Single Polyp Research Articles

Juvenile Polyps in Bangladeshi Children and Their Association with Fecal Calprotectin as a Biomarker.

PurposeColonoscopy is considered the most reliable method for the diagnosis of juvenile polyps. However, colonoscopic screening is an invasive and expensive procedure. Fecal calprotectin (FCP), a marker of intestinal inflammation, has been shown to be elevated in patients with polyps. Therefore, this study aimed to evaluate FCP as a screening biomarker for the diagnosis of juvenile polyps.MethodsThis cross-sectional, observational study was conducted at the Pediatric Gastroenterology and Nutrition Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. For children with polyps, colonoscopic polypectomy and histopathology were performed. FCP levels were analyzed before and 4 weeks after polypectomy in all patients. Information was recorded in a datasheet and analyzed using the computer-based program SPSS.ResultsThe age of the children was between 2.5 and 12 years. Approximately 93% of the polyps were found in the rectosigmoid region. Children with juvenile polyps had elevated levels of FCP before polypectomy that subsequently normalized after polypectomy. The mean FCP levels before and after polypectomy were 277±247 µg/g (range, 80–1,000 µg/g) and 48.57±38.23 µg/g (range, 29–140 µg/g) (p<0.001), respectively. The FCP levels were significantly higher in patients with multiple polyps than in those with single polyps. Moreover, mean FCP levels in patients with single and multiple polyps were 207.6±172.4 µg/ g and 515.4±320.5 µg/g (p<0.001), respectively.ConclusionColonic juvenile polyps were found to be associated with elevated levels of FCP that normalized after polypectomy. Therefore, FCP may be recommended as a noninvasive screening biomarker for diagnosis of colonic juvenile polyps.

Colonoscopic Polypectomy: Analysis of 429 cases

Aim: It is well known that most colorectal cancers develop from colon polyps. Therefore, removing polyps found during colonoscopy, regardless of their size and characteristics, is critical because of the risk of developing colorectal cancer. This study aimed to evaluate the outcomes of colonoscopic polypectomy performed in our clinic. Materials and Methods: The data of patients who underwent colonoscopy for various reasons between January 2018 and December 2020 and who had polypectomy performed during the procedure were evaluated retrospectively. These patients were divided into two groups, single polypectomy, and multiple polypectomy cases. Results: Single polyp was detected in 72% (n=309) of the 429 patients included in the study, whereas multiple polyps were detected in 28% (n=120). Of these patients, 62.9% (n=270) were male and 37.1% (n= 159) were female. The median age of patients with a single polyp (61,0) was lower than that of patients with multiple polyps (65,0) (p= 0.014). In patients with a single polyp, the most common localization was rectum (32.4%), and the most common histopathological subtype was tubular adenoma (50.8%). In patients who underwent multiple polypectomies, the most common localization was a sigmoid colon (25.5%), while the most common histopathological subtype was again tubular adenoma (48.1%). There was no statistically significant difference between the two groups in the severity of dysplasia (p = 0,838). A significant difference was found between polyp diameter and dysplasia severity in adenomatous polyps in both groups (p&lt;0.001). Conclusion: Colonoscopic polypectomy effectively reduces the risk of colorectal cancer by removing precancerous polyps. Colon polyps are often prominent in the rectosigmoid region and more common in the male gender. An increase in the number of colon polyps is observed with age. In our country, a multicenter prospective study with many participants is required to characterize polyps.

Atypical uterine polyps show morphologic and molecular overlap with mullerian adenosarcoma but follow a benign clinical course

A subset of clinically benign uterine polyps shows atypical morphologic features worrisome for, but not diagnostic of, Mullerian adenosarcoma. We report clinicopathologic data for 63 polyps from 58 women with atypical morphologic features including abnormal architecture, abnormal periglandular stroma, stromal atypia, and mitoses >2 per 10 hpf. Four (11%) of 36 women with follow-up tissue sampling had residual/recurrent atypical polyp. Twelve (27%) of 44 women underwent hysterectomy subsequent to a diagnosis of atypical polyp. No patient developed adenosarcoma over median follow-up of 150 months. Twenty-one primary atypical polyps underwent molecular profiling. Five (24%) harbored chr 12q13-15 gain or amplification, 9/20 (45%) harbored chr 6q25.1 gain, and 7/21 (33%) had no significant copy number alterations. Gains of chr 1q, chr 8p12, and chr 10q11.21-23, amplifications of chr 12q24.12-13, chr 15p24.1-26.1, and chr 18q21.33, and loss of chr 7 and chr 11q21 were each seen in a single polyp. Mean tumor mutational burden was 3.1 (range, 0.76–8.365) mutations/Mb. Pathogenic point mutations were identified in 12/20 (60%) primary atypical polyps. We propose the term “atypical uterine polyps” for these lesions, which show biologic overlap with early Mullerian adenosarcoma but lack molecular alterations characteristic of clinically aggressive adenosarcoma and appear to follow a benign clinical course. Conservative management with close clinical follow-up and repeat sampling can be considered for these lesions, when clinically appropriate.

