Tubular Villous Adenoma Research Articles

Significant Missed Polyps in the UK Bowel Cancer Screening Programme (BCSP): A Retrospective Analysis of Prevalence and Contributing Factors.

Background Colorectal cancer (CRC) remains a significant public health challenge. Patients having abnormal faecal immunochemical test (FIT) results are offered a colonoscopy. The effectiveness of colonoscopies can, however, often be challenged by the occurrence of missed polyps. This study aims to assess the rate of significant missed polyps in the Bowel Cancer Screening Programme (BCSP) in the UK. Methods A retrospective analysis of BSCP screening data in the Cheshire region in the UK from 2020 to March 2023 was conducted. A significant polyp was defined as a polyp ≥ 10mm. The inclusion criteria included patients (age range: 54-74 years) who had had an index colonoscopy followed by site checks, repeats, or planned polypectomies. Results Out of 2,759 index colonoscopies, 261 (9.5%) met our criteria, and 23 (8.8%) of these had significant polyps. Of the 261, the missed polyp rate was 30% (453/1531 polyps). The overall significant missed polyp rate was 1.6% (24/1531). Of the missed polyps, 5% (24/453) were significant polyps. The majority (71%) of the significant polyps were found on the left of the colon. Men had a higher missed polyp rate (22%) compared to women (7%) (relative risk (RR) = 2.56, 95% CI: 2.1-3.13, p<0.0001). They also had a higher significant missed polyp rate (1.1%) compared to women (0.4%) (RR = 2.41, 95% CI: 1-5.8, p<0.05). A total of 50% of the bowel prep at index colonoscopy was rated as 'adequate/fair' and 79% of the bowel prep at the discovery of the significant polyp was rated as either 'excellent' or 'good' (odds ratio (OR) = 3.8, 95% CI: 1.07-13.5, p<0.05); 92% (22/24) of the significant polyps found were either tubular adenoma (TA) low-grade dysplasia (LGD) or tubular villous adenoma (TVA) LGD, and none were found to be cancerous. Conclusions Almost a third of all polyps detected were missed, and one in 20 of these were significant polyps, putting these patients in the high-risk group for CRC. Improving bowel preparation and monitoring patients with multiple polyps could reduce the rate of missed polyps.

Tubular-villous adenoma against the background of ulcerative colitis (clinical case)

A clinical case of the development of tubular-villous adenoma with moderate epithelial dysplasia (high grade) is described, taking into account the presence of foci of squamous metaplasia in the epithelium of the glands. The pathology presented in the article according to ICD-O has code 8263/2.Description of the clinical case. The patient had an initial colonoscopy in 2020 and was diagnosed with chronic ileitis and colitis with moderate and in some areas high inflammation activity, which is most characteristic of nonspecific ulcerative colitis. The patient was treated by a gastroenterologist. In December 2021, she had a follow-up colonoscopy with the histological material sampling. Endoscopic conclusion: ulcerative colitis, total lesion, exacerbation phase.Results and discussion. When the device was inserted into the rectum at a distance of 13 cm, a neoplasm was visualized, the mucosa was pale, shiny, when trying to pass the device through the narrowing of the contact-vulnerable mucosa, with instrumental palpation, the formation was displaced by a conglomerate, a polyfragmentary biopsy was taken. In the study of histological preparations of the recto-sigmoid junction, a tubular-villous adenoma with moderate epithelial dysplasia (high grade) is determined, taking into account the presence of foci of squamous metaplasia in the epithelium of the glands. According to the literature, with ulcerative colitis affecting almost the entire colon for more than 10 years, there is an increased risk of colon cancer formation (10 %), which increases by 2–5 % annually. The possibility of malignancy is present in 10–20 % of patients with ulcerative colitis for more than 20 years. Other researchers describe the identified low-grade dysplasia as progressing to high-grade dysplasia and carcinoma in 29–54 % of cases.Conclusions. The study of patients with this pathology should be carried out against the background of thorough preparation of the large intestine with modern preparations using high-tech verification methods and polyfragmental biopsy with a qualified assessment of biopsy specimens.

Laparoscopic Approach in the Surgical Management of McKittrick–Wheelock Syndrome

Mckittrick-Wheelock syndrome is a pathological entity that is represented by the presence of a large rectal tumour with histopathological findings of tubular-villous adenoma that associates important secretion of electrolyte-rich mucin.

