Symptomatic Polyps Research Articles

Surgical indications and histopathologic results analysis of gallbladder polyps: A single-center experience

Gallbladder polyps (GBP) are solid lesions originating from the gallbladder mucosa and extending into the gallbladder lumen. Preoperative diagnosis of GBP can be easily performed via USG; however, which patients should be followed up and which patients should be operated on is still a matter of discussion. This study aimed to investigate the histopathologic results and indications for surgery in patients diagnosed with GBP in the preoperative period and to present our clinical experience in light of current literature. Patients diagnosed with GBP and who had surgery in our general surgery clinic between July 2019 and July 2023 were retrospectively reviewed. A total of 57 patients were included in the study. The medical records, laboratory results, imaging results, and pathology reports of the patients were examined. The mean age of the patients was 47.1±11.7 years (23-78 years). The male/female ratio was 1.3/1. Polyp diameter was above 10 mm in 61.4% of patients and below 10 mm in 38.6%. The indication for surgery was the presence of coexisting cholelithiasis in 35.1% of the cases, symptomatic polyps in 33.3%, and increased polyp diameter in 21.1%. In histopathologic evaluation, cholesterol polyp was the most frequently encountered polyp (40.4%). The follow-up and treatment of GBP is still controversial. The most important factors to be considered in the surgical treatment of SCP are the polyp being over 10 mm and being symptomatic. In follow-up patients, further detailed clinical examination should be performed if necessary, and other imaging modalities should be preferred along with USG. Furthermore, it is required to establish up-to-date international algorithms for the follow-up and treatment of GBP.

The risk and predictors of gallbladder cancer in patients with gallbladder polyps: A retrospective cohort study with an insight into confounding by indication.

We aimed to determine the risk and predictors of gallbladder cancer in all individuals with gallbladder polyps (GP) including those who did not have cholecystectomy. The STROCSS guideline was followed to conduct a retrospective cohort study. All individuals with GP between 2010 and 2019 were followed up to determine the risk and predictors of gallbladder cancer. The primary outcomes were gallbladder cancer and gallbladder dysplasia, and the secondary outcomes included polyp growth rate and polyp disappearance rate. Binary logistic regression analysis and receiver operating characteristic curve analysis were conducted to evaluate the outcomes. Analysis of 438 patients showed risk of gallbladder cancer was 0.7% in all polyps (0% in polyps <10mm; 5.9% in polyps ≥10mm). The risk of gallbladder dysplasia or cancer was 1.1% in all polyps (0% in polyps <10mm; 10% in polyps ≥10mm). The polyp size (P=0.0001) was predictor of cancer; however, patient's age (P=0.1085), number of polyps (P=0.9983), symptomatic polyps (P=0.3267), and change in size (P=0.9012) were not. Size of 21mm was cut-off for risk of cancer (area under the curve [AUC]: 0.995, P<0.001) and 11.8mm for risk of dysplasia or cancer (AUC: 0.986, P<0.001). The mean polyp growth rate was 0.3mm/year and polyp disappearance rate was 16%. The GP size remains the only predictor of malignant changes regardless of patient's age, patient's symptoms and number of polyps. The polyp growth rate is unremarkable, and a significant proportion disappears during follow-up. We changed our follow-up protocol with reduced number of scans and early discharge policy.