LONG-TERM ULTRASOUND FOLLOW-UP IN PATIENTS WITH SMALL GALLBLADDER POLYPS

Introduction Gallbladder polyps often have a benign appearance by ultrasonography. Even so, the current guideline recommends follow-up in gallbladder polyps lesser-than 6 mm. The aim of this study was to investigate long-term follow-up growth of polyps in patients with a polyp size lesser-than 6 mm in a ten-year cohort. Methods Abdominal ultrasonography reports from 2007 to 2009 were reviewed, including reports on patients diagnosed with a gallbladder polyp (polyp size lesser-than 6 mm) during the 2007-2009 period. The patients were invited to a final follow-up ultrasonography of the gallbladder conducted during October 2019 to February 2020. A total of 154 patients were included (100 women and 54 men). Results In 53 patients (34.4%), the polyp was not visible at the ultrasonography follow-up. Gallbladder polyps were confirmed in 101 (65.6%) patients. A total of 49 patients had a single polyp (31.8%) and 52 (33.8%) patients had multiple polyps. The median size of the gallbladder polyp was 4 mm (range: 2.0-5.9 mm) at baseline compared with 4 mm (range: 1.7-15.0 mm) at the follow-up. A total of 15 patients experienced polyp growth of 2 mm or more. None developed gallbladder cancer. Conclusions Our study showed that gallbladder polyps lesser-than 6 mm has a low probability of increasing in size. None of the patients with small polyps developed gallbladder cancer. Funding none. Trial registration not relevant.

The Importance of CT Pneumocolon in Detecting Colonic Lesions

Background: Colonic masses are clinically important because some of them are malignant and others have a tendency to become malignant such as polyps. CT pneumocolon may have a role in the evaluation and diagnosis of these masses. Objective: To determine the accuracy of computed tomography (CT) pmeumocolon in the detection of colonic masses compared with colonoscopy. Patients and Methods: A total of 60 patients with colorectal symptoms underwent evaluation for the presence of colorectal neoplasms by using both colonoscopy and CT pneumocolon and a comparison was made between them. Results: On colonoscopy, 10 out of 60 patients were having a negative colonoscopy. The results of colonoscopy of the other 50 patients were as follow; three out of fifty colonoscopies revealed invasive colorectal carcinomas in threse patients. The remaining 47 colonoscopies for 47 patients revealed benign polyps. The sizes of these polyps were as follows; (6 polyps were ˃1 cm in diameter), (17 polyps were 6-9 mm), and (24 polyps were ≤5 mm). CT pneumocolon detected all 3 malignant masses seen and biopsied by colonoscopy, but only (28 single polyps) which according to their size (4 polyps were ≥ 1cm), (11 polyps were 6-9 mm) and (13 polyps ≤5 mm), this gives CT pneumocolon a sensitivity of (63%), specificity of (70%) and accuracy (63%). Conclusion: CT pneumocolon has high sensitivity and specificity for a detection of large-sized masses, but not for small ones. CT pneumocolon may be suitable for investigating patients with symptomatic colorectal masses noninvasively. Keywords: Pneumocolon, colonoscopy, polyp, colonic carcinoma

Association of preserved vegetable consumption and prevalence of colorectal polyps: results from the Lanxi Pre-colorectal Cancer Cohort (LP3C).

Although fresh vegetable consumption has been linked with a lower risk of colorectal polyps, a precursor lesion for colorectal cancer (CRC), the association between preserved vegetable consumption and colorectal polyps is unknown. We aimed to assess the association of preserved vegetable intake with the prevalence of colorectal polyps with the consideration of subsites, sizes and multiplicity of polyps. We analyzed the cross-sectional data from 40-80 years Chinese at a high risk of CRC from the Lanxi Pre-colorectal Cancer Cohort (LP3C) baseline survey, which was conducted between March 2018 and December 2019. Dietary information was obtained via a validated food frequency questionnaire. Multivariate logistic regression was employed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of preserved vegetable consumption and the prevalence of colorectal polyps. Of 6783 eligible participants in 2018-2019 survey of LP3C, 2064 prevalent colorectal polyp cases were identified. In the multivariable-adjusted model, preserved vegetable consumption was positively associated with the prevalence of colorectal polyps (OR for fourth vs. first quartile: 1.18; 95% CI 1.01-1.36; P trend = 0.02). The similar association was also detected for small polyps [ORQ4 vs Q1 (95% CI): 1.17 (1.00-1.37); P trend = 0.03]. The similar trend was detected for multiple polyps [OR Q4 vs Q1 (95% CI):1.27 (0.98-1.64); P trend = 0.04], proximal colon polyps [ORQ4 vs Q1 (95% CI): 1.12 (0.90-1.38); P trend = 0.07], and single polyp [ORQ4 vs Q1 (95% CI) for 1.15 (0.98-1.35); P trend = 0.06]. No significant association was observed for distal colon [ORQ4 vs Q1 (95% CI) 1.19 (0.98-1.45); P trend = 0.09]. Replacing one serving per day of preserved vegetables with fresh vegetables was related to 20%, 23%, and 37% lower prevalence of overall, small, and multiple polyps, respectively. Preserved vegetable consumption was associated with a higher prevalence of colorectal polyps in a Chinese population at a high risk of CRC. Replacing preserved vegetables with fresh vegetables may be conducive to lower prevalent colorectal polyps.

