Sessile Polyps Research Articles

Malakoplakia, a rare inflammatory condition presenting as a colon polyp

Abstract Introduction/Objective Malakoplakia is a rare histiocytic disease caused by defects in phagocytic or degradative functions of histiocytes in response to gram negative coliforms (E. coli or Proteus) that results in chronic inflammatory state, followed by intracellular deposition of iron and calcium (known as Michaelis-Gutmann bodies). It’s more common in immunocompromised patients and the mean age at diagnosis is fifth decade. It occurs in all organs, common in GU tract, particularly bladder, but also seen in gastrointestinal tract (most commonly colon, followed by stomach and duodenum), central nervous system and female genital tract. In gastrointestinal tract, it can present as a polyp with diffuse mucosal involvement, submucosal thickening, and even may cause mass. Methods/Case Report A 60 -year-old male smoker presented to our hospital with history of colon polyps; colonoscopy revealed a 6 mm sessile polyp at the hepatic flexure. A biopsy was performed which showed numerous epithelioid histiocytes with granular eosinophilic cytoplasm, abundant Michaelis-Gutmann bodies and increased lymphocytes. Immunohistochemical stains showed diffuse positivity for CD68; and PAS stain was positive for histiocytic cytoplasmic granules. Based on this data, the diagnosis of Malakoplakia was confirmed. Malakoplakia is treated with antibiotics that concentrate in macrophages (quinolones or trimethoprim-sulfamethoxazole), antibiotics directed against E. coli, surgery and possibly discontinuation of immunosuppressive drug therapy. Results (if a Case Study enter NA) Malakoplakia, in this case, was presented clinically as a sessile colon polyp and histologically showed numerous epithelioid histiocytes with granular eosinophilic cytoplasm, with Immunohistochemical stains (CD68; and PAS stain) the correct diagnosis was made. Other presentations of Malakoplakia include diffuse mucosal involvement, submucosal thickening, or mass. Histologically, it may rarely be mistaken as signet ring carcinoma. These variable presentations in GU tract or colon can be interpreted as malignancy with consequent unnecessary interventions. Hence, awareness of Malakoplakia with careful histopathologic examination and the use of immunohistochemical studies are advisable in that cases. Conclusion We would like to emphasize that Malakoplakia can be clinically and histologically misdiagnosed as a malignant condition; therefore histopathologic and immunohistochemical studies are needed to correctly diagnose this entity.

Impact of linked color imaging on the proximal adenoma miss rate: a multicenter tandem randomized controlled trial (the COCORICO trial).

Missed lesions are common during standard colonoscopy and are correlated with post-colonoscopy colorectal cancer. Contrast-enhanced technologies have recently been developed to improve polyp detection. We aimed to evaluate the impact of linked color imaging (LCI) on the proximal adenoma miss rate in routine colonoscopy. This national, multicenter, tandem, randomized trial compared the outcomes of colonoscopy with white-light imaging (WLI) versus LCI for polyp detection in the right colon. Two consecutive examinations of the right colon (upstream of the hepatic flexure) were made with WLI and LCI by the same operator. First-pass examination by WLI or LCI was randomized 1:1 after cecal intubation. According to statistical calculations, 10 endoscopy units had to include approximately 700 patients. The primary outcome was proximal adenoma miss rate. Secondary outcomes were the proximal miss rates for sessile serrated lesions (SSL), advanced adenomas, and polyps. 764 patients were included from 1 January 2020 to 22 December 2022, and 686 patients were randomized (345 WLI first vs. 341 LCI first). Both groups were comparable in terms of demographics and indications. The proximal adenoma miss rate was not significantly higher in the WLI-first group (36.7%) vs. the LCI-first group (31.8%) (estimated mean absolute difference: 4.9% [95%CI -5.2% to 15.0%], P = 0.34). There was also no significant difference in miss rates for SSLs, advanced adenomas, and polyps in the proximal colon. In contrast to previous data, this study does not support the benefit of LCI to the proximal adenoma miss rate in routine colonoscopy.