S3660 Prolapsed Gastric Polyp Causing Gastric Outlet Obstruction

Introduction: Gastric polyps are epithelial and subepithelial lesions that encompass various pathological conditions. While largely asymptomatic, some may present with bleeding or obstruction. Our case demonstrates a rare presentation of a gastric polyp leading to mechanical complications. Case Description/Methods: A 64 year old female presented with progressively worsening nausea and vomiting associated with a 20 lbs weight loss since the last 5 weeks. The patient reported vomiting of undigested food shortly after her meals and occasionally during her meals. She denied abdominal pain, dysphagia, odynophagia, alteration of taste, constipation or loss of appetite. She denied similar symptoms with liquids. Upon evaluation, the patient appeared well and was hemodynamically stable. Labs were unremarkable. An abdominal CT scan showed nodular thickening of distal pylorus and distal duodenal bulb which raised suspicion for malignancy considering the patient’s reported weight loss. An EGD was performed which revealed a bilobed pedunculated gastric antral polyp (approximately 8 mm each lobe) prolapsed into the duodenal bulb with multiple papules and nodules in the antrum and inflamed gastric mucosa. The pedunculated gastric polyp was thought to be the cause of the patient's symptoms and was resected. Biopsy results revealed inflamed hyperplastic polyps with mildly active H. pylori gastritis, negative for intestinal metaplasia and dysplasia with some evidence of reactive foveolar hyperplasia. The patient had complete resolution of her symptoms post polypectomy. She was discharged with HP treatment and outpatient follow up care (Figure 1). Discussion: The patient’s symptomatic relief confirmed that the pedunculated antral polyp prolapsed into the duodenal bulb causing gastric outlet obstruction (GOO). Polyps in the stomach are usually small, asymptomatic and discovered incidentally on upper endoscopy. Several risk factors are associated with hyperplastic polyps including HP infection, bile reflux, and autoimmune gastritis. Rarely, large lesions greater than >2 cm in size that are more prone to surface erosion and can cause chronic blood loss and/or GOO. Endoscopic resection of symptomatic polyps and hyperplastic polyps >5 mm is currently recommended. Gastric polypectomy is considered a safe and easy procedure however, the risk of bleeding and perforation increases with the polyp size. Studies have found that eradication of HP resulted in regression of the existing polyps and prevented new polyp development.Figure 1.: Pylorus with bilobed gastric polyp manually pulled back into the stomach.

S1583 Surveillance With Double Balloon Enteroscopy in Adult Patients With Peutz-Jeghers Syndrome: A Single Center Experience

Introduction: Peutz-Jeghers syndrome (PJS) is an inherited polyposis syndrome caused by mutation in the STK11 gene, and characterized by hamartomatous polyps throughout the gastrointestinal tract, most often in the small bowel (60-90%) and colon (50-64%). Presenting symptoms in PJS are often related to symptomatic polyps, including intestinal obstruction, abdominal pain, and bloody stools. For PJS patients, current recommendations support screening upper endoscopy, colonoscopy, and video capsule endoscopy at age 8-10, and if no polyps identified then again at age 18. Small bowel screening is recommended every 2-3 years. Deep enteroscopy, via antegrade or retrograde balloon enteroscopy, is often required for clearance of larger polyps visualized on video capsule endoscopy (VCE). The optimal follow-up strategy and modality of screening and surveillance of small bowel polyps is controversial. We aimed to evaluate if proactively performing deep enteroscopy vs serial VCE in adult PJS patients reduces risk of requiring subsequent surgical intervention. Methods: We retrospectively collected data from adult patients over 18 years of age with Peutz-Jeghers syndrome who underwent deep balloon enteroscopy for small bowel surveillance. Patients within this subset underwent proactive screening with antegrade double balloon enteroscopy performed approximately every one to 2 years. Data collected included number of prior small bowel surgeries before onset of and during deep enteroscopy surveillance, and complications. Results: Thirteen patients underwent deep enteroscopy from 2010 through 2021. Average number of prior small bowel surgeries was 1.9 (SD 1.4), average number of balloon enteroscopies during surveillance period 2.8 (SD 1.4), and average number of surgeries during balloon enteroscopy surveillance 0.46 (SD 0.66). There was a significant difference between number of surgeries before and during surveillance period (P=0.002). Conclusion: The initial standard screening modality for small bowel polyps and malignancy, VCE, can be complicated by increased risk of capsule retention given likelihood of prior surgery and possibility of obstructing polyps. Additionally, within the PJS cohort, there is a high yield for pathology which may ultimately require therapeutic deep enteroscopy anyhow. Our study, though small, does indicate that on a proactive balloon enteroscopy surveillance protocol there is a significantly lower risk of requiring small bowel surgery.