Mucosal Mast Cell Distribution in the Gastrointestinal Tract of Children: A Preliminary Study for Establishing Reference Values.

The physiological number and distribution of mast cells (MCs) in the pediatric gastrointestinal (GI) tract is not well defined and reference values of normality are missing. To define a physiological and disease defining cut-off, a systematic histological exploration of MC distribution from the esophagus to the rectum in healthy as well as in patients with gastrointestinal food allergies (GFA) was performed. Nine pediatric subjects that exhibited unremarkable histopathological evaluations or underwent endoscopy for surveillance reasons after a previous polypectomy of single colonic juvenile polyps served as reference cohort. In all of these subjects, a chronic inflammatory disease (eg, inflammatory bowel disease, celiac disease) or allergy was excluded. In addition, a group of 15 patients with gastrointestinal complaints suspected to be caused by a GFA were investigated. Immunohistochemistry was performed from all biopsies using CD117 (c-Kit) as a reliable marker to identify MCs in the lamina propria. There were distinct differences of MC counts in all parts of the pediatric GI tract. The highest counts of MCs in both symptomatic patients and control cohort, were found in the duodenum, terminal ileum, cecum and ascending colon. The lowest counts were found in the esophagus. Significant disparities between GFA and healthy subjects were found in the gastric corpus (22.1 ± 4.0/ high power field [HPF] vs 32.0 ± 10.1/HPF; P = 0.034) and ascending colon (44.8 ± 10.4/HPF vs 60.4 ± 24.3/HPF; P = 0.047). Mucosal MC counts in the pediatric GI tract are higher than previously reported, with a considerable overlap between healthy and GFA patients. These results provide detailed information on distribution and numbers of MCs in pediatric allergic patients while allowing estimates of physiological values in childhood for the first time. With regard to diagnostic procedures in GFA further laboratory parameters have to be integrated.

Asymptomatic Postmenopausal Endometrial Thickening: A Comparison between Transvaginal Ultrasound and Hysteroscopy

<h3>Study Objective</h3> Compare the ultrasonography and the hysteroscopy findings in asymptomatic postmenopausal patients showing endometrial thickening. <h3>Design</h3> Observational study (Canadian Task Force Classification II-2). <h3>Setting</h3> San Salvatore Hospital of L'Aquila, Department of Obstetrics and Gynecology. <h3>Patients or Participants</h3> 315 asymptomatic postmenopausal women with endometrial thickening >4 mm. <h3>Interventions</h3> Diagnostic hysteroscopy, endometrial biopsy. <h3>Measurements and Main Results</h3> That patients had normal endometrium (8.6%), atrophic endometrium (26.7%), single benign polyp (47.6%), multiple polyps (8.6%), myoma (1.9%), focal hyperplasia (3.8%), diffuse hyperplasia (0.9%) and endometrial carcinoma (1.9%). In 30 women under therapy for breast cancer (thickening >5 mm) the hysteroscopic exam showed normal endometrium (50%), multiple polyps (20%), focal hyperplasia (20%) and diffuse hyperplasia (10%). For this subcategory of patients, the histopathological analysis confirmed the hysteroscopic diagnosis in 100% of case. It is not statistically valid to give to the homogeneity data of the endometrial thickening a direct association with the suspicion of polyp, as well as the ascription of a direct association with all the other suspicions except polyp to a non-homogeneous thickening cannot be considered statistically valid. The ROC analysis shows that the best cut-off for suspected polyp in ultrasonography is ≤6 mm (sensibility of just 66.0%, specificity of just 58.18%). By the ROC analysis, an 8 mm cut-off of ultrasound thickness was identified, above which the suspicion of endometrial carcinoma is strongly solid (specificity of 84.47% and a sensibility of 100%). <h3>Conclusion</h3> Hysteroscopy has a positive predictive value (PPV) of 100%and a negative predictive value (NPV) of 97.952% in detecting a risk of malignancy, with a specificity of 100% and a sensibility of 77.78%, demonstrating that hysteroscopy is the gold standard for the diagnosis of malignant endometrial pathology or an endometrial condition at severe risk of malignancy. A direct endoscopic exam is the only valid exam in the diagnosis of the intracavitary pathologies, especially in asymptomatic postmenopausal patients.

