest diameter ranging from 12 to 40mm), and histologically, polypoid neoplasms presented papillary configuration containing tubular and cribriform components with thin inflammatory, fibrotic stroma. Polypoid carcinoma invaded directly and continuously into the gallbladder wall with destruction of the muscle layer. These patterns of PICA were different from ICPN, showing papillary patterns containing tubular components with fine fibrovascular stalks and with occasional focal stromal invasion but with preserved muscle layer. Post-operative outcome was not favorable in PICA but was favorable in ICPN. Polypoid invasive carcinoma shared several pathological features with ICPN, such as intraluminal polypoid pattern with papillary configurations, but PICAs were invasive adenocarcinoma with destruction of muscle layer while ICPNs were preinvasive neoplasm with occasional focal stromal invasion, thus both should be differentiated from each other.

Prevalence and risk factors of gallbladder polyps in primary health care centers among patients examined by abdominal ultrasonography in Qatar: a case-control study.

Background: Gallbladder (GB) polyps are raised lesions from the GB wall and projected into its lumen. The prevalence of GB polyps ranged between 4.3% and 12.3%. The clinical presentation of GB polypoid lesions vary, can be nonspecific and vague, and may be asymptomatic. Identifying malignant and premalignant polyps is important to provide treatment early and prevent cancer spread or development of malignancy. Ultrasonography (US) is the first imaging modality widely used in abdominal imaging. It is a noninvasive, rapid, painless, and safe imaging technique, with no radiation; thus, it is considered the best available examination with good sensitivity and specificity for GB polyps.Aim of the work: This study aimed to determine the relative frequency of the GB polyps and its risk factors among patients who underwent abdominal US in Primary Health Care Corporation, Qatar.Materials and methods: This was quantitative multicenter observational case–control study nested in a cross-sectional design. For the cross-sectional top-level study, the first step was to assess available abdominal ultrasound studies for the presence of GB polyps and stones. The second step was to perform a case–control study with three groups (a case group and two control groups; first, participants without GB stones and GB polyps; second, patients with GB stones but without GB polyps).Results: The study evaluated the GB images of 7156 individuals. The overall prevalence of GB polyps was 7.4% in the study population. Specifically, the overall prevalence of solitary GB polyp was 4.2% and that of multiple GB polyps was 3.2%. Regarding the size distribution of GB polyps in positive cases, 89.4% were < 6 mm, 9.3% were 69 mm, and 1.3% were ≥ 10 mm. Prevalence rate of selected comorbidities were as follows: liver disease, 1.8%; diabetes mellitus, 25.5%; hypertension, 25.5%; and dyslipidemia, 29.8%. The prevalence in male and female patients was 7.7% and 7%, respectively. The prevalence of GB polyps was higher in south-eastern patients (21.4% of positive cases) and was the highest in the overweight group (8.8%). A higher prevalence was noted in the hypertensive group (hypertensive group, 9.8%; non-hypertensive group, 6.6%) and dyslipidemia group (dyslipidemia group, 7.8%; no dyslipidemia group, 7.2%). Moreover, a higher prevalence was noted in hepatitis B surface (HBS)-positive group (15%) than in the HBS-negative group (8.2%) and slightly higher in Helicobacter pylori antigen positive group than in the negative group.Conclusion: Abdominal US is an important and commonly used imaging modality in the detection of GB polyps. In this study, the prevalence of GB polyps was approximately 7.4%, with higher prevalence in participants who were overweight and had diabetes mellitus, hypertension, and dyslipidemia.