Collective exploitation of large prey by group foraging shapes aggregation and fitness of cnidarian polyps

Group living is widespread and beneficial to metazoans. It improves protection and survival opportunities, reinforcing interspecific competitiveness. Benthic cnidarians often colonize large surfaces. Evidence of collective capture and exploitation of large prey by small, clumped polyps suggests that aggregation is functional to access food resources hardly achievable by isolated individuals. In turn, the chance to catch large prey may represents a driver of aggregation in polyps, whether beneficial to their fitness. Here, the effects of group foraging on aggregation, asexual reproduction, and growth rates of Aurelia coerulea von Lendenfeld 1884 polyps were experimentally tested by providing them with either small or large prey, or a mix of both to simulate the co-occurrence of preys at sea. As expected, some polyps were not able to reach the large prey. Hence, the population was a posteriori divided into group-foragers and solitary-feeders. In general, the large prey diet resulted in higher population fitness and when simultaneously supplied with the small prey represented an energetic booster resulting beneficial for all group-members. The decrease of interindividual distances was reported among group-foragers, that converged towards each other. Cnidarians are basal in metazoan evolution, and the comprehension of their collective foraging behavior, as well as the processes leading to the selective feature driving them to forage in group or not, may be essential to better understand the evolution and spread of social foraging in animals. Moreover, the access to large prey by sessile polyps of Aurelia coerulea could be pivotal in determining the increase in abundance of adult bloom-forming medusae.

Performance of Computer-Aided Detection and Quality of Bowel Preparation: A Comprehensive Analysis of Colonoscopy Outcomes

BackgroundArtificial intelligence (AI) has emerged as a promising tool for detecting and characterizing colorectal polyps during colonoscopy, offering potential enhancements in traditional colonoscopy procedures to improve outcomes in patients with inadequate bowel preparation.AimsThis study aimed to assess the impact of an AI tool on computer-aided detection (CADe) assistance during colonoscopy in this population.MethodsThis case–control study utilized propensity score matching (PSM) for age, sex, race, and colonoscopy indication to analyze a database of patients who underwent colonoscopy at a single tertiary referral center between 2017 and 2023. Patients were excluded if the procedure was incomplete or aborted owing to poor preparation. The patients were categorized based on the use of AI during colonoscopy. Data on patient demographics and colonoscopy performance metrics were collected. Univariate and multivariate logistic regression models were used to compare the groups.ResultsAfter PSM patients with adequately prepped colonoscopies (n = 1466), the likelihood of detecting hyperplastic polyps (OR = 2.0, 95%CI 1.7–2.5, p < 0.001), adenomas (OR = 1.47, 95%CI 1.19–1.81, p < 0.001), and sessile serrated polyps (OR = 1.90, 95%CI 1.20–3.03, p = 0.007) significantly increased with the inclusion of CADe. In inadequately prepped patients (n = 160), CADe exhibited a more pronounced impact on the polyp detection rate (OR = 4.34, 95%CI 1.6–6.16, p = 0.049) and adenomas (OR = 2.9, 95%CI 2.20–8.57, p < 0.001), with a marginal increase in withdrawal and procedure times.ConclusionThis study highlights the significant improvement in detecting diminutive polyps (< 5 mm) and sessile polyps using CADe, although notably, this benefit was only seen in patients with adequate bowel preparation. In conclusion, the integration of AI in colonoscopy, driven by artificial intelligence, promises to significantly enhance lesion detection and diagnosis, revolutionize the procedure’s effectiveness, and improve patient outcomes.

FP2.12 - 'To Evaluate Lower Threshold of Polyp Size for Tattooing Routinely, a Single Trust Observational Study.'

Abstract Aim The goal of the study is to establish the lowest polyp size for clinically effective tattooing routinely. Method Retrospective data collection of colonoscopy and flexible sigmoidoscopy for bowel screening and non-bowel screening patients; 450 patients underwent polypectomy of &amp;lt;20mm from September 2021 to September 2022 in MTW NHS Trust. Patients were included according to 'single patient single polyp' criteria. We excluded 20+ mm polyps, multiple polyp, known FAP, lynch syndrome and other genetic predisposed colorectal polyps. Histology was obtained from electronic patient records (Allscripts). SPSS version 25.0 was used for the statistical analysis, which also included ROC curve analysis and Chi-Square test. Results A total of 450 participants, 288 males (64.0%) and 162 females (36.0%), were enrolled. Polyp sizes: 0-9mm (42.2%) and 10-19mm (57.8%). 8.0% were tattooed. Polyps found in right- hemicolon, transverse, left-hemicolon, sigmoid and rectum accordingly 29.78%, 20.5%, 9.1%, 28.4% and 12.22%. Pedunculated polyps were found in 143 individuals (31.8%), while sessile polyps were observed in 256 individuals (56.9%). Furthermore, in histological analysis, 251 individuals (55.8%) exhibited tubular adenomas and the majority of the cohort (77.6%) presented with low-grade dysplasia. Malignant invasion was detected in 27 subjects (6%). Receiver operating system (ROC) curve analysis indicated that polyp size was a predictive factor for malignancy development, with a cut-off lower point identified at 8.5 mm. Conclusions The findings confirm the advice to tattoo polyps bigger than 8-9 mm to make tracing and follow- up easier.