S1772 A Giant Hyperplastic Colorectal Polyp With No Malignant Features

Introduction: Hyperplastic polyps (HP) are a benign subgroup of serrated polyps. HP larger than 10 mm is considered a large polyp and larger than 2 cm carry a risk for malignancy. A case of near obstructing giant hyperplastic polyp of the recto-sigmoid colon with no malignant features is presented with a topic review and proposed further follow-up. Case Description/Methods: A 29-year-old African American man presented to the gastroenterology clinic with a 1-year history of early satiety, intermittent rectal bleeding, alteration in bowel habits, and weight loss. Upper and lower endoscopies identified a large pedunculated mass with near-complete obstruction in the recto-sigmoid colon [Figure 1A]. Biopsies show hyperplastic mucosa with no evidence of a malignant process. Imaging revealed distal colonic mass extending over a 6 cm segment [Figure 1B]. CEA and cancer antigen CA 19-9 markers were unremarkable. Laparoscopic sigmoid resection was performed. Histology reported pedunculated polyp 2.5 x 2.5 x 1.8 cm and 2 cm stalk with serrated appearance, hyperplasia, and no evidence of malignancy [Figure 1C]. Postoperative course was uneventful, with improvement in appetite and weight gain. Genetics evaluation deferred further testing. Discussion: HP are the most abundant type and now believed to be a subgroup of serrated polyps (SP). SP are classified into two main subgroups based on malignant potential. The majority of the serrated carcinomas arising from HP follow BRAF and KRAS pathways. Microsatellite instability has also been associated [1]. Serrated polyposis syndrome is associated with the risk of colorectal cancer. Due to the inability of subtracting a single responsible gene, other syndromes should be excluded. Polyps larger than 1 cm are classified as large, and exceeding 3 cm as a giant. Parallel to the size increases the malignant potential. Risk stratification of giant, pedunculated polyps is advised prior to endoscopy due to the risk of perforation and bleeding. Due to the concern for malignant transformation with obstructive signs and symptoms, surgical excision was advised.Further discussions are needed to establish clear guidelines for testing and surveillance of single giant non-malignant polyps. We propose our own management including surgical vs. endoscopic resection, genetic testing, and colonoscopy in 1,3, and 5- year intervals, followed by standard surveillance.Figure 1.: A. Abdominal CT scan. B. Colonoscopic view. C. Lower Endoscopic Ultrasound View. D. Histopathology.

S220 Cancer-Specific 5-Year Survival Following Endoscopic Polypectomy versus Surgery for Malignant Colorectal Polyps

Introduction: Current guidelines recommend polyp resection strategies, endoscopic resection (ER) or surgical resection (SR) based on high-risk histological features and depth of invasion to ensure complete removal of the malignant lesion, minimizing the risk of progression through micrometastasis. Data comparing cancer-specific survival following ER or SR for localized malignant polyps based on the AJCC staging (Stage 0, I & II & grade) are scarce. Methods: We used the Surveillance Epidemiology and End Results (SEER) database (2004-2015) on patients diagnosed with at least a single malignant colorectal polyp (Table) on the colonoscopies performed for any indication or screening. Data extraction was through a case listing session using SEER*Stat v8.3.9 on combined SEER 18 incidence registries using specific codes for CRC polyps with cancer. Statistical analysis was performed using SPSS v27 for Mac. Results: A total of 63,147 patients with a diagnosis of a colorectal polyp with a malignant component were identified. The mean age was 47.48 years (± 12.15 SD), 45.6% were females. T stages ranged T1-T3. Patients with stage 0 (carcinoma in situ) polyps showed equivalent 5-year cancer-specific survival regardless of ER or SR (mean 170 vs 169 months, 94.2% vs 93.7%, P=0.429, Figure 1A). Stage I and II patients showed superior 5-year survival with SR than ER (mean 165 vs 159 months, 91.1% vs 88%, p< 0.001, Figure 1B). Patients with well-differentiated histological grade demonstrated no survival differences regardless of ER or SR (mean 165 vs 166 months, 92.7% vs 93%, P=0.175, Figure 1C). In contrast, those with polyps of poor differentiation or anaplastic features showed superior 5-year cancer-specific survival with SR than ER (mean 161 vs 145months, 90% vs 88%, P=< 0.001, Figure 1E). Patients with polyps of moderate differentiation showed superior 5-year cancer-specific survival with SR compared with ER (mean 164 vs 159months, 92% vs 90% p< 0.001, Figure 1D) Conclusion: Our results show that cancer-specific survival improved in patients with malignant polyps with AJCC Stage I or II who underwent SR compared with ER, but not Stage 0 (carcinoma in situ). Another novel finding was superior 5-year cancer-specific survival in patients with polyps of moderately-differentiated histological grade, in addition to poorly differentiated and anaplastic grades, which has not been reported before. These novel findings warrant further corroboration from well-constructed clinical trials.Figure 1.: Five-year cancer specific survival comparing endoscopic resection versus surgical resection for colorectal polyps by cancer stage and histological grade.Table 1.: Number of patients diagnosed with polyps with a malignant component by stage and year of diagnosis.