Primary hepatic neuroendocrine carcinoma with colon adenoma: A case report with literature review.

Introduction and importancePrimary hepatic neuroendocrine tumors (PHNETs) are extremely rare, and the clinical symptoms, test results, and imaging characteristics are nonspecific in most patients; thus, it is difficult to differentiate from other liver masses before surgery. Histopathology and immunohistochemistry are the main basis for the diagnosis. PHNETs and colon tumors co-occur in a patient and are non-homologous, as reported in the English-language literature for the first time.Case presentationWe present a case of a 60-year-old woman with right hepatic lobe mass accidentally discovered on abdominal ultrasonography during a routine examination. Preoperative liver contrast-enhanced computed tomography suggested hepatocellular carcinoma; then, surgery were performed. Pathological results revealed a Grade 2 neuroendocrine tumor of the liver. In search of the primary tumor, upper and lower endoscopy of the GI tract was performed and revealed a mass in the ascending colon. Ascending colon cancer was considered; then, laparoscopic right hemicolectomy was performed. Pathological results suggested tubular villous adenoma of the ascending colon. The final diagnosis was not colon cancer with liver metastases but was PHNETs with colon adenoma.Clinical discussionPHNETs are rare cancers that are difficult to diagnose, requiring not only differentiation from other liver masses but also exclusion of metastases from extrahepatic sources. The pathological results play an important in making an accurate diagnosis.ConclusionPathology, postoperative follow-up, and comprehensive imaging examinations are powerful tools in the diagnosis of PHNETs. Currently, surgery is the best treatment to achieve a potential cure and prolong the patient's survival.

Acetic Acid Chromoendoscopy in the Preliminary Diagnosis of Histological Type of Colon Polyp during Colonoscopy

Aim: to increase the efficiency of endoscopic diagnosis of serrated and non-serrated histological types of colon polyps in real time.Materials and methods. From September 2017 to February 2018, 63 polyps were detected among 51 patients (male 11, women 40, aged between 30–78 years, average age 52.2 ± 12.5 years) in all parts of the colon.Polyps were found in all parts of colon, sizes varied: 24 (38.1 %) ≤5 mm, 31 (49.2 %) 6–10 mm, 8 (12.7 %) ≥10 mm. The macroscopic types 0–IIa were 44 (69.8 %), and 0–Is — 19 (30.2 %). During colonoscopy, 1.5%-acetic acid, 5 ml, was sprayed onto the identified polyps. Additionally was blowed 40 ml of air jet. Mucosa was observed endoscopically for 2 minutes. Then polyps were removed and sent for pathology.Results. Use of acetic acid leads to fast acetowhitening reaction of lesions and surrounding mucosa. 2 groups were distinguished (table): 1) Loss of acetowhitening (LAW) of polyps occurs earlier than LAW of surrounding mucosa — «acetowhitening negative». 2) LAW of polyps occurs later than LAW of surrounding mucosa — «acetowhitening positive». Group 1 includes 25 (39.7%) polyps, 88.0% of which were non-serrated: 18(72.0%) — tubular adenoma; 4 (16.0%) — tubular-villous adenoma, one of which had high-grade dysplasia. Only 3(12.0%) polyps were serrated — hyperplastic polyps. Group 2 includes 38 (60.3%) polyps, 97.4% of which were serrated: 24 (63.2%) — hyperplastic polyp; 12 (31.6%) — sessile serrated polyp, including one with low-grade dysplasia, 1 (2.6%) - traditional serrated adenoma. Only 1 (2.6%) polyp was non-serrated — tubular adenoma. This suggests that LAW of non-serrated polyps occurs faster than LAW of surrounding mucosa — «acetowhitening negative». On the contrary, the LAW of serrated polyps is delayed compared to the LAW of the surrounding mucosa «acetowhitening positive». LAW of 4(6.3%) polyps was atypical. The reason for this phenomenon requires further study.Conclusion. Acetic acid chromoendoscopy can be used as a diagnostic method to determine the histological type of polyps during colonoscopy.