P-BN31 Surveillance for Gallbladder polyps at a NHS District General Hospital – a retrospective analysis

Abstract Background Gallbladder polyps are encountered in 5% of ultrasound scans and continue to remain a dilemma in terms of management. Very few polyps progress to cancer. However, most cancerous polyps are usually found at an advanced stage. It is therefore important to identify the premalignant polyps. There is a lack of national consensus in UK for surveillance of gallbladder polyps. Many trusts in the UK either adopt the European guidelines or formulate local protocols. We aim to present our findings based on our local surveillance policy existent during the study period with a view to recommending new local guidelines. Methods A search from our radiology database being coded to gallbladder polyp identified patients. We identified 431 patients from 2017 – 2019 who had a total of 1014 scans. The data was collected from local hospital IT databases in terms of variables such as number of scans, polyp size, number of polyps, progression to surgery or discharge from surveillance and histology. The data was analysed on excel platform. Results Patient demographics revealed an incidence of 54% in females (males 46%) with an average age of 59.7 years. Pain was the dominant symptom prompting the first scan (48%). An average of 2.3 scans were performed per patient. 45% of the polyps were less than 5mm. Overall, 22% polyps demonstrated interval growth. Only 15% of polyps less than 5mm demonstrated interval growth and none required cholecystectomy. 6% patients proceeded to surgery mainly for symptoms (46%) compared to polyp progression (1.5%). No malignancy was identified in this study. 43% of patients with polyp diagnosis in primary care had no identified surveillance plan. Conclusions Our study demonstrates a low incidence of polyp progression. We would recommend stopping annual surveillance after 2 years from the index scan for multiple small (&amp;lt;5mm) polyps with little or no progression but continue with annual surveillance for polyps greater than 5mm. We would recommend reserving cholecystectomy for symptomatic polyps and polyps greater than 10mm. There is wide variation in surveillance practice particularly in primary care. We would recommend sharing the guideline widely with primary care for optimal surveillance.

Diagnosis, management and recurrence rates of Mitrofanoff polyps

Intraluminal polyps are a known complication following creation of a urinary continent catheterizable channel (Mitrofanoff). These polyps can lead to difficult catheterizations in addition to symptomatic bleeding. However, there is limited data available regarding management and outcomes of these polyps. We aim to describe clinical presentation and management of a large series of polyps occurring in a Mitrofanoff channel. We performed a retrospective review of all patients that were treated for polyps in a Mitrofanoff at our institution. Information was collected regarding presenting symptoms, management and recurrence rates of the polyps. A total of 24 patients were identified that fulfilled inclusion criteria. The majority of these polyps developed in channels composed of appendix (87%), while only 3 patients (13%) had polyps develop in an ileal composed channel. Thirteen (54%) of these polyps were incidentally diagnosed while 11 patients presented with a variety of symptoms such as difficulty in catheterization, bleeding with catheterization or both difficulty catheterizing and bleeding. For management of the polyps, a cystoscopy was performed and snaring the polyp with stone basket was performed in 37%, energy was applied to base to remove polyps in 33%, 16% were fulgurated and only 13% were left in situ. All procedures were performed under general anesthesia and all of the pathology was benign showing chronic inflammatory tissue. Eight polyps (33%) recurred after initial treatment. We did not observe an asymptomatic channel polyp convert to a symptomatic during our follow up period. Our experience has led us to not intervene on all asymptomatic Mitrofanoff polyps encountered during cystoscopy under assumption they will inevitably become symptomatic. Although we admit our follow up period may not be long enough to make this a universal declaration of best practice when any Mitrofanoff polyp is diagnosed. Endoscopic treatment was effective minimally invasive method to address the symptomatic polyp rather than excision and construction of new channel. This is the largest series to date of polyps developing in urinary continent catheterizable channels. The majority of these polyps were encountered incidentally however symptomatic polyps presented with difficulty with catheterizations. Symptomatic polyps can be managed endoscopically but recurrence of the polyp can occur.

Screening for Cervical Polyp among Women Attending SalahAldin General Hospital

Background: Cervical polyps are the commonest cervicallesions, affecting up to 10% of women, witha reported recurrence rate of 6.2%, they arise from the endocervical canal or, less frequently, from theectocervix, and vary in size from 5 mm to 50 mm. Symptomatic polyps are significantly more frequent inthe premenopausal women, while asymptomatic polyps are significantly more common in post-menopausalwomen.Aim of the Study: Screening for cervical polyps among women attending Salah-Aldin general hospital.Patients and Method: A cross sectional study conducted in outpatients clinic and obstetrical ward in SalahEl-Din general hospital at the period from the 1st of March 2018 to the end of August 2018. Simple randomsample of (200) women in different ages were included.Results: 200 women were enrolled in this study with the mean age of them were (27.30±6.8 years),the BMImean of the patients with polyp was (30.2±2.1),4(40%) in age group between 26-35years. Patients withpolyps have ? 1 parity 9(9%) and 1(10%) in nulliparous.Conclusion: The frequency of cervical polyp was 5% with no relation to the age, and 60% of the patientswere healed.