Analysis of Ca1-xSrxCO3 phases generated by competitive Sr2+ replacement in pre-formed aragonite

The ratio of Sr/Ca ions in marine biogenic minerals is considered advantageous for tracking geochemical and biomineralization processes that occur in the oceans. It is debatable, though, whether the ratio in biominerals such as coral skeleton is simply related to values in the seawater environment or controlled by the organism. Recent data show that coral larvae produce partially disordered immature aragonite in Mg-containing Sr-poor calcifying fluids, which transforms into well-ordered aragonite in Mg-depleted Sr-enriched environments, upon animal metamorphosis into the sessile polyp state.Inspired by the process in young coral, we explored in vitro substitution of Ca by Sr in aragonite by exposing aragonite crystals precipitated a priori to Sr solutions with variable concentrations. The resulting biphasic material, comprised of Sr-doped aragonite and Ca-doped strontianite, was carefully analyzed for foreign cation substitution in each polymorph. This allowed to establish a linear correlation between Sr levels in mineralizing solutions and Sr in aragonite as well as Ca in strontianite. It indicated that ca. 5-fold higher Sr solution concentration is needed for substitution in the crystal to reach the level found in corals. It also provided with Sr levels required for a putative strontianite phase to form.

Identification and Predictive Analysis of Colorectal Polyps Using Flexible Sigmoidoscopy: A Retrospective Cohort Study

Background: Colorectal polyps are mucosal growths in the colon and rectum that may progress to cancer if not removed early. Flexible sigmoidoscopy is a common diagnostic tool for detecting these polyps, particularly in symptomatic patients, though predictive factors in younger populations remain unclear. Objective: This study aims to analyze the characteristics of colorectal polyps diagnosed via flexible sigmoidoscopy and identify predictive factors for their presence. Materials and Methods: We conducted a retrospective study on 1004 patients who underwent sigmoidoscopy from August 2023 to February 2024 at Ghurki Trust &amp; Teaching Hospital, Lahore, Pakistan. The study included data from 84 patients diagnosed with colorectal polyps. Analyzed variables were age, gender, polyp count, type (pedunculated or sessile), distribution, and indications for sigmoidoscopy (bleeding vs. other). Statistical analysis using SPSS version 15 included chi-square tests and odds ratios to identify significant associations. Results: Colorectal polyps were detected in 8.4% of patients, with a gender distribution of 7.9% in males and 8.4% in females. Sessile polyps predominated at 64.3%, and the majority of polyps were solitary (75%). Polyps primarily affected the rectum (53.6%) and were less frequently found in the sigmoid colon (21.4%), rectosigmoid junction (17.9%), and descending colon (7.1%). Significant predictors of polyp detection included age (45% in children vs. 6.5% in adults, p &lt; 0.001) and indication for sigmoidoscopy (14% in cases of rectal bleeding vs. 3.3% for other reasons, p &lt; 0.001). Gender was not a significant factor (p=0.467). Conclusion: Sigmoidoscopy effectively detects colorectal polyps, particularly in symptomatic children and those with rectal bleeding. This highlights the need for targeted screening to improve early detection and management. Further research is required to validate these findings and refine screening guidelines.

Metastatic Cervical Cancer Presenting as a Sessile Polyp in the Ascending Colon

Patients with metastatic cervical cancer, particularly hematogenous metastasis, have a worse prognosis compared to those with localized cervical cancer. Gastrointestinal involvement of cervical cancer occurs in approximately 8% of cases and most lesions are located in the recto-sigmoid area due to direct extension of the disease. Here, we present a case of cervical adenocarcinoma spreading to the ascending colon as a sessile polyp and mimicking a hyperplastic polyp. Histopathological evaluation followed by immunohistochemistry analysis is needed to confirm the diagnosis.

The Safety of Cold Versus Hot Snare Polypectomy in Polyps 10-20 mm: A Systematic Review and Meta-Analysis.