CASE STUDY: MAJOR DUODENAL PAPILLA CANCER COMPLICATED BY ACUTE PARACANCROTIC NECROTIZING PANCREATITIS

The given paper describes a case of treating adenocarcinoma of the papilla of Vater diagnosed as the cause after an episode of acute pancreatitis. The etiology of aсute pancreatitis was considered idiopathic until the onset of complaints caused by tumor growth. The volume of radical surgery has changed intraoperatively due to the detection of infected limited necrotic clusters, didn’t diagnosed both laboratory and instrumentally. Pathomorphological conclusion: considering clinical data, low-grade (G3) adenocarcinoma of the major duodenal papilla, which developed from pre-existing tubular villous adenoma of the duodenum or intraampullary papillary neoplasia (IAPN). Predicting the early detection of MNPs after AP episode requires further research by improving imaging techniques, introducing new non-invasive techniques and investigating circulating biomarkers. The scope of surgery for patients with clinically significant complications of tumor growth and identified competing diagnosis at the target site should be individually decided and weighed. Infected pancreatitis in the late stages requires careful diagnosis.

A study on the genomic alterations of transformation from colorectal adenoma to colorectal cancer.

e15607 Background: Colorectal cancer is one of the most common malignancies worldwide. Approximately 85% of colorectal cancers are thought to result from adenoma. However, the molecular mechanism of adenoma transformation into colorectal cancer is still unclear. Methods: Ninety-nine adenoma patients aged from 25 to 78 years old were enrolled in this study. We collected tissue sample from each patient and 77 matched blood samples. Pathological subtypes included tubular villous adenomas, villous adenomas, tubular adenomas, high-grade intraepithelial neoplasia, and polyps. Eighty-one stage I colorectal cancer patients (CRC I) were also enrolled in this study. All samples underwent Next-generation sequencing with a panel of 405 cancer related genes. Results: Mutational profiles of adenoma and CRC I patients were compared. The top 5 most frequently mutated genes in adenoma were APC (71%), KRAS (41%), ATM (33%), RIF1 (31%), SYNE1 (28%). While in CRC I patients, top 5 mutated genes were APC (78%), TP53 (57%), TTN (35%), KRAS (33%) and TCF7L2 (22%). There were significant differences between TP53 and TTN by chi-square test. The frequency, number and TMB of mutations in stage I colorectal cancer patients were significantly higher than those in various adenoma subtypes. Stage I colorectal cancer patients have more mutated genes enriched in the Wnt and Notch pathways than adenoma patients. We analyzed mutation signatures in CRC I and adenoma patients, and CRC I were more focused on mutation signatures of mismatch repair such as signature 1, signature 6, signature 10, and signature 15. A total of 391 mutations were identified in tissue samples, while 130 mutations were found in plasma cell-free DNA, with 116 mutations shared between them. The two genes with the highest consistency between tissue and blood were PAX7 and KMT2D. Conclusions: TP53 and TTN are associated with the transition from CRC I to adenoma, and Wnt and Notch pathways may also be involved. PAX7 and KMT2D mutations frequently found in adenoma tissue and blood cfDNA demonstrate the diagnostic potential of these two genes in clinic.

Clinical characteristics of non-ampullary duodenal polyps in the elderly and the outcomes of endoscopic mucosal resection.

At present, there are no reports on non-ampullary polyps of the duodenum (NAPDs) in the elderly. The aim of this study was to analyze the clinicopathological features of NAPDs in elderly and non-elderly patients to explore the efficacy and safety of endoscopic mucosal resection (EMR) of NAPDs in the elderly.A total of 110 patients underwent EMR of NAPDs between April 2016 and December 2019. The shape, location, size, postoperative complications, and histopathological types of NAPDs were compared between the elderly group (n = 44) and the non-elderly group (n = 66).Sessile type was the most common form of NAPD in both groups. In the elderly group, the average size of NAPDs was 12.6 ± 3.9 mm. In the non-elderly group, NAPDs had an average size of 10.1 ± 5.8 mm. Complete EMR was performed in both groups. The postoperative complications of EMR did not significantly differ between the 2 groups. Postoperative pathological examination showed that tubular villous adenomas were more common in the elderly group than in the non-elderly group (P = .005), while tubular adenomas were more common in the non-elderly group than in the elderly group (P = .007). Of the 110 patients, 99 completed postoperative follow-up (median follow-up duration, 20.93 months). There were no residual or recurrent lesions.EMR is safe and effective for the treatment of NAPDs in elderly patients.