Laparoscopic cholecystectomy by paediatric surgeons: can established standards of care be delivered?

Laparoscopic cholecystectomy (LC) case volume is low for paediatric surgeons relative to the adult sector; coupled with service differences, internationally accepted standards may be more challenging to meet. This study sought to determine (i) the outcomes of LC in children, and (ii) whether recognised care pathways (e.g. acute LC, access to cholangiogram/ERCP and day-case LC provision) can be delivered. Patients who underwent LC were identified retrospectively in a single institution between January 2009 and January 2019. Data are presented as median [IQR] and continuous variables compared using a t test. 101 cases were included (age 12.9 years [10.2–15]; female 65/101). Indications for LC were symptomatic gallstones (98/101) and polyps (2/101). ERCP and/or endoscopic ultrasound were performed in 23/101. For acute presentations, 7/24 (29%) had LC during the same admission. Trainees performed LC in 33/101. 4/101 required intra-operative cholangiogram. Operative time was 109.5 min [90.8–139.5]: consultant vs. trainee times were similar (114 [93.3–149.5] vs. 99.5 [81.5–125.3], p = 0.06). Length of stay was one day [1–1] with 10/101 being day-cases. There were no major complications or re-operations. We report good outcomes from LC. Furthermore, we have demonstrated the capacity to deliver recognised standards of care within a paediatric setting.

Three-port versus conventional four-port laparoscopic cholecystectomy: a comparative study

Objectives This prospective comparative study aims at evaluating the feasibility of three-port technique without affecting safety and at comparing the outcome of three-port and four-port techniques. Patients and methods This study included 94 patients with symptomatic gallstone disease and gallbladder polyp in Surgical Department, Minia University Hospital, from beginning of 2018 to beginning of 2019. Patients who were unwilling to be a part of the study, jaundiced patients with radiologically evidence of common bile duct stones, patients unfit for general anesthesia, patients with liver cirrhosis, patients with portal hypertension, patients with coagulopathy, patients with acute pancreatitis, patients with generalized peritonitis, or patients with malignancy were excluded. All patients were operated by the same operating team. Patients were randomized for three-port laparoscopic cholecystectomy (LC) group (45 patients) or four-port LC group (49 patients). Numeric Pain Rating Scale, operative time, operative difficulty, intraoperative and postoperative complications, duration required to stop oral analgesics, and duration required to return to normal activity were recorded. Results Numeric Pain Rating Scale, required number of diclofenac ampoules, duration required for oral analgesia, and duration required to return to normal activity were significantly less in three-port group. Other parameters were comparable between the two groups. Conclusion It seems that three-port LC is a safe and feasible technique with superior clinical outcomes to four-port LC.

Premalignant and Malignant Changes in Symptomatic Endometrial Polyps in Women Aged 20-70 years

