Polyps In Gastrointestinal Tract Research Articles

A large inflammatory fibroid polyp of jejunum with unusual presentation: very difficult to diagnosis in paediatric patient

Inflammatory fibroid polyps (IFP), also known as Vanek tumours, are one of the rarest groups of gastrointestinal tract polyps. They represent 0.1-3.0% of all polyps in this organ system. Most common location is the stomach, mainly the antrum (70%), ileum (19%), and colon (6%). Large polyps of the stomach can cause intermittent obstruction, described as “ball valve syndrome”. This case report, reported in SMS medical college Jaipur in one year six months old child. We report a case of a 1 year 6 months female child with complaint of abdominal lump noted since 7 days, due to this reduced oral intake. On examination single, around 5×5 cm size non-tender lump is situated in left hypogastric region. On CECT abdomen shows mesenteric origin, may be desmoid tumour, Castleman disease, mesenteric haemangioma or inflammatory myo-fibroblastic tumour. Further MRI abdomen suggestive of inflammatory myo-fibroblastic tumour or NHL. Tumour marker study shows serum ferritin and LDH level raised. On exploration revealed a single, 6×5×4 cm lobulated jejunal mass encircle the jejunum, for this resection and anastomosis done. On histopathological report, suggestive of inflammatory fibroid polyp. Patient discharged successfully on 6th pod without any complication. Exploration done and a mass, which encircle the jejunum found. Resection and anastomosis done and patient discharged on 6th pod without any complications. Such an occurrence was incidental in the reported case, which can confuse our diagnosis, so knowledge about this type of disease is very important, especially in paediatrics population.

Double Intussusceptions in Peutz-Jeghers Syndrome Patient: A Case Report

Background: Peutz-Jeghers Syndrome is one of the hereditary gastro-intestinal cancer syndrome with characteristic mucocutaneous pigmentation and histologically distinctive hamartomatous polyps in gastro-intestinal tract. Although it is characteristically benign hamartomatous polyp, majority of affected individuals develop symptoms starting from their second decades. We reported a known Peutz-Jeghers Syndrome case developed recurrent polyps leading to double intussusceptions required bowel resection. Multidisciplinary management and patient compliance to surveillance regime are important in managing PJS patients with potential gastro-intestinal tract complications and relative high risk of developing syndrome specific cancers.

Genotype-phenotypic correlation of Peutz-Jeghers syndrome on the example of a series of clinical cases

Introduction: Peutz-Jeghers syndrome (PEUTZ-JEGHERS SYNDROME; PJS; OMIM#175200) is hereditary tumor syndrome and is characterized by the occurrence of hamartomatous polyps of gastrointestinal tract, melanocytic pigmentation of the skin and mucous membranes, as well as a high predisposition to malignant tumors of various locations. Despite the fact that the clinical features of PJS are currently well understood, the nature of the variability in the phenotypic manifestations of the disease has not been fully described. Aims: to determine the phenotypic and clinical features in patients with PJS depending on the type of mutation in the STK11 gene. Patients and methods: the clinical and genetic data of 3 patients aged 21, 28 and 39 years with clinical signs of PJS are presented. All patients underwent medical genetic counseling and molecular genetic diagnostics of the STK11 gene using NGS and MLPA methods. Results: large deletions of ex2-8 and ex1 in the STK11 gene were revealed in two patients, and one patient showed a splice site variant c.921-1G > A. The identified variant ex2-8 has not previously been described in international databases. When evaluating the clinical and genetic features, the most severe picture of the disease was in a patient with an extended deletion of exons 2-8, large number of polyps and surgical procedures in history. However, in this case, melanocytic pigmentation became less with age, in contrast to patients with a splice site mutation and a single exon deletion. No cancers were detected in the patients. Conclusion: the molecular genetic test made it possible to confirm the clinical diagnosis of PJS, based on various phenotypic features, and to work out the personalized plan for follow-up. Evaluation of the genotype-phenotype correlations will be possible with the development of a unified register of mutation carriers.