Colorectal endometriosis with a large polypoid lesion

A 39-year-old woman was referred to our hospital because of a positive fecal occult blood test result. She had undergone uterine myomectomy 6 years earlier, and she had been treated with levothyroxine for hypothyroidism after thyroidectomy for Graves’s disease. A physical examination revealed a left-sided abdominal mass without tenderness. A laboratory test showed that the levels of serum tumor markers were within normal range. A barium enema revealed a 4-cm protruding lesion in the descending colon (A). The lesion looked like a submucosal tumor with reddish mucosa and dilatated vessels (B). Magnifying endoscopy with crystal violet staining showed 2 types of pit pattern: most was regular and rounded, whereas a small area had an enlarged and irregular pit pattern (C). Surgical histopathologic examination confirmed that the protruding lesion was composed of endometrial glands and stroma surrounded by smooth muscle bundles (D, H&E, orig. mag. ×40). The results of testing for immunohistochemistry, estrogen receptor (ER), and progesterone receptor were positive. Therefore, we diagnosed polypoid endometriosis. Retrospectively, a biopsy specimen from the lesion with irregular pits showed that a few glands were positive for ER (E, Immunohistochemistry for ER, orig. mag. ×200). Colorectal endometriosis usually presents as eccentric wall thickening and surface nodularities, and diagnosis by endoscopic biopsy is difficult. Our case suggests that magnifying endoscopy is useful for diagnosis with target biopsy for intestinal endometriosis.

S2436 Coincidence or Not? A Rare Case of a Mixed Adenoneuroendocrine Rectal Tumor in the Setting of Ulcerative Colitis

Introduction: For decades it has been known that patients with inflammatory bowel disease (IBD) are at an increased risk for colorectal cancer, with adenocarcinoma being the most common. Risk of colorectal malignancy increases with years since diagnosis of IBD. However, very rarely diagnosed are mixed adenoneuroendocrine carcinomas (MANEC), comprising of at least 30% adenoma and 30% neuroendocrine components. Less than 20 cases have been reported of a MANEC in ulcerative colitis (UC) patients in the literature. Some hypothesize that chronic colonic mucosal inflammation and distant cytokine release eventually lead to MANECs. We present a case of high grade MANEC diagnosed in the setting of UC. Case description/methods: An 85 year old male with a 4-year history of refractory pan-UC with failure of multiple biologics (TNF alpha inhibitors, monoclonal antibodies), mesalamine, and azathioprine presented with worsening diarrhea, fecal urgency, rectal bleeding, muccorhea, and failure to thrive. He was placed on a long steroid taper. Fecal calprotectin was 1380 μg/g. Colonoscopy revealed severe pan-UC and a 4 cm sessile, exophytic, polypoid lesion in the proximal rectum. Biopsies revealed a high grade large cell neuroendocrine tumor positive for chromogranin, synaptophysin, CDX2, and Ki-67 cellular proliferation index of 40-50%. Robotic subtotal proctocolectomy with end ileostomy was performed with rectal specimen pathology revealing a high grade large cell poorly differentiated neuroendocrine carcinoma with low grade adenocarcinoma, consistent with pT3N1a MANEC. Given a single lymph node was positive, the patient is currently seeking oncologic opinion for potential chemotherapy. Discussion: The incidence of MANEC in a UC patient is very rare. To our knowledge, there are only 20 cases describing a MANEC diagnosis in a UC patient. There is now discussion as to whether or not MANECs correlate with IBD, specifically UC. In addition, MANEC lesions are associated with poor survival rates due to diagnosis at advanced stages. The decision to proceed with subtotal proctocolectomy for MANEC in an elderly patient with refractory pan-UC without severe co-morbidities was made due to a higher MANEC related mortality rate compared to other causes. Given the aggressive nature of MANECs, further research should be conducted regarding association between MANECs and UC to guide future diagnosis and treatment.Figure 1.: A 4 cm sessile, exophytic, polypoid lesion in the proximal rectum on colonoscopy status post biopsies revealing a MANEC on pathology.