Background: endometrial polyps are localized over growth of endometrium including glandular and stromal tissue with prominent angiogenesis regulated by growth factors. Polyps occur in different age group and could be asymptomatic and discovered incidentally or it cause abnormal premenopausal and postmenopausal bleeding. Most endometrial polyps are benign but premalignant and malignant changes also occur frequently. Objective: this study was carried out to identify the age-group in which endomaterial polyps are encountered in routine surgical pathology practice, to document the agegroup in which these polyps underwent malignant changes and to identify the histological subtype of endometrial polyps according to age group. Patients and methods: This prospective study conducted to demonstrate the premalignant and malignant changes in symptomatic endometrial polyps in relation to patients age group ranging from 20-70 years with abnormal uterine bleeding examined in gynecology and obstetric department in Al-Ramadi and Al-Yarmouk Teaching Hospital during the period from January 2017 to May 2018. The endometrial samples were obtained either by D and C, hysteroscopy or the polyps were demonstrated after surgical hysterectomy. All endometrial samples were fixed in 10% formalin solution and sent to the private histopathology laboratory in Baghdad for histopathological diagnosis. Results: The total number of examined women were 150. The most common recorded age was 20-70 years. 74.6% were premenopausal and 25.4% of patients were post-menopausal at the time of diagnosis. Most of patients presented with symptomatic polyps in this study were in age group 41-50 years (36.6%) in which most of the polyps were benign, while premalignant and malignant changes were more common in women between 51-60 years. The final pathological diagnoses showed benign endometrial polyps (49.3%), (48.6%) were pre-malignant polyps and (2 %) were malignant polyps. From benign lesions secretary endometrium was the most common finding in 43 cases (58.1%), while simple endometrial hyperplasia without atypia was the most common finding in the pre-malignant group 40 cases (54.7%). The distribution of histopathological changes in each age group were significant with a P value equal to 0.02. Conclusion: all endometrial polyps in pre- and post-menopausal women should be removed and submitted for histopathological examination as some of them even though there are benign but could carry areas of cellular atypia or malignant transformation.

Current Management of Benign Epithelial Gastric Polyps.

Purpose of review Benign epithelial gastric polyps, although typically asymptomatic, are identified incidentally on upper endoscopy in up to 23% of patients. These include fundic gland, hyperplastic, and adenomatous polyps. Their appropriate characterization is critical as some have malignant potential, may be indicative of a gastric mucosal field defect, or may be related to an underlying polyposis syndrome. This review will discuss the current management of benign epithelial gastric polyps. Recent findings Association of gastric polyps with proton pump inhibitor use, Helicobacter pylori infection, risk of malignant transformation, and association with polyposis syndromes have been the focus of recent literature. Summary All symptomatic polyps, polyps larger than 1cm in size, and polyps later found to contain dysplasia or cancer should be completely removed. Additionally, random biopsies from the intervening non-polypoid mucosa should be obtained. Finally, identification of multiple polyps of fundic gland type and/or concomitant dysplasia should raise suspicion for an underlying polyposis syndrome and prompt appropriate workup. Surveillance is generally only indicated if there is confirmed dysplasia and/or carcinoma within the polyp itself or if preneoplastic changes are identified in the non-polypoid gastric mucosa.

Revisión de la poliposis gástrica: a propósito de un caso operado por laparoscopia, con protocolo fast track

Introduction: Gastric polyps are commonly found incidentally on upper gastrointestinal endoscopy. Objective: Review the most common gastric polyps and present a case of symptomatic polyps managed with laparoscopic total gastrectomy following the fast track protocol. Clinical case: Patient with symptomatic diffuse gastric polyps who had a total laparoscopic gastrectomy following the fast track protocol, who is discharged at home at fourth day post-surgery. Discussion: The most common are hyperplastic polyps, fundic gland polyps, adenomas and inflammatory fibroid polyps. Is very important to obtain biopsies to assess the histology and malignant potential. In certain cases a total gastrectomy is recommended. The fast track rehabilitation protocol is a safe method to decrease hospital stay and improve recovery. Key words: gastric polyposis; gastrectomy; laparoscopic surgery.