Colonoscopy remains the primary method for preventing colorectal cancer. Traditionally, hot snare polypectomy (HSP) was the method of choice for removing polyps larger than 5 mm. Yet, for polyps smaller than 10 mm, cold snare polypectomy (CSP) has become the favored approach. Lately, the use of CSP has expanded to include the removal of sessile polyps that are between 10 and 20 mm in size. Our systematic review and meta-analysis aimed to evaluate the safety of cold snare polypectomy (CSP) compared to hot snare polypectomy (HSP) for resecting polyps measuring 10-20 mm. We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, and Cochrane databases up to April 2020 to find studies that directly compared CSP to HSP for polyps larger than 10 mm. Our main focus was on assessing the risk of delayed bleeding after polypectomy; a secondary focus was the incidence of any adverse events that required medical intervention post procedure. Our search yielded three comparative studies, two observational studies, and one randomized controlled trial (RCT), together encompassing 1,193 polypectomy procedures. Of these, 485 were performed using CSP and 708 with HSP. The pooled odds ratio (OR) for post-polypectomy bleeding (PPB) was 0.36 (95% confidence interval {CI}: 0.02, 7.13), with a Cochran Q test P-value of 0.11 and an I2 of 53%. For the risk of any adverse events necessitating medical care, the pooled OR was 0.15 (95% CI: 0.01, 2.29), with a Cochran Q test P-value of 0.21 and an I2 of 35%. The quality of the two observational studies was deemed moderate, and the RCT was only available in abstract form, preventing quality assessment. Our analysis suggests that there is no significant difference in the incidence of delayed post-polypectomy bleeding or other adverse events requiring medical attention between CSP and HSP for polyps measuring 10-20 mm.

Host–symbiont plasticity in the upside-down jellyfish Cassiopea xamachana: strobilation across symbiont genera

IntroductionIn the upside-down jellyfish, Cassiopea xamachana (Cnidaria: Scyphozoa), the establishment of photosymbiosis with dinoflagellates (family Symbiodiniaceae) is necessary for the sessile polyp to undergo metamorphosis (strobilation) into a free-swimming adult. C. xamachana has the capacity to associate with a wide variety of dinoflagellate species and representatives of divergent genera. While some studies have looked at the successful induction of symbiosis, none to date have examined the lasting effect of diverse symbiont taxa on host survivorship and development, which is needed to assess the fitness costs of such symbioses.MethodsOur study exposes C. xamachana polyps to 22 different cultured Symbiodinaceae strains representing 13 species from 5 genera. We analyzed the time to strobilation, the number of ephyra (juvenile medusa) produced, and the proportion of ephyra that died prematurely.ResultsHere we show that C. xamachana strobilation can be induced by nearly each symbiodinacean strain we tested, with the exception of free-living species (i.e., unknown to establish symbiosis with any other marine host). Additionally, ephyrae did not display morphological variation or survivorship differences with varying symbionts. However, we observed intraspecific variation in time to induce strobilation with different cultured dinoflagellate strains.DiscussionThis work expands the known symbiont species that can form stable mutualisms with C. xamachana, primarily in the genera Symbiodinium and Breviolum. Additionally, we provide evidence of differences in ability of cultured symbiodiniaceans to establish symbiosis with a host, which suggests population-level differences in dinoflagellate cultures impact their symbiosis success. By utilizing an animal like C. xamachana with flexible symbiont uptake, we are able to explore how symbiont diversity can influence the timing and success of symbiosis-driven development.

Underwater versus conventional endoscopic mucosal resection for ≥10 mm sessile or flat colorectal polyps: A systematic review and meta-analysis.

Underwater endoscopic mucosal resection (UEMR) has been an emerging substitute for conventional EMR (CEMR). This systematic review and meta-analysis aimed at comparing the efficiency and safety of the two techniques for removing ≥10 mm sessile or flat colorectal polyps. PubMed, Cochrane Library and Embase databases were searched up to February 2023 to identify eligible studies that compared the outcomes of UEMR and CEMR. This meta-analysis was conducted on the en bloc resection rate, R0 resection rate, complete resection rate, procedure time, adverse events rate and recurrence rate. Nine studies involving 1,727 colorectal polyps were included: 881 were removed by UEMR, and 846 were removed by CEMR. UEMR was associated with a significant increase in en bloc resection rate [Odds ratio(OR) 1.69, 95% confidence interval(CI) 1.36-2.10, p<0.00001, I2 = 33%], R0 resection rate(OR 1.52, 95%CI 1.14-2.03, p = 0.004, I2 = 31%) and complete resection rate(OR 1.67, 95%CI 1.06-2.62, p = 0.03, I2 = 0%) as well as a significant reduction in procedure time(MD ‒4.27, 95%CI ‒7.41 to ‒1.13, p = 0.008, I2 = 90%) and recurrence rate(OR 0.52, 95%CI 0.33-0.83, p = 0.006, I2 = 6%). Both techniques were comparable in adverse events rate. UEMR can be a safe and efficient substitute for CEMR in removing ≥10 mm sessile or flat colorectal polyps. More studies verifying the advantages of UEMR over CEMR are needed to promote its application.