Bladder hamartoma in Peutz-Jeghers syndrome: a rare case report

BackgroundPeutz-Jeghers syndrome is an autosomal dominant disease characterized by mucocutaneous pigmentation and hamartomatous polyps in the gastrointestinal tract (GIT). There have also been cases of extra GIT polyps such as the renal pelvis, urinary bladder, lungs and nares. Bladder hamartoma is an extremely rare finding, with only 12 cases described in the literature up to now. The rarity of the condition necessitates a comprehensive compilation of managements up to now so as to provide a better tool for the treatment of such conditions in the future.Case presentationA twenty-year-old male, known to have Peutz-Jeghers syndrome, presented to us complaining of obstructive urinary symptoms. A urethrogram done showed a filling defect at the base of the urinary bladder. The mass was resected transurethrally, and histopathology revealed a hamartoma of the bladder. The patient has since remained tumor-free on follow-up.ConclusionsTransurethral resection of the bladder mass proved to be an effective therapy in this patient with no recurrence on the patient’s follow-up till now. There is still, however, a dearth of knowledge regarding the management of bladder hamartomas owing to the extreme rarity of the case.

The Histopathological Study of Gastrointestinal Polyps

Polyps covered by non-neoplastic squamous epithelium may develop anywhere in the esophagus. Squamous polyps may be divided in to two types: Inflammatory polyps and squamous papillomas. To study the incidence and morphology of Gastro Intestinal Tract polyps from specimens received at Sree Balaji Medical College and Hospital, Chennai. To analyze the incidence and morphological features of malignancies associated with polyps. Of the 102 cases, intestinal cancer was found predominately 51(50%) followed by stomach. The ages ranged from 17 to 77 yrs and average was 44 yrs. The female ratio was 0.77. Expression of P53 was varied with the property of the polyps and it could be a useful marker for determining the treatment regime.

Spectrum of gastrointestinal polyps: A tertiary care hospital experience of five years

Introduction: Polyps of gastrointestinal tract are not uncommon specimens received in surgical pathology laboratory. With advent of advanced endoscopy it is now possible to precisely sample polyps and determine its nature; weather benign, malignant or with malignant potential. Present study was performed with aim to study incidences of various histological types of polyps of gastrointestinal tract, to study its clinical presentation and to study polyps in relation to their size and site, in a tertiary care hospital. Materials and Methods: A retrospective and prospective analysis of 189 cases of gastrointestinal polyps was carried out over a period of eight and half years. Relevant clinical details of patient, size, number, size and presence of stalk etc. were noted. Specimens were studied for gross and microscopic examination after fixation of specimen with 10% formalin and microscopically examining H & E slides. They were classified according to site and various histological types. Results: Overall, we analysed 189 cases of gastrointestinal polyps. Commonest site was large intestine and commonest type was Juvenile polys, followed by neoplastic polyps, hyperplastic polyps, inflammatory pseudo polyps, hamartomatous polyps, inflammatory fibroid polyps and 2 cases of Familial polyposis coli were note. Conclusion: Present study reveals that gastrointestinal tract had wide spectrum of non-neoplastic as well as neoplastic polyps. They have different clinical significances and therapeutic implications. Histopathology play pivotal role in arriving at final diagnosis which enables to study detail incidences and helps to differentiate non-neoplastic diseases with clinical presentation of malignancy. Incidence of various polyps in based on institutional data and may not reflect incidence of state or nation. Keywords: Gastrointestinal polyps, Adenomatous polyps, Juvenile polyps, Neoplastic polyps.

Polypoid disease of colon in children.

Polyps in gastrointestinal tract are mostly benign and result from hamartomas or lymphoid hyperplasia of submucosa. They usually occur as isolated lesions in children and are referred to as juvenile polyps. Multiple polyps with inherited origin are called polyposis and can be seen as a part of the syndrome. The polyps with adenomatous histopathology have malignant potential and necessitate genetic testing and colonoscopy to define the risk of cancer. Although simple endoscopic removal is adequate in the treatment of juvenile polyps, children with familial adenomatous polyposis (FAP) need total colectomy with ileorectal anastomosis (IRA) or ileal pouch-anal anastomosis (IPAA). The timing of prophylactic colectomy and the type of surgical treatment are controversial in children. The clinical features, the assessment of cancer risk, and the alternatives of the surgical treatment of polyps are reviewed in this paper.