S327 National Trends in the Incidence of Sporadic Malignant Colorectal Polyps in Young Patients (20-49 Years): An 18-Year SEER Database Analysis

Introduction: Recent changes in the USPSTF guidelines recommend that CRC (Colorectal Cancer) screening in average-risk patients should commence at 45 years with the intent of finding sporadic premalignant or malignant polyps, allowing early endoscopic interventions to improve clinical outcomes. This study aims to find the incidence of sporadic malignant polyps in adult patients < 50 years of age) from the National Cancer Institute's SEER (Surveillance Epidemiology and End Results) database over a period of 18 years. Methods: We interrogated the SEER database (2000-2017) on patients aged 20-49 years diagnosed with at least a single malignant sporadic colorectal polyp. Data extraction was performed through a case listing session using SEER*Stat v8.3.9 on combined SEER 18 incidence registries using specific codes for CRC polyps with cancer (Table). Microsatellite instability (MSI-H) high lesions and adenomatous polyposis coli (APC) were excluded from the analysis. Descriptive statistical analysis was performed using SPSS v27 for Mac. Results: A total of 10,742 patients with a diagnosis of colorectal polyps with a malignant component were identified. Female patients comprised 42.9% of the cohort with a mean age of any malignant polyp incidence of 43.07 years (42.91-43.23, 95% CI). The annual mean age (95% CI) of incidence of new-onset malignant polyps over time is shown in Figure 1. Approximately 50% of malignant polyps were diagnosed between 45-49 years of age, and about 25-30% were diagnosed between 40-45 years of age (Table). The incidence of malignant villous adenomas decreased, whereas malignant adenomas and tubulovillous adenomas increased over time (Table). A rising temporal trend for the total number of patients diagnosed with malignant polyps was also observed. Serrated polyps with cancer were noted to be scarce in the population studied. Conclusion: Our results show the mean age of sporadic malignant colorectal polyp incidence occurrence at 43 years. Approximately half of the malignant polyps under age 50 occurred in patients under age 45, below the current screening threshold of 45 years. Also observed was a temporal change in the histological patterns of colorectal malignant polyps, with malignant tubulovillous and adenomatous adenomas increasing and villous adenomas decreasing with the scarcity of serrated polyps with cancer in this population. These results have profound implications for colorectal cancer screening.Figure 1.: Age of malignant colorectal polyp incidence over time in 20 to 49 year age group.Table 1.: Distribution of gender and histological trend over time (2000-2017) of sporadic* malignant colorectal polyps in patients aged 20-49 years.

Early development and coloniality in Oligophylloides from the Devonian of Morocco-Are Heterocorallia Palaeozoic octocorals?

Heterocorals represent an enigmatic group of Palaeozoic corals, known from relatively short time intervals in the Devonian and Carboniferous periods. The major differences between Heterocorallia and other Palaeozoic corals are the lack of an external theca (epitheca), lack of calices and the presence of dichotomously dividing septa-like structures. Heterocoral skeleton was presumably externally covered by the soft tissue and each branch of their skeleton has, until now, been regarded as a corallite–a skeleton of a single polyp. We investigated upper Famennian Oligophylloides from Morocco, focussing on branching processes, wall structure, previously poorly known initial growth stages and the growing tip, described here for the first time. We demonstrate that Oligophylloides shows a unique colony development not known in any group of anthozoans possessing a septate-like architecture and suggest that the previously postulated homology between true septa in hexa- and rugose corals on one hand, and Oligophylloides on the other, must be rejected. Based on the skeleton structure and branching patterns, we postulate, contrary to former ideas, that the stem and branches of heterocorals represent the skeleton of a multi-polyp colonial coral, similar to many extant octocorals. We found numerous potential homologies with octocoral skeletons (notably the Keratoisidinae within the Isididae) and, as a result, we propose the inclusion of the order Heterocorallia within the subclass Octocorallia. This suggestion requires, however, further research on the other taxa of heterocorals. We also propose some changes to the morphological terminology for the Heterocorallia.

Adenovirus is prevalent in juvenile polyps and correlates with low vitamin D receptor expression.

BackgroundThe objective of this study was to assess human adenovirus (HAdV) infection in juvenile polyps (JPs) and to preliminarily establish a correlation to vitamin D receptor (VDR) expression.MethodsThe study includes 76 patients of 5.2 ± 2.8 years old. Seventy-eight JP specimens and 24 parapolyp tissues from polypectomy were used. PCR was used to detect HAdV DNA and quantitative reverse transcription-PCR for viral and host gene expression. The PCR products were sequenced for virus typing. The correlation between VDR expression and HAdV infection was established using nonparametric Spearman’s analysis.ResultsSeventy-four children (97.4%) had a single polyp and two had two polyps. The histopathological characteristics of the polyps were in line with JP. Thirty-three samples had HAdV DNA (43.4%), including 32 subgroup C and 1 subgroup B HAdV; no enteric HAdV was detected. HAdV messenger RNA was detected in 5 of the 33 samples (15.2%). The samples had increased interleukin-1β (IL-1β), IL-6, and calprotectin expression, and reduced E-cadherin and VDR expression. JP samples with low VDR expression were more prevalent of HAdV DNA (r = 1.261, 95% confidence interval, 1.017–1.563), while VDR expression positively correlated with E-cadherin and negatively with inflammation gene expression.ConclusionsHAdV latent infection was prevalent among JP tissues. The presence of HAdV correlated positively to low VDR expression.Impact The HAdVs infect the upper airways and gastrointestinal system and is found to persist in lymphoid tissues. The prevalence of HAdV and the status of the infection is unknown.The study investigated the prevalence of HAdV from polypectomy specimens of JP patients and found that HAdV was prevalent and was in a persistent state. HAdV infection was more prevalent in samples with low VDR expression.Whether HAdV infection and reactivation is a contributing factor to JPs is unknown. Factors such as proinflammation and bacterial metabolites that are known to promote HAdV reactivation warrant further investigation.