Pancreaticoduodenectomy for benign disease

Background: Pancreaticoduodenectomy (PD) has now become the standard treatment for malignant and benign peri-ampullary pathologies. PD for benign pathologies rates varies between 5-13% in the literature. The aim of this study was to evaluate the incidence of patients with benign disease with PD applied histopathologically and to review our clinical experience in view of the literature. Method: All patients who underwent PD between 2010 and 2017 were included in the study. The incidence, demographic characteristics, morbidity and mortality of the patients with histopathologically diagnosed as benign disease were evaluated. Results: A total of 283 pancreaticoduodenectomies had been performed during the study period. In 20 (7%) of these patients, benign disease was detected in postoperative histopathological evaluation. The mean age of the patients was 55.8 years. In 20 patients with benign disease, 8 patients underwent endoscopic ultrasound fine needle aspiration (EUS-FNA) and 10 endoscopic brush biopsy. EUS-FNA and endoscopic brush biopsy were not performed in 2 patients. The distribution of histopathological diagnosis of patients after PD was chronic pancreatitis in 7 patients, pancreatic intraepithelial neoplasia in 4 patients, tubular villous adenoma in 3 patients, mucinous cystic neoplasia in 3 patients, biliary intraepithelial neoplasia in 1 patient, dysplasia in 1 patient and benign cyst in 1 patient. Conclusion: Because of delays related to diagnosis and treatment for periampullary tumors lead to short survival generally stressed out the surgeons and gastroenterologists, and tent to behave more meticulous during the diagnosis and treatment. There is a tendency to be performed PD in the association of unclear mass and jaundice. PD will continue to be performed due to many benign pathologies in the future. However, more effective use of diagnostic Methods and multimodal approach will be able to reduce this rate.

1669 Cancer Within the Family Tree: The Risks, Diagnosis, and Treatment of Juvenile Polyposis Syndrome

INTRODUCTION: Juvenile Polyposis Syndrome (JPS) is characterized by the development of numerous hamartomatous polyps in the GI tract, increasing individuals’ risk of colorectal and gastric cancer by as much as 68% by age 60. These odds are further compounded by the syndrome’s autosomal dominant (AD) mode of inheritance, placing children at a 50% risk of transmission from an affected parent. Bone Morphogenic Protein Receptor type-1A (BMPR1A) genes located on chromosome 10q22-23 are strongly associated with JPS, with nearly 60% of cases testing positive for the mutation. Effects of this anomaly cascade down the transforming growth factor-beta (TGF-beta) pathway, resulting in patients developing tens to hundreds of polyps within their lifetime, often by the first decade. Mutations in SMAD4 proteins can also lead to JPS and Hereditary Hemorrhagic Telangiectasia (HHT) as they are also vital in TGF-beta signaling. JPS is clinically diagnosed by the absence of other hamartomatous polyposis syndromes (eg, Peutz-Jeghers or Cowden) and the presence of either &gt;5 juvenile polyps in the colorectum, multiple juvenile polyps elsewhere in GI tract, or any polyps with a family history of juvenile polyps. CASE DESCRIPTION/METHODS: A 41-year-old female with intermittent IBS symptoms presented for colon cancer screening. Two years earlier, the patient’s mother had been diagnosed at age 64 with multiple juvenile colon polyps and colon cancer testing positive for BMPR1A gene mutation. Patient’s initial colonoscopy revealed multiple 3–4 cm irregularly shaped pedunculated polyps, many less than 1cm and an irregularly shaped mass in the mid-ascending colon. The mass was circumferential, broad-based at 4–5 cm and nearly completely obstructing. Polyps removed revealed tubular adenomas and tubular villous adenomas. Though none of these were documented as juvenile polyps, the patient did test positive for BMPR1A mutation suggestive of JPS. The patient was referred to general surgery for resection of the mass and upper endoscopy. DISCUSSION: JPS is a rare polyposis syndrome with AD inheritance. In at-risk patients, it is imperative that genetic testing be performed to determine appropriate cancer screening. Testing should include both SMAD4 and BMPR1A gene mutations, with positive SMAD4 mutations undergoing evaluation for HHT. Current guidelines recommend screening the stomach and colon early, as the length of time to diagnosis remains the single most influenceable and impacting factor in the outcomes of patients and their families.