Gastrointestinal manifestations in patient with Common Variable Immunodeficiency Syndrome (CVID): A Case Report

A 57 yo male with a background history of common variable Immunodeficiency syndrome (CVID) on Immunoglobulin Infusion (Kiovig) 40mg three weekly was referred for investigation of diarrhoea and follow up from previous history of colonic polyps. Colonoscopy showed an irregular looking ileocaecal valve (ICV) with an adjacent flat polyp (Paris IIa). Biopsies showed low grade dysplasia. There was also a duodenal polyp noted on gastroscopy and biopsy again showed low grade dysplasia. In light of the findings of upper and lower gastrointestinal tract polyps, a small bowel capsule endoscopy (SBCE) was arranged. This showed an irregular area of mucosa in the proximal small bowel with significant ulceration and inflammation (Figure 1). There were also multiple scattered lymphagiectasias and lymphoid hyperplasia in the distal small bowel (Figure 2). Anterograde double ballon enteroscopy (ADBE) was subsequently performed to the distal jejunum about 8 weeks after the SBCE. The duodenal polyp seen at gastroscopy was visualised during ADBE (Figure 3). In addition, two diminutive (<3mm) jejunal sessile polyps were encountered and excised (Figure 4). There was no evidence of ulcerative enteritis as seen on SBCE. The enteritis features initially visualized on the SBCE was thought to be a transient phenomenon possibly related to his CVID background. However, for completion, the distal point of enteroscopy insertion was marked and a repeat SBCE performed immediately after recovery from the ADBE. This again showed the known duodenal polyp as well as 2 further diminutive small bowel polyps and minimal distal patchy enteritis only, with complete resolution of the previously observed ulcerative jejunitis. The jejunal polyps’ histology was reviewed at a histology multidisciplinary meeting, there were no adenomatous or hamartomatous features and biopsies were thought to have non-specific changes only. The patient was referred for polyp resection and further follow up and surveillance will be arranged based on histology.

79-Year-Old Man With Shortness of Breath and Fevers

79-Year-Old Man With Shortness of Breath and Fevers

Efficacy and Safety of Curcumin in Treatment of Intestinal Adenomas in Patients With Familial Adenomatous Polyposis

Familial adenomatous polyposis is an autosomal dominant disorder characterized by the development of hundreds of colorectal adenomas and eventually colorectal cancer. Oral administration of the spice curcumin has been followed by regression of polyps in patients with this disorder. We performed a double-blinded randomized trial to determine the safety and efficacy of curcumin in patients with familial adenomatous polyposis. This study included 44 patients with familial adenomatous polyposis (18-85 years old) who had not undergone colectomy or had undergone colectomy with ileorectal anastomosis or ileal anal pouches, had at least 5 intestinal adenomatous polyps, and had enrolled in Puerto Rico or the United States from September 2011 through November 2016. Patients were randomly assigned (1:1) to groups given 100% pure curcumin (1,500 mg orally, twice per day) or identical-appearing placebo capsules for 12 months. The number and size of lower gastrointestinal tract polyps wereevaluated every 4 months for 1 year. The primary outcome was the number of polyps in the curcumin and placebo groups at 12 months or at the time of withdrawal from the study according to the intention-to-treat principle. After 1 year of treatment, the average rate of compliance was 83% in the curcumin group and 91% in the placebo group. After 12 weeks, there was no significant difference in the mean number of polyps between the placebo group (18.6; 95% CI, 9.3-27.8) and the curcumin group (22.6;95% CI, 12.1-33.1; P= .58). We found no significant difference in mean polyp size between the curcumin group (2.3 mm; 95% CI, 1.8-2.8) and the placebo group (2.1 mm; 95% CI, 1.5-2.7; P= .76). Adverse events were few, with no significant differences between groups. In a double-blinded randomized trial of patients with familial adenomatous polyposis, we found no difference in the meannumber or size of lower intestinal tract adenomas between patients given curcumin 3,000 mg/day and thosegiven placebo for 12 weeks. Clinicaltrials.gov ID NCT00641147.

Wireless capsule endoscopy in adolescents with familial adenomatous polyposis.

Guidelines for surveillance in patients with familial adenomatous polyposis (FAP) recommend mutation carriers to undergo periodic colorectal examination starting in the early teens. Performing colonoscopy in children may lead to complications. Wireless capsule endoscopy (WCE) has been introduced recently to evaluate both the upper and lower gastrointestinal tract, and seems suitable as a first screening examination for adolescents. The aim of this study was to evaluate the pros and cons of WCE. This was a retrospective review of a single institution database of adolescent patients with FAP identified through the Hereditary Colorectal Tumor Registry between 2007 and 2013. The main outcomes were identification of upper and lower gastrointestinal tract polyps, tolerance of the examination, and number and size of polyps. Of 46 adolescent patients with FAP, 14 (30.4%) patients carrying adenomatous polyposis coli gene (APC) mutation, 6 male and 8 female, age (median, range) 12 (10-17) years, body mass index 19 (13-24), underwent WCE as first screening examination. The examination was completed in 13 patients (93.3%). Wireless capsule endoscopy identified the duodenal papilla in 4 patients and colonic and rectal polyps in all 13 patients. In 7 patients, fewer than 25 polyps were identified. No complications were recorded related to the use of the video capsule. Wireless capsule endoscopy is feasible and well-tolerated as a first screening examination in adolescent patients. It cannot be used as alternative to the colonoscopy, but could improve compliance with colonoscopy, and increase early adherence to a surveillance program.