S3520 An Unusual Surprise on Routine Colonoscopy

Introduction: Gastrointestinal xanthomas are rare, benign lesions that are incidentally found during endoscopy or colonoscopy. They most frequently occur in the stomach with incidence of gastric xanthomas reported to range between 1-4%. The incidence of colonic xanthoma is unknown but expected to be even lower as it is limited to a few case reports. Here, we present a rare occurrence of a xanthoma incidentally detected in the sigmoid colon. Case Description/Methods: A 77-year-old female presented for a screening colonoscopy. Her past medical history was significant for cirrhosis secondary to autoimmune hepatitis diagnosed 30 years ago and a prior colonoscopy notable for multiple tubular adenomas, tubulovillous adenoma and a transverse colon lipoma. Colonoscopy revealed multiple diverticula in the sigmoid and descending colon, a lipoma in the transverse colon and a polyp in the sigmoid colon. The polyp was 8 mm, semi-pedunculated and removed with a cold snare. Pathology identified the polyp as a xanthoma. Given history of tubulovillious polyp and multiple tubular adenomas, she was instructed to undergo a repeat colonoscopy in 5 years. Discussion: Colonic xanthomas are a rare occurrence with previous cases describing the most common location in the sigmoid colon. The largest case series of 28 colorectal xanthomas described the median age of the patients as 64 years and there were 15 men and 10 women. Macroscopically they generally present as plaques and rarely as polypoid lesions as seen in our patient. Microscopically they contain foamy macrophages that are thought to be lipids derived from damaged cell membranes. Unlike cutaneous xanthomas, gastrointestinal xanthomas do not have a clear association with hyperlipidemia. Our patient did not have history significant for diabetes or hyperlipidemia. Reported associations of colonic xanthomas include adenomas (16%) and adenocarcinomas (4.8%) and hence, should prompt a thorough examination when xanthomas are suspected during a colonoscopy. Although generally asymptomatic, they have a potential of presenting with gastrointestinal obstruction and therefore should be in the differential diagnosis for polypoid lesions found on colonoscopy.Figure 1.: Colonoscopy showing approximately 8mm polypoid lesion in the sigmoid colon.

Evaluation of colon mucosa using screening colonoscopy and flexible spectral imaging color enhancement in patients with long lasting ulcerative colitis

AimTo determine which flexible spectral imaging color enhancement (FICE) channel best visualizes colon mucosa in ulcerative colitis (UC) and to compare FICE imaging with standard imaging.MethodsThe study enrolled patients with ulcerative colitis in remission who had inflammatory bowel disease for at least 8 years. All patients underwent screening colonoscopy. The entire colon, especially the suspicious areas in terms of dysplasia, were imaged with standard endoscopy and FICE. Random and target biopsies were obtained. Histopathological diagnosis was made and image patterns were evaluated. Seven endoscopists evaluated normal, colitis, and polyp images obtained with FICE.ResultsOne hundred and twenty-three colon segments were evaluated and 1831 images were obtained from 18 patients. A total of 1652 images were FICE and 179 were standard images. Separate FICE images were obtained for normal colon mucosa, polypoid lesions, and colitis areas. Normal colon mucosa was best visualized using the second, sixth, and ninth FICE channel; polyps using the third, seventh, and ninth channel; and colitis using the second, third, and ninth channel. When all images were analyzed, the second and ninth channel were significantly better than the other channels. A total of 584 biopsies were obtained, including 492 (84.2%) random biopsies and 92 (15.7%) target biopsies. Random biopsies detected no dysplasia, but target biopsies detected low-grade dysplasia in three diminutive polyps.ConclusionFICE was not significantly better at dysplasia screening than the standard procedure, but it effectively detected diminutive polyps and evaluated surface patterns without using magnification. FICE might contribute to the assessment of inflammation severity in patients with UC in clinical remission. However, more extensive studies are necessary to confirm these findings.

S2383 A Shockingly Rare Bleed: Polypoid Small Bowel Arteriovenous Malformation Causing Hemorrhagic Shock in a Child