Risk analysis of the canceration of colorectal large polyps

To analyze the risk factors of carcinogenesis of large colorectal polyps (diameter ≥ 10 mm) found by colonoscopy. Clinicopathological and follow-up data of 418 consecutive patients who were diagnosed as colorectal polyps with diameter≥10 mm by colonoscopy at two endoscopy centers of the Affiliated Wuxi Second People's Hospital, Nanjing Medical University (n=207) and Zhongshan Hospital, Fudan University (n=211) from January 2015 to December 2016 were retrospectively collected. High-grade intraepithelial neoplasia and cancer were defined as malignancy in this study. Chi square test was used for univariate analysis, and logistic regression was used for multivariate analysis (in patients with multiple polyps, if the pathological findings were all low grade intraepithelial neoplasia, one polyp with the largest diameter was selected to enter the model; in patients with high grade intraepithelial neoplasia, one polyp of high grade intraepithelial neoplasia with the largest diameter was selected to enter the model). Associated risk factors of malignancy were analyzed. Among the 418 patients, 278(66.5%) were male and 140(33.5%) were female, with mean age of (58.7±10.2) (range 15-87) years old. Of 398 patients undergoing endoscopic treatment with resected 456 polyps, 142 cases with 150 polyps were malignant, including 134 polyps of high-grade intraepithelial neoplasia and 16 polyps of intra-mucosal cancer. The other 20 patients showed negative elevation signs after endoscopic submucosal injection and were transferred to surgery, of whom 20 polyps were resected. Histological examination of these 20 polyps indicated invasive cancer. Univariate analysis showed that age ≥ 50 years [40.5% (150/370) vs. 25.0% (12/48), χ² =4.323, P=0.041], multiple polyps [77.5%(31/40) vs. 34.7%(131/378), χ² =12.900, P=0.001], polyp locating at rectum [59.0%(36/61) vs. 32.3%(134/415), χ² =22.736, P=0.000], polyp diameter ≥31 mm [74.1%(20/27) vs. 33.4%(150/449), χ² =36.493, P=0.000] and tubular villous adenoma [67.4%(120/178) vs. 16.8%(50/298), χ² =71.810, P=0.000] were associated with malignancy. Multivariate analysis showed that age ≥ 50 years(OR=2.473, 95%CI:1.209-5.058, P=0.013), multiple polyps (OR=2.472, 95%CI: 1.300-4.702, P=0.006), polyp locating at rectum (OR=1.253, 95%CI: 1.091-1.439, P=0.001) and the polyp diameter ≥31 mm (OR=1.500, 95%CI:1.196-1.881, P=0.000) were independent risk factors for malignancy of large colorectal polyps. The mean follow-up time was (9.6±4.2) months. During the follow-up period, 86 patients (20.5%) who received endoscopic resection developed recurrent adenoma which all were successfully removed by colonoscopic polypectomy. Two patients(0.5%) developed colon cancer 6 months after endoscopic resection and both underwent radical surgery and chemotherapy. Their previous pathology from endoscopic resection was tubular villous adenoma and high grade intraepithelial neoplasia. All the patients were alive during the follow-up period. Age ≥50 years old, multiple polyps, polyps locating at rectum and polyps with diameter ≥ 31 mm are the risk factors of malignancy. Emphasized examination should be recommended for those with the above mentioned risk factors to avoid missed diagnosis and misdiagnosis. The choice of endoscopic treatment must be reasonable for curative resection.

Expression of tight junction proteins Claudin-1 in colorectal carcinoma and colorectal adenoma