Upper gastrointestinal tract polyps: what do we know about them?

This study aimed to evaluate upper gastrointestinal polyps detected during esophago- gastroduodenoscopy tests. We conducted a retrospective analysis on data regarding 55,987 upper gastrointestinal endoscopy tests performed at the endoscopy unit of Istanbul Education and Research Hospital between January 2006 and June 2012. A total of 66 upper gastrointestinal polyps from 59 patients were analyzed. The most common clinical symptom was dyspepsia, observed in 41 cases (69.5%). The localizations of the polyps were as follows: 29 in the antrum (43.9%), 15 in the corpus (22.7%), 11 in the cardia (16.7%), 3 in the fundus (4.54%), 3 in the second portion of the duodenum (4.54%), 2 in the bulbus (3.03%) and 3 in the lower end of the esophagus (4.54%). Histopathological types of polyps included hyperplastic polyps (44) (66.7%), faveolar hyperplasia (8) (12.1%), fundic gland polyps (4) (6.06%), squamous cell polyps (4) (6.06%), hamartomatous polyps (3) (4.54%), and pyloric gland adenoma (3) (4.54%). Histopathological analysis of the gastric mucosa showed chronic atrophic gastritis in 30 cases (50.84%), HP infection in 33 cases (55.9%) and intestinal metaplasia in 19 cases (32.20%). In 3 cases with multiple polyps, adenocarcinoma was detected in hyperplastic polyps. Among polypoid lesions of the upper gastrointestinal tract, the most common histological type is hyperplastic polyps. Generally, HP infection is associated with chronic atrophic gastritis and intestinal metaplasia. The incidence of adenocarcinoma tends to be higher in patients with multiple hyperplastic polyps.

Inflammatory Fibroid Polyps of Gastrointestinal Tract Rarely Show Increased IgG4 Expression

Inflammatory Fibroid Polyp (IFP) of gastrointestinal tract is characterized by concentric perivascular fibrosis and a mixed inflammatory infiltrate rich in eosinophils and also few plasma cells. IgG4-related sclerosing diseases (IgG4-RSD) are a heterogenous group of disorders described in many organs, characterized by a significant increased of IgG4+ plasma cells in a context of storiform fibrosis, obliterative vasculitis and mixed inflammatory infiltrate containing eosinophils. The histological similarities between IFP and IgG4-RSD prompted the present study in the attempt to find a possible link between IgG4 over-expression and IFP. The expression of IgG4 and IgG was evaluated in a series of 23 cases of IFP belonging to 23 patients. All cases were reviewed by two pathologists and the histological diagnosis confirmed. Immunohistochemistry for antibodies anti-IgG, anti-IgG4, and anti-IgA was performed on all cases and the results were evaluated by two observers. One case of IFP out of 23 (4.3%) fulfilled the IgG4-RSD histological criteria. The case did not differ histologically from the others. The patient did not present either a raised serological level of IgG4, nor other sign of IgG4-RSD. IgG4 increased expression can be rarely observed in IFP. Steroid therapy in cases of IFP with abundant IgG4+ plasma cells, especially in patients with multiple tumors, could be considered as an alternative to surgical treatment.

Endoscopic resection of tumors in the lower digestive tract.

As endoscopic technology has developed and matured, the endoscopic resection of gastrointestinal tract polyps has become a widely used treatment. Colorectal polyps are the most common type of polyp, which are best managed by early resection before the polyp undergoes malignant transformation. Methods for treating colorectal tumors are numerous, including argon plasma coagulation, endoscopic mucosal resection, endoscopic submucosal dissection, and laparoscopic-endoscopic cooperative surgery. In this review, we will highlight several currently used clinical endoscopic resection methods and how they are selected based on the characteristics of the targeted tumor. Specifically, we will focus on laparoscopic-endoscopic cooperative surgery.