Management of incidentally detected gallbladder polyps: a review of clinical scenarios using the 2022 SRU gallbladder polyp consensus guidelines.

Gallbladder (GB) polyps are a common incidental finding on sonography, but only a small fraction of polyps become GB cancer. The Society of Radiologists in Ultrasound (SRU) consensus committee recently performed an extensive literature review and published guidelines for GB polyp follow-up/management to provide clarity among the many heterogeneous recommendations that are available to clinicians. As these guidelines have become adopted into clinical practice, challenging clinical scenarios have arisen including GB polyps in primary sclerosing cholangitis (PSC), high risk geographic/genetic patient populations, shrinking polyps, pedunculated vs sessile polyps, thin vs thick stalked polyps, vascular polyps and multiple polyps. According to the SRU guidelines, clinicians should refer to gastroenterology guidelines when managing GB polyps in patients with known PSC. If patients at high geographic/genetic risk develop GB polyps, 'extremely low risk' polyps may be managed as 'low risk' and 10-14mm 'extremely low risk' or '7-14mm' low risk polyps that decrease in size by ≥ 4mm require no follow-up. Thin-stalked or pedunculated polyps are 'extremely low risk' and thick-stalked pedunculated polyps are 'low risk'. Sessile polyps are 'low risk' but should receive immediate specialist referral if features suggestive of GB cancer are present. Neither polyp multiplicity nor vascularity impact risk of GB cancer and follow up should be based on morphology alone.

Recurrences of advanced sessile and lateral spreading colorectal adenoma after endoscopic mucosal resection (EMR) thermal ablation versus no adjuvant therapy (RESPECT): a protocol of an international randomized controlled trial

BackgroundNowadays, large benign lateral spreading lesions (LSLs) and sessile polyps in the colorectum are mostly resected by endoscopic mucosal resection (EMR). A major drawback of EMR is the polyp recurrence rate of up to 20%. Snare tip soft coagulation (STSC) is considered an effective technique to reduce recurrence rates. However, clinical trials on STSC have mainly been conducted in expert referral centers. In these studies, polyp recurrence was assessed optically, and additional adjunctive techniques were excluded. In the current trial, we will evaluate the efficacy and safety of STSC in daily practice, by allowing adjunctive techniques during EMR and the use of both optical and histological polyp recurrence to assess recurrences during follow-up.MethodsThe RESPECT study is a multicenter, parallel-group, international single blinded randomized controlled superiority trial performed in the Netherlands and Germany. A total of 306 patients undergoing piecemeal EMR for LSLs or sessile colorectal polyps sized 20–60 mm will be randomized during the procedure after endoscopic complete polyp resection to the intervention or control group. Post-EMR defects allocated to the intervention group will be treated with thermal ablation with STSC of the entire resection margin. Primary outcome will be polyp recurrence by optical and histological confirmation at the first surveillance colonoscopy after 6 months. Secondary outcomes include technical success and complication rates.DiscussionThe RESPECT study will evaluate if STSC is effective in reducing recurrence rates after piecemeal EMR of large colorectal lesions in daily clinical practice performed by expert and non-expert endoscopists. Moreover, endoscopists will be allowed to use adjunctive techniques to remove remaining adenomatous tissue during the procedure. Finally, adenomatous polyp recurrence during follow-up will be defined by histologic identification.Trial registrationClinicalTrials.gov NCT05121805. Registered on 16 November 2021. Start recruitment: 17 March 2022. Planned completion of recruitment: 31 April 2025.

Enhanced accuracy with Segmentation of Colorectal Polyp using NanoNetB, and Conditional Random Field Test-Time Augmentation.