The diagnostic value of squirting rectal bleeding: The first description of such bleeding pattern

Background and objective: Rectal bleeding is a common symptom that has many patterns, but none of them are accurately diagnostic. One newly noticed pattern can be diagnostic, namely, the squirting pattern, for which this study was conducted. Methods: The study was conducted between Jan 2013 and Jun 2018, including 132 patients who presented with a squirting pattern of rectal bleeding, which is thought to be due to hemorrhoids. All these patients underwent clinical evaluation and anoscopy, and the majority (n=94) underwent colonoscopy. Results: At the time of clinical examination, 23 patients showed actively bleeding hemorrhoids. Fifteen patients were not convinced to undergo colonoscopy. The rest (n=94) who had no visible active bleeding at the time of examination underwent a colonoscopy to exclude other possible rectal or colonic pathology. All the 94 colonoscopies were negative for other bleeding sources. Two patients showed single benign non bleeding polyps, which were excised and biopsied. Conclusion: This study highlights a pattern of rectal bleeding that is not described before and proved it is a reliable diagnostic pattern for hemorrhoids. It also showed that colonoscopy is not needed in patients below 40 years complaining of squirting rectal bleeding unless indicated for some other reason. This decision is to be made very carefully. Keywords: Squirting rectal bleeding; Hemorrhoids; Colonoscopy.

A self-attention based faster R-CNN for polyp detection from colonoscopy images

At present, the incidence rate of colorectal cancer (CRC) is increasing year by year. It has always affected people's physical and mental health and quality of life. How to improve the detection ability of polyp plays a key role in colonoscopy. In order to solve these problems, in this paper, we first enhance the contrast of the input image by well distinguishing the foreground from the background in order to improve the saliency of the polyp regions. Then, we feed the enhanced image into an improved Faster R-CNN architecture comprised three processing modules for feature extraction, region proposal generation, and polyp detection, respectively. In order to further improve the quality, as well as the feature abstraction capability of the feature maps produced by the feature extraction network, we append an attention module to attend to the useful feature channels and weaken the contributions of the helpless feature channels. The experimental results demonstrate that the accuracy of the proposed polyp detection network is greatly improved compared with the existing algorithms, and the network not only can accurately identify polyps of varying sizes and conditions in single polyp images, but also can achieve excellent performance in handling multiple polyp images. This paper will be greatly helpful to alleviate the missed diagnosis of clinicians in the process of endoscopic examination and disease treatment, as well as providing effective assistance for the early diagnosis, treatment and prevention of the CRC, which is also of great significance to the clinical work of physicians.

Gastroesophageal reflux is associated with an increased risk of gastric cardiac polyps: a case-control study of 140 cases.

The pathogenesis of gastric cardiac polyps is not yet clear, and there is little research on their clinical and histopathologic characteristics and correlation with gastroesophageal reflux. Early detection and treatment of premalignant lesions in this area can prevent the development of cancer. We aimed to evaluate the clinical and histopathologic characteristics and risk factors of gastric cardiac polyps to improve the current understanding of the disease. Patients diagnosed with gastric cardiac polyps at the Third Affiliated Hospital of Sun Yat-Sen University between January 1, 2010, and December 31, 2019, were sought for the study. The exclusion criteria were missing clinical data, insufficient pathological reports, gastric malignancy, or a previous history of gastroduodenal surgery. Ultimately, 140 patients were included in the case group, while 140 patients diagnosed with chronic superficial gastritis from the same 10-year period were identified randomly and selected as a control group. The exclusion criteria for this group were the same as those for the case group. Patients in both groups were matched in age and gender to ensure comparability between the two groups. We evaluated and compared the demographic and clinical data and endoscopic impressions of each group and analyzed the endoscopic, histologic features of gastric cardiac polyps. Gastroesophageal reflux was significantly associated with a higher risk of gastric cardiac polyps after adjustment for other covariates [adjusted odds ratio (OR) =2.809; 95% confidence interval (CI): 1.178-6.697; P=0.020]. Most gastric polyps were single (97.9%), sessile (92.8%), and small polyps with a diameter less than 1 cm (88.6%). Most were located in the gastroesophageal junction region (65.0%) with a smooth surface (56.4%) or surface congestion (30.0%). Hyperplastic (inflammatory) polyps (88.0%) were the most common pathological type and comprised gastric-type foveolar epithelium, squamous epithelium, or admixture of the two epithelia, with a minority showing intestinal metaplasia, mild, or moderate epithelial dysplasia. Gastroesophageal reflux was associated with a significantly higher incidence of gastric cardiac polyps with a 2.8-fold increased risk. Most gastric cardiac polyps were found to be benign lesions and had a favorable prognosis in the clinic despite their malignant potential.