Clinical characteristics of upper gastrointestinal tract polyps: An analysis of 2 376 cases

Clinical characteristics of upper gastrointestinal tract polyps: An analysis of 2 376 cases

Two variants in STK11 gene in Chinese patients with Peutz–Jeghers syndrome

Peutz–Jeghers syndrome (PJS) is an autosomal domi-nant disease manifested as multiple hamartomatous polypsof gastrointestinal tract, mucocutaneous pigmentation andincreased risk of cancers. The typical clinical symptoms ofPJS are abdominal pain, intestinal obstruction, volvulus andanaemia. The causative gene for PJS was localized to chro-mosome 19p13.3, further studies identified variants of

Multiple desmoid tumors in a patient with familial adenomatous polyposis caused by the novel W421X mutation

Familial adenomatous polyposis (FAP) is a rare syndrome characterized by the presence of hundreds to thousands of colorectal adenomas and is responsible for less than 1% of all colorectal cancers. The syndrome is also characterized by extra-colorectal features including amongst others upper gastrointestinal tract polyps and desmoid tumors. The syndrome is inherited by an autosomal dominant gene, the adenomatous polyposis coli (APC) gene. We present the physical history, clinical presentation, diagnosis and treatment of a patient with a novel germline APC mutation, the W421X mutation, which resulted in FAP presenting with about a hundred colorectal polyps, gastric hyperplastic polyps and multiple aggressive intra-abdominal and extra-abdominal desmoid tumors.

Hereditary Mixed Polyposis Syndrome - Own Experience

Hereditary mixed polyposis syndrome (HMPS) is a rare condition of unknown genetic origin. The paper presents 25-year clinical follow up in a female patient with multiple gastrointestinal tract polyps of varied histology. They most likely served as sites of multiple colorectal cancers development. The clinical course is interesting in terms of diagnostics and therapy. The patient required extended genetic testing, intensive conservative treatment and numerous surgical procedures. This is the first case of HMPS presented in Polish publications.

Polipose gastroduodenal em doentes com polipose adenomatosa familiar Pós-Retocolectomia

The extra colonic manifestations, like upper gastrointestinal tract polyps and duodenal cancer are disorders that affect long-term morbidity and mortality of patients with familial adenomatous polyposis, after rectocolectomy. To describe the frequency of those disorders in patients with familial adenomatous polyposis and to review efficacy of upper gastrointestinal endoscopic surveillance. Between 1984 and 2005, 62 patients with familial adenomatous polyposis after rectocolectomy, were studied retrospectively, by Coloproctology Group, Medical Sciences Faculty, State University of Campinas, SP, Brazil. It was possible to analyze 53 patients (85,5%) in this study. Twenty seven (50,9%) of 53 patients in follow-up had upper gastrointestinal polyps. Eight (15,4%) had gastric adenomatous polyps, 14 (27%), duodenal polyps and 5 (9,6%) duodenal and gastric polyps. Two patients (3,8%) had adenomatous duodenal polyps with severe dysplasia, and one (1,9%) had adenocarcinoma of the duodenal papilla. The upper gastrointestinal endoscopic surveillance has importance and the aim is to detect as early as possible the occurrence of duodenal adenocarcinoma and upper gastrointestinal polyps with severe dysplasia.

Familial Adenomatous Polyposis

Familial adenomatous polyposis (FAP) is an autosomal-dominant colorectal cancer syndrome, caused by a germline mutation in the adenomatous polyposis coli (APC) gene, on chromosome 5q21. It is characterized by hundreds of adenomatous colorectal polyps, with an almost inevitable progression to colorectal cancer at an average age of 35 to 40 yr. Associated features include upper gastrointestinal tract polyps, congenital hypertrophy of the retinal pigment epithelium, desmoid tumors, and other extracolonic malignancies. Gardner syndrome is more of a historical subdivision of FAP, characterized by osteomas, dental anomalies, epidermal cysts, and soft tissue tumors. Other specified variants include Turcot syndrome (associated with central nervous system malignancies) and hereditary desmoid disease. Several genotype-phenotype correlations have been observed. Attenuated FAP is a phenotypically distinct entity, presenting with fewer than 100 adenomas. Multiple colorectal adenomas can also be caused by mutations in the human MutY homologue (MYH) gene, in an autosomal recessive condition referred to as MYH associated polyposis (MAP). Endoscopic screening of FAP probands and relatives is advocated as early as the ages of 10-12 yr, with the objective of reducing the occurrence of colorectal cancer. Colectomy remains the optimal prophylactic treatment, while the choice of procedure (subtotal vs proctocolectomy) is still controversial. Along with identifying better chemopreventive agents, optimizing screening of extracolonic cancers and applying new radiological and endoscopic technology to the diagnosis and management of extracolonic features are the major challenges for the future.