Hysteroscopy in an outpatient setting–38 months experience

INTRODUTION: Hysteroscopy is one the main diagnostic and therapeutic tools of modern Gynecology, allowing a direct visualization of the uterine cavity for diagnosis and minimally invasive intervention with sampling or removal of any structural abnormalities. At our unit office-based diagnostic hysteroscopy is not available; as such the pre-operative imaging diagnosis is largely based on transvaginal or pelvic ultrasound, often with hysterosonography. OBJECTIVE: Evaluate de correlation between the pre-operative diagnosis, hysteroscopic findings, and histological analysis, concerning all hysteroscopies performed at our Outpatient Surgery Unit during 38 months of activity. METHODS: The authors performed a retrospective study based on the review of medical files from patients who underwent hysteroscopic procedures at our institution's Outpatient Surgery Unit from November 1st 2012 to December 31st 2015. RESULTS: During the study period 644 hysteroscopies were performed, all under sedation. The patients’ average age was 55 years (27 to 87), 60% were post-menopausal and 77% presented co-morbidities, 8% having a history of breast cancer with current or previous treatment with tamoxifen. All patients had an ultrasound evaluation, 66% at our ultrasound unit (55% with hysterosonography). The main indications for hysteroscopy were: suspected post-menopausal asymptomatic polyps (34%); suspected pre-menopausal polyps (31%); suspected post-menopausal symptomatic polyps (12%); post-menopausal endometrial thickening (12%); retained trophoblastic products (2%). The main findings were: endometrial polyp(s) (70%); endometrial thickening/irregularities (6%); polypoid/secretory endometrium (2%); submucosal leiomyoma (1,2%); suspicious vegetative formations (0,5%); no abnormalities, normal endometrium (11%). Cervical dilation was used in 14% of the procedures; in 0,8% the endometrial cavity was not accessed due to cervical stenosis. Globally, intra-operative findings were concordant with the presumptive diagnosis by ultrasound in 77% of cases, 82% when hysterosonography was previously used. Bipolar energy was used in 39% of the operative procedures; curettage was performed in 37% of the cases. There was four cases of endometrial adenocarcinoma and two of complex hyperplasia with atypia. The diagnosed complications were: uterine perforation (n = 5); bowel injury (n = 1); moderate uterine bleeding (n = 3). CONCLUSION: The indications and complications rate were similar to other centers described in literature. The previous detailed ultrasound study with hysterosonography resulted in a high rate of agreement between the presumptive diagnosis and intra-operative findings, resulting in a more accurate referral to operative hysteroscopy and obviating a previous diagnostic hysteroscopy. This strategy has been previous advocated by other authors, which reduces the number of hysteroscopies per patient, and is particularly relevant in centers without the possibility of office-based procedures.

Analysis of the Diferential Genic Expression Between Symptomatic and Asymptomatic Endometrial Polyps

Analysis of the Diferential Genic Expression Between Symptomatic and Asymptomatic Endometrial Polyps

Should we be bothered with asymptomatic endocervical polyps in perimenopausal women

Cervical polyps are defined as focal hyperplastic protrusions of endocervical folds with an incidence of 1%-10%. The majority of endocervical polyps are benign and the incidence of high-grade squamous intraepithelial lesion (HSIL) or carcinoma is relatively rare (1: 1000). Endocervical polyps are mostly incidentally discovered, however the most frequent symptoms are post-coital, postmenopausal or intermenstrual bleeding and/or profuse discharge. Here, we present a perimenopausal women with an asymptomatic polyp, later to be diagnosed with cervical carcinoma. A 46-year-old woman applied to our outpatient clinic without any complaint. The examination revealed a 2.3x2 cm cervical polyp with a slim pedincule. An immediate cervical polypectomy was performed and histopathological examination was resulted as HSIL. The patient then underwent cold-knife conization and endocervical curettage (ECC). The excized cone material’s histopathology was consistent with the polyp and the cervical lesion was continous at the surgical borders. ECC was positive for cervical intraepithelial changes. A type 1 hysterectomy was carried out. The definitive pathological diagnosis was microinvasive squamous carcinoma. Accummulating literature advises against routine polypectomy, despite the possibility of displasia in cervical polyps. Various clinical aspects, such as symptoms, age, menopausal status, cytological and colposcopic findings have been evaluated in conjunction with this common entity. In conclusion, the gen- eral notion that symptomatic polyps over 5 mm should be evaluated may be cost-effective, but will not discern cases of polyp associated operable microin-vasive /invasive cervical carcinomas.

Management of Symptomatic Hamartomatous Polyps in Stomach: Analysis of a Single Center Experience

Background: No consensus has been reached on the management of gastric hamartomatous polyps, owing to a lack of knowledge of the long-term outcome of after removal of these polyps. Methods: A retrospective database review was performed in a tertiary referral hospital between 1995 and 2011. Thirty-two consecutive patients who were diagnosed with gastric hamartomatous polyps were managed by surgical or endoscopic resection. Results: Patients developed the disease predominantly in their seventh and eighth decades of life. The tumors were located mostly in the antrum, and the diameter ranged from 5 to 52 mm. In one patient, adenocarcinoma in situ accompanied by gastric hamartomatous polyp was diagnosed by pathologic examination after endoscopic mucosal resection (EMR).There were no significant differences in the rates of technical success, treatment success, complications, or recurrence between surgery and endoscopic excision. The endoscopic excision group had a shorter mean post procedure hospital stay than the surgery group (7.2 vs. 21.4 days, P = 0.002). Conclusions: Endoscoipic resection for gastric hamartomatous polyps is an effective procedure and a less-invasive alternative to surgery.