Objective Detecting the expression of Claudin-1 protein in the normal mucosa, colorectal adenoma with different pathological types and colorectal carcinoma with different stages and probing its meaning in different stages of colon carcinogenesis. Methods 80 colorectal adenoma samples of different pathological types resected endoscopically were collected, including 30 cases of tubular adenoma, 30 cases of tubular villous adenoma, and 20 cases of villous adenoma. Furthermore, the samples also included 60 cases of colorectal carcinoma specimens and 40 cases of paracancerous normal tissue specimens resected by general surgery. Immunohistochemistry was applied to detect the expression of Claudin-1 protein in the tissue samples. Results The positive rate of Claudin-1 expression in normal mucosa group, colorectal adenoma group and colorectal carcinoma group was 20.0%, 46.2% and 81.7% respectively, with the statistically significant difference (P=0.000). A significant rise in its expression from colorectal adenoma, to colorectal carcinoma gradually increased. And the expression of Claudin-1 was associated with the Dukes staging and the lymph node metastasis. The positive rate of Claudin-1 expression in tubular adenoma group, mixed pattern of adenoma group and villous adenoma group was 33.3%, 43.3% and 70.0% respectively, with significant differences among them (P=0.036). Conclusion The expression of Claudin-1 promotes the occurrence and development of colorectal carcinoma. The changes of Claudin-1 probably imply the occurrence of early colorectal carcinoma, and/or the malignant transformation risk of colorectal adenoma. Key words: Colorectal adenoma; Colorectal carcinoma; Immunohistochemistry; Tight junction proteins; Claudin-1

Expression of doublecortin-like kinase 1 in colorectal cancers and colorectal adenomas and its clinical significance

Objective To investigate the expression of doublecortin-like kinase 1 (DCLK1) in colorectal cancer and colorectal adenomas, and it's role in the development and progression of colorectal carcinoma, and explore the relationship of the DCLK1 expression and prognosis in colorectal cancer patients with diabetes medical history. Methods Expression of DCLK1 in 70 cases of colorectal cancers, 70 cases of para-carcinoma tissues, and 35 cases of tubulovillous adenomas were detected by immunohistochemical method. Results ⑴ The DCLK1 high expression rate in colorectal cancers was 41.4% (29/70), and 45.7% (16/35) in tubular villous adenomas, both significantly higher than the para-carcinoma tissues (4.3%; 3/70) (P<0.01). ⑵ DCLK1 high positive expression had statistical significance with pathological grading (P<0.01), infiltration depth (P<0.05), lymph node metastasis (P<0.05), vascular invasion (P<0.05), and distant metastasis (P<0.01). ⑶ There was no obvious correlation between the Diabetes medical history, expression of DCLK1, and prognosis of patients. Conclusions DCLK1 has high positive expression in colorectal carcinomas, and may have certain significance for the early clinical diagnosis and prognostic judgment of colorectal cancers. The expression of DCLK1 and prognosis of colorectal cancers has no obvious correlation with diabetes medical history. Key words: Microtubule-associated proteins/ME; Colorectal neoplasms/ME; Adenoma/ME

Еxpression of claudin-1, 3, and 4 in colorectal cancer and polyps

Claudins are a family of transmembrane tight junctions proteins. It is proven that claudins undergo structural and functional alteration in malignant cells. However, very few researches are pursued on this topic, the data provided by different researchers are controversial. The aim of this study was to evaluate expression of tight junction proteins in cancer and benign polyps of the colon and rectum. Specimens of 32 colorectal adenocarcinomas and biopsy specimens of 86 polypoid lesions of the colon and rectum were selected from diagnostic material. Polyps were divided into 6 groups following the 2010 WHO classification of premalignant lesions of the colon and rectum. Immunohistochemical labeling with claudin-1, claudin-3 and claudin-4 antibodies was performed in all cases. We used G. Sheehan et al. (2007) method to evaluate the expression of claudins in neoplasm as well as in adjacent normal mucosa in each slide. Immunohistochemical staining with claudins antibodies had membranous pattern; claudins expression in adjacent normal mucosa was uniformly close to maximum. Serrated lesions showed the lowest level of expression of claudin-1 among other groups (p<0,05). In the group of adenocarcinomas we found moderate negative correlation between claudin-1 expression level and grade of adenocarcinoma. Claudin-3 expression level was significantly higher in adenocarcinomas compared to serrated lesions (p=0,025) and in conventional adenomas compared to serrated lesions (p=0,034). Expression of claudin-4 was strong in most cases, except for tubular adenomas that showed moderate expression in most cases. We found no statistically significant difference between levels of expression of claudin-1, claudin-3 and claudin-4 expression levels among adenocarcinomas, hyperplastic polyps, sessile serrated adenomas, traditional serrated adenomas, tubular and tubular-villous adenomas. But we detected significant difference after enlargement of the groups. This fact may argue for general development pathway of hyperplastic polyps and sessile serrated adenomas, and of tubular and tubular-villous adenomas. Expression of claudin-1 and claudin-3 revealed difference of serrated lesions from conventional adenomas and adenocarcinomas, that confirms conception of independent «serrated» pathway of cancerogenesis.