Introduction: Benign arteriovenous malformations (AVMs) in the small intestine, rare causes of brisk bleeding, are especially uncommon in pediatric patients. Rarely, AVMs present as protruding, polypoid lesions. When mesenteric computed tomographic angiography (CTA) does not identify a bleeding source, video capsule endoscopy (VCE) can help localize the etiology of bleeding. We describe a unique case of ulcerated polypoid AVM leading to hemorrhagic shock found in a child by VCE. Case Description/Methods: An 11-year-old female with no past medical history presented with syncope, non-bloody emesis and painless large hematochezia with a hemoglobin of 4 g/dl. She was admitted to the intensive care unit for hypotension, was intubated, and received massive blood transfusions and vasopressor support. Due to hemodynamic instability she underwent CTA that showed no extravasation. Esophagogastroduodenoscopy was also unrevealing, and flexible sigmoidoscopy was aborted due to blood obscuring visualization. Meckel scintigraphy was negative for heterotopic gastric tissue. Colonoscopy showed blood extending through colon to ileum, but no bleeding source, so VCE was deployed for small bowel evaluation. VCE showed a small submucosal lesion with surface ulceration in proximal small bowel. Given potential for surgical resection, she underwent deep enteroscopy in the operating room. Enteroscopy revealed a spherical mass in the jejunum. The mass was tattooed to guide resection of a 3 cm segment of jejunum. Pathology reported a markedly dilated submucosal vein (up to 0.6 cm in diameter) eroding the mucosa, likely a benign AVM. Two months after surgery, the patient had abdominal pain and blood-streaked stool that self-resolved, but no recurrent large volume bleeding. Discussion: Small intestine AVMs are difficult to identify as standard endoscopies cannot reach that portion of bowel. When CTA fails to identify the bleeding source and bleeding obscures the lumen, as with our patient, VCE is a minimally invasive modality in which concurrent bleeding and raised lesions increase the likelihood of lesion identification. To the best of our knowledge, there are only 13 polypoid AVM cases, with 2 reported in children. Whether flat or polypoid, AVMs can cause life-threatening bleeding in all patients. As such, it may be beneficial to use VCE earlier in cases of significant bleeding. VCE can provide precise localization of intestinal AVMs, which is imperative for limited surgical resection of bowel – a definitive management of isolated AVMs.Figure 1.: Dilated submucosal vein (up to 0.6 cm in diameter) with surface ulceration eroding the mucosa and oozing located 100 cm distal to the ligament of Treitz. Likely a benign AVM.

Clinicopathological characteristics of rectal neuroendocrine neoplasms

Objective: Clinicopathological characteristics of neuroendocrine neoplasms are highly heterogeneous based on variable origins.Our study aims to explore the clinical features of rectal neuroendocrine neoplasm (RNEN). Methods: Patients with histologically diagnosed rectal neuroendocrine neoplasms were retrospectively analyzed between January 2012 and December 2020. Epidemiological characteristics, clinical manifestations, complete blood count, endoscopy findings, and pathological features were recorded and analyzed. T-test was used for measurement data analysis, Chi-square test was performed for classification data analysis, and Binary logistic regression was applied for analyzing risk factors of metastasis. Results: Among 172 patients, the male to female ratio was 107 to 65 with an average age of (52±12) years (16-77 years). Altered bowel habit was the most common initial symptom (58/172, 33.7%), followed by abdominal pain (36/172, 20.9%) and loss of body weight (27/172, 15.7%). One hundred and sixty-one cases were neuroendocrine tumors, 9 were neuroendocrine carcinomas and 2 were mixed neuroendocrine-non-neuroendocrine neoplasms. Most endoscopic presentations were polypoid lesions (147/172, 85.5%), mainly limited to mucosa (48/172, 27.9%) and submucosa (96/172, 55.8%). Twenty-nine patients developed lymph node invasion or distant metastasis at diagnosis. There were statistical difference of neutrophil-to-lymphocyte ratios (NLR) among groups with different tumor size (<10 mm vs. 10-20 mm vs.>20 mm, mean NLR 1.79±0.55 vs. 2.27±1.23 vs. 2.95±0.66, P<0.01. Compared with non-metastatic group, the metastatic group presented higher NLR(2.61±0.81 vs. 1.89±0.80, P<0.01). Tumor size (<10 mm vs. 10-20 mm vs.>20 mm, OR 1.00 vs. 2.10 vs. 5.25×109, P =0.001), invasion to bowel wall (mucosa vs. submucosa vs. muscularis vs. serosa invasion,OR 1.00 vs. 3.26 vs. 14.11 vs. 39.42, P=0.008), and NLR (NLR<2.25 vs. NLR≥2.25, OR 1.00 vs. 5.19, P =0.024) were risk factors for metastasis. Conclusion: Metastasis of RNEN is related with tumor size, degree of bowel invasion and NLR. High NLR is a poor prognostic factor of RNEN.