Polypoid lesions of the gallbladder: disease spectrum with pathologic correlation.

Gallbladder polyps are seen on as many as 7% of gallbladder ultrasonographic images. The differential diagnosis for a polypoid gallbladder mass is wide and includes pseudotumors, as well as benign and malignant tumors. Tumefactive sludge may be mistaken for a gallbladder polyp. Pseudotumors include cholesterol polyps, adenomyomatosis, and inflammatory polyps, and they occur in that order of frequency. The most common benign and malignant tumors are adenomas and primary adenocarcinoma, respectively. Polyp size, shape, and other ancillary imaging findings, such as a wide base, wall thickening, and coexistent gallstones, are pertinent items to report when gallbladder polyps are discovered. These findings, as well as patient age and risk factors for gallbladder cancer, guide clinical decision making. Symptomatic polyps without other cause for symptoms, an age over 50 years, and the presence of gallstones are generally considered indications for cholecystectomy. Incidentally noted pedunculated polyps smaller than 5 mm generally do not require follow-up. Polyps that are 6-10 mm require follow-up, although neither the frequency nor the length of follow-up has been established. Polyps that are larger than 10 mm are typically excised, although lower size thresholds for cholecystectomy may be considered for patients with increased risk for gallbladder carcinoma, such as patients with primary sclerosing cholangitis.

Premalignant and malignant lesions in endometrial polyps in patients undergoing hysteroscopic polypectomy.

ABSTRACTObjective:To evaluate the incidence of premalignant lesions and cancer in endometrial polyps, in patients undergoing hysteroscopic polypectomy.Methods:The results of 1,020 pathological examinations of patients submitted to hysteroscopic polypectomy were analyzed, as well as their diagnostic and surgical hysteroscopy findings. As to their menstrual status, 295 (28.9%) patients were in menacme. Of the total, 193 (65.4%) presented abnormal uterine bleeding, and 102 (34.6%) were asymptomatic with altered endometrial echo on transvaginal ultrasound. Out of 725 (71.1%) postmenopausal patients, 171 (23.6%) were symptomatic (abnormal uterine bleeding), and 554 (76.4%) were asymptomatic with endometrial echo >5.0mm.Results:Twenty-one (2.0%) patients presented premalignant lesions in the polyps, 13 had simple glandular hyperplasia, of which 5 had no atypia, and eight presented atypia. Eight polyps presented focal area of complex hyperplasia: 4 with atypia and 4 without lesions. Cancer was diagnosed in 5 (0.5%) polyps. Of the 21 polyps that harbored premalignant lesions, 12 were interpreted as benign in diagnostic and surgical hysteroscopy. Of the polyps with cancer, 4 were also histeroscopically interpreted as normal.Conclusion:Symptomatic polyps in menacme and in all postmenopausal women should be resected and submitted to histopathological examination, since they may have a benign aspect, even when harboring areas of cellular atypia or cancer.

Lipoma of the sigmoid colon

Lipoma is a benign tumor of adipose tissue, the most common tumor of the human body soft tissues. As such, it can be found almost anywhere in the human body including the gastrointestinal system (incidence below 0.5%), but rarely in the sigmoid colon. This is a case report on symptomatic polyp of the sigmoid colon, which after one year, at control colonoscopy, caused suspicion to malignancy. Endoscopically diagnosed polipoid lesion was laparoscopically removed. The pathohistological diagnosis determined benign, submucosal, incapsulated lipoma of the sigmoid colon. Although lipomas of the gastrointestinal tract are rare, this case clearly indicates that we should not prematurely and without histological confirmation of malignancy do more extensive resection for a suspected malignancy.

Large, Symptomatic Fibroid Polyp Treated Endoscopically, Case Report and Review of Literatures

Large, Symptomatic Fibroid Polyp Treated Endoscopically, Case Report and Review of Literatures