Mckittrick-Wheelock syndrome: A rare case report of acute renal failure

Giant tubular-villous adenoma of the rectum can determine secretory diarrhea, associated with a depleting syndrome of prerenal acute renal failure, hyponatremia, hypokalemia and hypoproteinemia. These symptoms are known as the McKittrick-Wheelock syndrome, and there are about 50 cases reported in literature. We present the case of a 59-year-old woman presented to our emergency department with abdominal pain, prerenal azotemia, and electrolyte disturbances with a background of chronic diarrhea, caused by a giant rectal tumor. Conservative therapy initially improved and normalized renal function, and made surgical resection of the tumor possible.

Right-Sided Colonic Adenomas Are Much More Prevalent Than Left-Sided Adenomas

Introduction: Colon cancer prevalence has been reduced since the implementation of colon cancer screening in the United States. However, there is a disproportionate risk reduction between right-sided and left-sided colon cancer after using colonoscopy as the primary tool for screening. The risk reduction after screening colonoscopy has a lesser impact for right-sided colon cancer than for left-sided colon cancer. The data analysis from our cohort population over the past 3 years suggests that the prevalence of adenomas is much higher on the right-side than on the left-side of the colon. Failure to detect and remove right-sided adenomas during routine screening colonoscopy may be the reason behind the higher incidence of right-sided colon cancer and inability to reduce the right colon cancer risk. Methods: From January 2012 to December 2014, our group collected data on 5894 colonoscopies, of which 3630 found adenoma(s). Right-sided adenomas and left-sided adenomas were recorded separately. A right-sided adenoma was defined as an adenoma found above the splenic flexure; specifically, an adenoma from the transverse colon, ascending colon, or cecum. A left-sided adenoma was defined as an adenoma found in the descending colon, sigmoid colon, or rectum. The pathology of each entry was confirmed by our staff pathologist. The types of adenomas included tubular adenomas, tubular-villous adenomas, villous adenomas, and sessile serrated adenomas. Results: Please see Table 1 and Figure 1.Figure 1Table 1: The Prevalence of Right-Sided vs. Left-Sided Colonic AdenomasConclusion: Colonoscopy is a good tool for detecting and removing colonic adenomas. The risk of colon cancer is reduced when the adenomas are found and removed. Failure to detect and remove right-sided colonic adenomas may be the reason for a higher incidence of right-sided versus left-sided colon cancer after screening colonoscopy. According to our data set, right-sided adenomas are twice as common as left-sided adenomas. More importantly, the number of adenomas are nearly three-times higher in the right colon. The average size of the largest adenoma is equivalent between the right and left colon. Therefore, it is important to pay more attention and to spend more time on detecting and removing right-sided adenomas during colonoscopy exams in order to reduce the risk of right-sided colon cancer.

Some indices of neoplastic angiogenesis in tissues of rectal tumors with various morphological structures

The development and growth of the neoplasm is carried out directly by the ability to produce angiogenic factors that stimulate neovascularization. In the tumors of the rectum of various origins (primary adenocarcinoma of stage III (n = 73) and polyps (n = 35): tubular adenoma, villous adenoma, tubular-villous adenoma) the performance of tissue fibrinolytic system and the level of growth factors was studied. A common feature in the tissue of colorectal cancer and polyps is the high content of VEGF-A, VEGF-R and TGF-β1, as well as the increased formation of plasmin, which indicates an increase in angiogenesis and cell proliferation processes violation tissue. Expression of growth factors and functioning of the fibrinolytic system in the case of malignant’s transformation is in better interaction and mutual influence and has a greater number of correlations. In tissue polyps indicators of studiedfactors generally occupy an intermediate position between the cancer and the intact tissue, which shows the possible ways of their cancer’s transformation.

GNAS1 mutation analysis in gastrointestinal tumors.