Establishment of a nomogram prediction model for long diameter 10–15 mm gallbladder polyps with malignant tendency

BackgroundSurgical indications for the treatment of gallbladder polyps are controversial. Evaluation of gallbladder polyps with malignant tendency and indications for cholecystectomy in patients with long diameter polyps of 10 to 15 mm require further analysis and discussion. In this study, our objective was to re-evaluate indications for the surgical resection of gallbladder polyps and construct a nomogram model for the prediction of gallbladder polyps with malignant tendency. MethodsClinicopathologic data of 2,272 patients who had undergone cholecystectomy for gallbladder polyps were collected from 11 medical centers in China. Risk factor analyses and nomogram prediction model for gallbladder polyps with malignant tendency were conducted. ResultsExcluding 311 patients with cholelithiasis and 488 patients with long diameter polyps ≤5 and >15 mm, factors that differed significantly among patients with gallbladder polyps having a long diameter of 6 to 9 mm (885 cases) and 10 to 15 mm (588 cases) were polyp detection time, CEA and CA19-9 levels, number of polyps, fundus, echogenicity, gallbladder wall thickness and postoperative pathologic features (P < .05). Among 588 patients with gallbladder polyps with a long diameter of 10 of 15 mm, multivariate analysis indicated the following independent risk factors of gallbladder polyps with malignant tendency: single polyps (OR = 0.286/P < .001), polyps with broad base (OR = 2.644/P = .001), polyps with medium/low echogenicity (OR = 2.387/P = .003), and polyps with short diameter of 7 to 9 or 10 to 15 mm (OR = 3.820/P = .005; OR = 2.220/P = .048, respectively). The C-index of the nomogram model and internal validation were .778 and .768, respectively. In addition, a sample online calculator for the nomogram prediction model had been created (https://docliqi.shinyapps.io/dynnom/). ConclusionIndications for cholecystectomy in patients with gallbladder polyps with a long diameter of 10 to 15 mm should be assessed by combining the information on short diameter, number of polyps, fundus, and echogenicity. The nomogram model can be used to predict the risk for the development of gallbladder polyps with malignant tendency.

Relationship between insulin resistance, serum VCAM-1, FGF19, IGF-1 and colorectal polyps

Objective: To explore the relationship between insulin resistance, glucose and lipid metabolism related molecules and colorectal polyps. Methods: A total of 262 healthy people who underwent colonoscopy in Shandong cancer hospital from June 2019 to September 2020 were selected. The levels of serum vascular cell adhesion molecule-1 (VCAM-1), fibroblast growth factor 19 (FGF19), insulin like growth factor (IGF-1), fasting blood glucose and fasting blood insulin were detected by enzyme-linked immunosorbent assay (ELISA). Insulin resistance index (HOMA-IR) was calculated, and the influencing factors of occurrence, pathological type, size and number of polyps were analyzed. Results: Among 262 cases, 116 cases were polyp free, 113 cases were adenomatous polyp and 33 cases were inflammatory polyp. HOMA-IR, VCAM-1 and FGF19 in polyp group were 2.904±1.754, (334.415±139.573) ng/ml and (135.865±98.470) pg/ml, respectively, which were higher than 2.369±1.306, (302.480±99.946) ng/ml and(110.694±76.044) ng/ml in non-polyp group, respectively (P<0.05). Multivariate Logistic regression analysis showed that the gender (OR=4.269, 95%CI: 1.963-9.405) and FGF19 (77.0-131.4 pg/ml: OR=2.385, 95%CI: 1.155-4.926) were independent factors of colorectal polyps. The gender (OR=3.799, 95%CI: 1.650-8.748) and FGF19 (77.0-131.4 pg/ml: OR=2.290, 95%CI: 1.072-4.891) were independent factors of colorectal adenomatous polyps. The gender(OR=6.725, 95%CI: 1.853-24.410) and fasting plasma glucose (≥6.5 mmol/L: OR=0.047, 95%CI: 0.009-0.245) were independent factors of colorectal inflammatory polyps. The gender (OR=3.539, 95% CI: 1.293-9.689) was an independent factor for the occurrence of single polyp. The gender (OR=5.063, 95% CI: 2.048-12.515), FGF19 (77.0-131.4 pg/ml: OR=2.502, 95%CI: 1.102-5.681), fasting plasma glucose (≥6.5 mmol/L: OR=0.282, 95%CI: 0.095-0.839) were independent factors of multiple polyps. The gender (OR=3.416, 95% CI: 1.134-10.289) and fasting insulin (≥9.4 μU/ml: OR=9.480, 95% CI: 1.485-60.521) were independent risk factors for colorectal polyps<0.5 cm. The gender (OR=3.151, 95%CI: 1.244-7.984) and fasting plasma glucose (≥6.5 mmol/L: OR=0.310, 95%CI: 0.102-0.941) were independent risk factors for colorectal polyps with the size of 0.5-0.9 cm. The gender (OR=22.649, 95%CI: 4.154-123.485), age (55 to 64 years old: OR=4.473, 95%CI: 1.070-18.704; ≥65 years old: OR=5.815, 95%CI: 1.300-26.009), BMI (≥28 kg/m(2): OR=5.310, 95%CI: 1.224-23.032) and FGF19 (77.0-131.4 pg/ml: OR=7.474, 95%CI: 1.903-29.351) were independent factors for colorectal polyps with size ≥ 1.0 cm. Gender stratification analysis showed that FGF19 was an independent factor for the occurrence of male polyps (77.0-131.4 pg/ml: OR=6.109, 95%CI: 1.688-22.104) and adenomas (77.0-131.4 pg/ml: OR=6.401, 95%CI: 1.717-23.864). The age (55 to 64 years old: OR=3.783, 95%CI: 1.052-13.611) and VCAM-1 (≥352.8 ng/ml: OR=4.341, 95%CI: 1.142-16.493) were independent risk factors of female polyps. The age (55 to 64 years old: OR=5.743, 95%CI: 1.205-27.362, ≥65 years old: OR=6.885, 95%CI: 1.143-41.467), VCAM-1 (≥352.8 ng/ml: OR=6.313, 95%CI: 1.415-28.159) and IGF-1 (≥7.6 ng/ml: OR=5.621, 95%CI: 1.069-29.543) were independent factors of female adenoma. Conclusions: The occurrences of colorectal polyps and adenomatous polyps are related to insulin resistance and glucose and lipid metabolism. Serum FGF19 is an independent influencing factor for the occurrence of colorectal polyps and adenomatous polyps, and is a potential serological diagnostic marker and therapeutic target for colorectal polyps and adenomatous polyps.