Colonoscopy is a reliable diagnostic method to detect colorectal polyps early on and prevent colorectal cancer. The current examination techniques face a significant challenge of high missed rates, resulting in numerous undetected polyps and irregularities. Automated and real-time segmentation methods can help endoscopists to segment the shape and location of polyps from colonoscopy images in order to facilitate clinician's timely diagnosis and interventions. Different parameters like shapes, small sizes of polyps, and their close resemblance to surrounding tissues make this task challenging. Furthermore, high-definition image quality and reliance on the operator make real-time and accurate endoscopic image segmentation more challenging. Deep learning models utilized for segmenting polyps, designed to capture diverse patterns, are becoming progressively complex. This complexity poses challenges for real-time medical operations. In clinical settings, utilizing automated methods requires the development of accurate, lightweight models with minimal latency, ensuring seamless integration with endoscopic hardware devices. To address these challenges, in this study a novel lightweight and more generalized Enhanced Nanonet model, an improved version of Nanonet using NanonetB for real-time and precise colonoscopy image segmentation, is proposed. The proposed model enhances the performance of Nanonet using Nanonet B on the overall prediction scheme by applying data augmentation, Conditional Random Field (CRF), and Test-Time Augmentation (TTA). Six publicly available datasets are utilized to perform thorough evaluations, assess generalizability, and validate the improvements: Kvasir-SEG, Endotect Challenge 2020, Kvasir-instrument, CVC-ClinicDB, CVC-ColonDB, and CVC-300. Through extensive experimentation, using the Kvasir-SEG dataset, our model achieves a mIoU score of 0.8188 and a Dice coefficient of 0.8060 with only 132,049 parameters and employing minimal computational resources. A thorough cross-dataset evaluation was performed to assess the generalization capability of the proposed Enhanced Nanonet model across various publicly available polyp datasets for potential real-world applications. The result of this study shows that using CRF (Conditional Random Fields) and TTA (Test-Time Augmentation) enhances performance within the same dataset and also across diverse datasets with a model size of just 132,049 parameters. Also, the proposed method indicates improved results in detecting smaller and sessile polyps (flats) that are significant contributors to the high miss rates.

Cowden syndrome in a male patient with metachronous triple cancers and various clinical features:a case report

A 66-year-old male patient with a thyroid and nasopharyngeal cancer history visited our hospital because of a positive fecal occult blood test. Total colonoscopy detected sessile or subpedunculated polyps in the ascending colon, sigmoid colon, and rectum. These polyps were endoscopically resected, and the rectal polyp was pathologically diagnosed as adenocarcinoma in adenoma and the others as adenomas. Additionally, multiple sessile lesions were revealed in the sigmoid colon and rectum. A complete gastrointestinal tract examination revealed multiple foci of glycogenic acanthosis in the esophagus, multiple sessile lesions in the stomach, multiple sessile lesions, clubbings (rod-shaped lesions), and venous malformations in the small bowel. Mucocutaneous examination indicated hemangiomas on the body trunk, patchy pigmentation on the glans penis, and keratotic papules in the inguinal region. The National Comprehensive Cancer Network diagnostic criteria for Cowden syndrome were used in this case. The patient met four major and two minor criteria;thus, Cowden syndrome was diagnosed. Moreover, the patient was had phosphatase and tensin homolog deleted on chromosome 10 gene mutation. This is the first reported case of metachronal triple cancers in a male patient with Cowden syndrome, and our results indicate the importance of cancer surveillance.

Molecular and cellular basis of life cycle transition provides new insights into ecological adaptation in jellyfish

&lt;p&gt;Jellyfish are renowned for their complex life cycles and important ecological and evolutionary position. The unique transition from the sessile polyp to motile medusa stages is a key process determining a switch in jellyfish behaviour and regulating the formation of jellyfish blooms. Here, we presented a comprehensive cell atlas spanning four successive life cycle stages during the polyp-to-medusa transition in the scyphozoan jellyfish &lt;i&gt;Aurelia&lt;/i&gt; &lt;i&gt;coerulea&lt;/i&gt;. Moreover, we characterised the variation in cell composition and gene expression patterns during the phase transition, especially in the neuromuscular system. We found several previously unreported cell types that potentially underpin the complex swimming behaviour of jellyfish. Furthermore, we discovered the pivotal role of &lt;i&gt;HOX1&lt;/i&gt; in modulating the genesis of striated muscles in &lt;i&gt;A&lt;/i&gt;. &lt;i&gt;coerulea&lt;/i&gt;. Collectively, this study provides valuable insights into the cellular and molecular mechanisms underlying the complex life cycle transition and helps to advance our understanding of ecological adaptation in jellyfish.&lt;/p&gt;