GNAS1 codes for a part of the a-stimulatory subunit (Gsa) of the G protein. Mutation of GNAS1 has been frequently found in myxoid soft tissues, however, in gastrointestinal tumors, little is known about the mutation status of GNAS1. The aim of the study was to analyze the occurrence of GNAS1 mutations indifferent gastrointestinal, gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and colorectal tumors. Mutation status of GNAS1 exon 8 was analyzed in one hundred thirty-five formalin-fixed, paraffin-embedded (FFPE) gastrointestinal tumor samples including 45 tubular-villous adenomas, 11 tubular adenomas, 6 villousadenomas, 10 hyperplastic gastric polyps, 31 GEP-NETs and 32 colorectal adenocarcinomas by using polymerase chain reaction (PCR) and direct sequencing. Five GNAS1 mutations were found in 2 tubular-villous adenomas, 2 villous adenomas and 1 colorectal adenocarcinoma. No mutations were detected in the tubular adenomas, the hyperplastic gastric polyps or GEP-NETs. GNAS1 mutation is not a frequent molecular event in GEP-NETs or hyperplastic gastric polyps. The study confirms the presence of GNAS1 mutations in colon tumors with villous differentiation.

Predicting Colonic Polyp Histology with White Light Endoscopy

Purpose: To determine the ability of endoscopists to predict polyp histology based on endoscopic appearance under white light using high definition colonoscopy. Methods: We prospectively collected data on consecutive patients undergoing routine colonoscopy at Walter Reed Army Medical Center from December 2009 to May 2010 as part of a quality improvement initiative. Data gathered included demographic, endoscopic and histologic characteristics. Prior to the study, endoscopists were instructed to categorize all polyps removed as tubular adenoma (TA), villous adenoma (VA), tubular villous adenoma (TVA), adenocarcinoma, or hyperplastic polyp using only white light. Actual histology was obtained on all retrieved polyps. For analysis purposes, actual and predicted histology were collated into 2 categories (benign [hyperplastic, normal tissue] and abnormal [adenomatous, adenocarcinoma]). Accuracy, sensitivity, specificity, positive/negative predictive values (PPV; NPV) and kappa statistics were calculated. Results: 1111 patients (56% male, 53% white, 56 years (18-91) (range)) were included in the study. The majority of patients (66%) had screening or surveillance colonoscopy. A total of 1049 polyps were identified (≤5mm, n=877; 6-9mm, n=137; ≥10mm, n=34), of which 45.6% (478) were benign, 53.4% (560) were adenomatous, and 1% (11) contained adenocarcinoma. Specificity for detecting benign histology was 48% (230/478) and a NPV of 78.2% (230/294). Sensitivity for detecting abnormal tissue (adenomatous; adenocarcinoma) histology was 86% (490/571) with a PPV of 66.4% (490/738). Of 11 histologically-proven adenocarcinoma, none were estimated to be normal tissue. This resulted in a kappa statistic of 0.381 (0.328-0.434) to accurately estimate polyp histology. Conclusion: Based on this study, endoscopists using high definition, white light endoscopy yielded an overall sensitivity for identifying abnormal polyps (adenomas, adenocarcinomas) of 86% and a specificity of 48%. Endoscopists tended to overestimate hyperplastic polyp histology, however they were unlikely to underestimate clinically significant lesions or polyps. None of the cancers were predicted to be benign histology. These findings suggest that white light endoscopy are modestly accurate in discriminating benign from abnormal tissue, however it is not sufficient to change our current practice of sampling all visualized polyps on colonoscopy.

An asymptomatic tubular villous adenoma in a young male: A case report

Polyps of the colon are a common occurrence, and whose incidence increases with age. Polyps have the ability to transform into neoplasms, and the polyp’s likelihood of becoming cancerous is closely related to its size. The larger a polyp grows, the more likely it is to become cancerous. Once a polyp reaches 2 cm, the risk of malignant transformation is in excess of 20%. There are several subtypes of polyps: tubular, villous, or tubulovillous. Villous adenomas are the most likely to transform, whereas tubular adenomas carry the least risk. Symptoms range from anemia and constipation, to abdominal pain and obstruction, depending on the size and location of the lesion. As a general rule, the larger the size of the polyp, the likelihood for pain and obstruction increases. Herein we present a case of a young patient presenting with mild anemia who was found to have a giant tubulovillous adenoma.