Conventional Ultrasound Combined With Contrast-Enhanced Ultrasound in Differential Diagnosis of Gallbladder Cholesterol and Adenomatous Polyps (1-2 cm).

This study aimed to determine ultrasonic image characteristics that enable differentiation between cholesterol and adenomatous polyps and to assess the diagnostic efficacy of combining conventional ultrasound (CUS) with contrast-enhanced ultrasound (CEUS). Eighty-nine patients with gallbladder polyps of 1-2 cm in diameter were enrolled and examined by CUS and CEUS before cholecystectomy. The appearances on CUS and CEUS were recorded and analyzed. The receiver operating characteristic (ROC) curve was used to calculate the optimal size threshold for distinguishing cholesterol from adenomatous polyps. A logistic regression analysis was performed to identify diagnostic variables. ROC analysis was performed to evaluate the diagnostic efficacy of the size, the independent variables, and the combined factors. There were differences in size, number, vascularity on CUS and intralesional vascular shape, wash-out, and area under the curve on CEUS between the two groups (P< .05). ROC analysis indicated that a maximum diameter of 1.45 cm was the optimal threshold for the prediction of adenomatous polyps. The logistic regression analysis proved that the single polyp, presence of vascularity, and intralesional linear vessels were associated with adenomatous polyps (P< .05). ROC analysis showed that the area under the ROC curve, sensitivity, and specificity for the combination of the three independent variables were 0.858, 87.3%, and 67.6%. The number combined with intralesional vascular shape had the highest diagnostic sensitivity of 91.2%. The combination of CUS and CEUS demonstrated great significance in the differential diagnosis of cholesterol and adenomatous polyps.

Clinicopathological study and immunohistochemical evaluation of cyclin D1 in adenomatous polyps

Background and objective: There are many histological types of colorectal polyps. Most of these polyps are benign epithelial polyps harboring very low risks of cancerous changes. Adenomatous polyps are the most known cancer precursors. Cyclin D1 gene amplification and or overexpression occurs in many human cancers. Cyclin D1 participates potentially in the multistep process of colorectal carcinogenesis. The present study aimed to assess the clinicopathological features of colorectal polyps and evaluate the significance of immunohistochemistry expression of cyclin D1 in adenomatouse polyp as a marker for predicting malignant transformation. Methods: A total of 180 cases of colorectal polyps were collected from Rizgary teaching Hospital and some private laboratories in Erbil, Kurdistan Region, Iraq, from January 2013 to January 2018. All cases underwent polypectomy by colonoscopy for removal of the polyp. Only cases presented with a single polyp were included. The histopathological diagnosis was revised, and the polyps were divided into four subtypes; inflammatory, hyperplastic, juvenile, and adenomas. All adenoma specimens were stained using IHC technique with cyclin D1. Results: Out of the 180 cases, the results showed that 70(38.9%) were adenomatous polyps, 56(31.1%) were hyperplastic polyps,40(22.2%) were juvenile polyps, and 14(7.8%)were inflammatory polyps. Cyclin D1 nuclear staining was detected in 24 (34.2%) adenomas. Statistical significant relations between cyclin D1 expression with male gender and with high grade dysplasia were found. Conclusion: Adenoma was the most common type among colorectal polyps. Cyclin D1 was shown to be aberrantly expressed in colorectal adenomas and may play a role in the early stages of adenoma carcinoma development. Keywords: Colorectal polyp; Cyclin D1; Adenoma.