Evaluation of polypus growth among fecal immunochemical test positive patients

Background: Colorectal cancer is a difficult clinical condition to treat all over the world. Adenomatous polyps are thought to be cancer precursors. A colonoscopy is required to detect and confirm ulcerative colitis mucosal healing. Different screening procedures, including as colonoscopy, fecal immunochemistry test (FIT), guaiac fecal occult blood test (gFOBT), computed tomography (CT) colonography, and others, are used to detect polyps or ulcers early. Although the gold standard colonoscopy serves both diagnostic and therapeutic purposes, the FIT can identify advanced adenoma or established cancer, as well as the mucosal condition of ulcerative colitis. The FIT is a less costly approach for detecting colonic disease that is appropriate for our demographic. The aim of the study was to observe the type of polypus growth among FIT positive patients. Methods: This observational cross-sectional study was conducted at the department of colorectal surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study duration was 1 year, from July 2019 to August 2020. At the initial stage, a total of 510 participants were selected among the patients attending the outdoor department of BSMMU colorectal surgery following the inclusion and exclusion criteria. Results: The male: female ratio was 1.7:1 in our study. 48.28% were from the age group of 50-59 years. The most common clinical presentation or symptom among the participants was constipation, observed in 81.03% of cases. 39.66% of the participants had abdominal pain, 32.76% had rectal mucus discharge, 12.07% had observed changes in their bowel movement, while 6.90% had a lack of appetite. Among the participants, 42 had pedunculated polyp, while 16 had sessile polyps. A total of 55.17% had non-advanced pedunculated polyp, 22.41% had non-advanced sessile polyp, 17.24% had advanced grade pedunculated polyp, while the remaining 5.17% had advanced grade sessile polyp. Histopathological findings revealed that 44.83% of the participants had tubular adenoma with low grade dysplasia (LGD) among the non-advanced pedunculated polyps’ cases, 17.24% had tubular adenoma with LGD among the non-advances sessile cases. Among the advanced pedunculated polyps’ cases, 6.90% had tubular adenoma with high grade dysplasia (HGD), 3 (5.17%) had villous adenoma with dysplasia, and 2 (3.45%) had tubulovillous with dysplasia. Among the 3 advances sessile polyps cases, 3.45% had tubular adenoma with HGD, while 1 patient had malignancy. Conclusions: It was observed that FIT positive patients had a higher frequency of pedunculated polyps, specifically advanced pedunculated polyps. Both sessile and pedunculated polyps had a high prevalence among patients aged between 50-59 years.

Contemporary diagnosis and management of gallbladder polyps

Gallbladder (GB) polyps are present in 5%–10% of the general population and consist of true neoplastic polyps (adenomas) and pseudopolyps (predominantly cholesterol, inflammatory, hyperplastic, focal adenomyomatosis). True polyps, although relatively rare neoplastic lesions (0.5%) are considered an important factor in malignant transformation and cancer development (5%) when their size is ≥ 1 cm. Given that it is essential to diagnose GB adenocarcinoma at an early stage to optimize therapeutic management, controversy exists about whether cholecystectomy is always necessary. Their imaging characteristics, size ≥ 1 cm, age &gt; 50 years and genetic predisposition determine the indications for immediate cholecystectomy. In younger patients with polyps &lt; 1 cm in size and without a familial history of GB carcinoma, imaging follow-up by ultrasound (US) seems to be a reasonable recommended policy. A scoring system by multivariate analysis (cross-sectional area &gt; 123 mm2, positive blood flow signal, age &gt; 55.5 years, alanine aminotransferase (ALT) levels &gt; 50 U/L and an ALT/AST (aspartate aminotransferase) ratio &gt; 0.77) can accurately predict true polyps. The widely accepted size threshold for US follow-up is 7 mm, and for intervention, it is 10 mm. Computed tomography or better magnetic resonance imaging can overcome any misdiagnosis of conventional US incidental findings alone that may lead to potentially unnecessary operations. In challenging cases, high-resolution US, novel three-dimensional US, endoscopic US or contrast-enhanced endoscopic US could be helpful. Novel microflow imaging can safely predict polyps. Risk factors for malignancy include age &gt; 60 years, large gallstones, primary sclerosing cholangitis, Asian ethnicity and sessile polyps accompanied by focal gallbladder wall thickening &gt; 4 mm. For polyps sized 6–9 mm, the absence of growth at recommended follow-up (6 months, one year, and two years) indicates treatment discontinuation; however, it is not required for size &lt; 5 mm without risk factors. In addition to laparoscopic cholecystectomy, the standard management, novel interventional modalities preserving the GB in selected cases include per-oral transmural endoscopic resection of GB polyps after a bridge of endoscopic US-guided cholecystostomy or laparoscopic gallbladder-preserving polypectomy. Generally, there are still no precise and strong evidence-based guidelines; thus, the management policy of GB polyps should be individualized in ambiguous cases.

Lymphoglandular Complex-Like Colorectal Carcinoma-A Series of 20 Colorectal Cases, Including Newly Reported Features of Malignant Behavior.

Distinguishing colon carcinoma that is surrounded by well-circumscribed lymphoid tissue from adenomas involving lymphoglandular complexes can be difficult. We assessed a multi-institutional international cohort of 20 colorectal carcinomas with associated prominent lymphoid infiltrates, which we referred to as lymphoglandular complex-like carcinoma (LGCC). We collected clinical and endoscopic features, including lesion size, endoscopic appearance, location, procedure, follow-up, AJCC stage, and mismatch repair status. We recorded the presence of the following histologic features: haphazard gland distribution, gland angulation, gland fusion, solid nest formation, single-cell formation, stromal desmoplasia, presence of lymphovascular invasion and perineural invasion, presence of lamina propria, cytologic atypia as low- or high-grade, presence of goblet cells in the invasive component, and the presence of a surface lesion. Most cases (9 of 13) were described endoscopically as sessile polyps with an average size of 1.56 cm. Most cases (90%) were associated with a surface lesion, of which the majority were tubular adenomas, though a subset was associated with sessile serrated lesions with dysplasia (3 of 18). All cases of LGCC demonstrated haphazard gland distribution and either gland angulation, fusion, or solid nest formation. A portion of cases demonstrated single-cell infiltration (35%) and desmoplasia (50%), and rarely lymphovascular invasion was present (5%). A subset (10%) of cases invaded beyond the submucosa. Deficient mismatch repair was present in 22% (2 of 9) of cases for which it was performed. In cases of colectomy or completion colectomy, nodal metastasis was present in 38% (3 of 8). No cases demonstrated disease recurrence or disease-specific mortality. Overall, LGCC represents an enigmatic subset of carcinomas that is important to distinguish from adenomas involving lymphoglandular complexes due to its varying prognostic outcomes.

Early-stage sigmoid colon cancer resection followed by liver metastasis recurrence 1 year later and mesenteric recurrence more than 5 years later: a case report

BackgroundEarly-stage colorectal cancer (CRC) is often treated endoscopically, but additional surgical resection may be considered depending on pathological findings.Case presentationA 73-year-old man was found to have early-stage sigmoid colon cancer by colonoscopy during a medical examination, and endoscopic mucosal resection (EMR) was performed. The lesion was a 7-mm-sized sessile polyp, and the pathological diagnosis was well-differentiated tubular adenocarcinoma, pT1 (submucosal invasion of 400 μm), with no lymphovascular invasion, low budding grade, and negative horizontal and vertical margins. Therefore, the patient was observed without postoperative treatment. One year later, a computed tomography (CT) scan showed multiple liver metastases. After five courses of preoperative chemotherapy with folinic acid, 5-fluorouracil and oxaliplatin (FOLFOX) and panitumumab, liver metastases were reduced. The patient underwent extended right hepatic lobectomy. The pathological finding was well-to-moderately differentiated tubular adenocarcinoma, and immunohistochemistry findings were consistent with liver metastases from sigmoid colon cancer. Postoperatively, the patient received five courses adjuvant chemotherapy with FOLFOX. Although the patient had been recurrence-free for 5 years after liver resection, a CT scan revealed a nodular lesion in the sigmoid mesentery. Positron emission tomography (PET) showed abnormal accumulation in the same lesion. Therefore, the mesenteric nodules diagnosed as lymph metastasis and recurrence of sigmoid colon cancer and performed laparoscopic sigmoid colon resection with lymph node dissection. The pathological findings showed that the recurrent lesion in the mesentery formed a nodular infiltrate with venous, lymphatic, and neural invasion, but lymph node structures were not found, and it was assumed to be metastasis or recurrence due to lymphovascular invasion. The pathologic specimen of the sigmoid colon had no neoplastic lesions, which are considered to be a local recurrence on the mucosal surface. After sigmoid colectomy, adjuvant chemotherapy with CapeOX was conducted, and the patient has been recurrence-free for 13 months at present.ConclusionEven early-stage CRCs that have no pathological indications for additional resection have risks of metastases and recurrences, and we may need to consider that the criteria for additional resection should not be limited to pathological findings alone.