Differentiation of neoplastic from non-neoplastic lesions and diagnosis of deeply invasive submucosal cancer dSM were compared between BLI magnification and pit pattern analysis. Type C2 in the Hiroshima classification was evaluated separately, because application of this category as an index of the depth of cancer invasion was considered difficult. The accuracy of differential diagnosis between neoplastic and non-neoplastic lesions was In addition, the diagnostic accuracy of BLI magnification and pit pattern analysis for dSM for cancer was The 18 type C2 lesions comprised 1 adenoma, 9 intramucosal or slightly invasive submucosal cancers, and 8 dSM.
Pit pattern analysis allowed accurate diagnosis of the depth of invasion in 13 lesions ADR is a widely used colonoscopy quality indicator. Calculation of ADR is labor-intensive and cumbersome using current electronic medical databases. Natural language processing NLP is a method used to extract meaning from unstructured or free text data. An NLP pipeline was developed to identify adenomas and sessile serrated polyps SSPs on pathology reports corresponding to these colonoscopy reports.
The pipeline was validated using a manual search. Precision, recall, and effectiveness of the natural language processing pipeline were calculated. We identified screening colonoscopies that were linked to pathology reports Mean total ADR was Mean total SDR was 4. This NLP pipeline can be used to evaluate colonoscopy quality parameters at both individual and practice levels. Inflammatory myoglandular polyp --a rare but distinct type of colorectal polyps. The aim of this paper was to report another example of a rare type of colorectal polyps , the inflammatory myoglandular polyp , and to reaffirm this type of polyp as a distinct entity.
This solitary pedunculated polyp was detected after a single episode of rectal bleeding. It was situated in the sigmoid colon, measured 2. The patient had neither chronic colitis nor diverticula. Clinical presentation, localization, and histology give this type of polyp a unique appearance and justify its designation as a separate entity.
Evaluation of risk factors for the recurrence of colorectal polyps and colorectal cancer. This study aimed to assess risk factors for the recurrence of colorectal polyps and CRC following polypectomy. Materials and methods: In this single-center trial, a total of patients who applied to the endoscopy unit of Hacettepe University Hospital for various reasons and who were diagnosed with at least one colorectal adenomatous polyp between and were retrospectively analyzed.
Patients with colorectal adenomatous polyps or CRC recurrences were examined in terms of clinical and histological risk factors. Results: A total of Among them, The only significant difference was observed in patients who had left-sided colon polyps.
In the first surveillance colonoscopy, CRC was detected in 12 patients. There was a significant correlation between the development of CRC and advanced histological type, anemia with high erythrocyte sedimentation rate, polyp size polyps polyps had a high risk of developing colorectal polyp recurrence. Moreover, the risk of developing CRC increased in patients who had advanced histology, a polyp larger than 10 mm, or more than three polyps.
In people with familial adenomatous polyposis, or FAP, a combination treatment of erlotinib Tarceva and sulindac Aflodac decreased the number of precancerous colorectal polyps , according to recently published clinical trial results.
Now colorectal cancer is the second most common cancer in males and the fourth most common cancer in females in Korea. Since most of colorectal cancers occur after the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer.
Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. The guideline was developed by the Korean Multi-Society Take Force and we tried to establish the guideline by evidence-based methods. Parts of the statements were draw by systematic reviews and meta-analyses. Herein we discussed epidemiology of colorectal cancers and adenomas in Korea and optimal methods for screening of colorectal cancer and detection of adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.
Distinct features between MLH1-methylated and unmethylated colorectal carcinomas with the CpG island methylator phenotype: implications in the serrated neoplasia pathway. By contrast, MLH1-unmethylated tumors were associated with earlier age of onset, increased distal colorectal localization, adverse pathologic features, and KRAS mutations. High resolution microendoscopy for classification of colorectal polyps.
It can be difficult to distinguish adenomas from benign polyps during routine colonoscopy. High resolution microendoscopy HRME is a novel method for imaging colorectal mucosa with subcellular detail. HRME criteria for the classification of colorectal neoplasia have not been previously described. Study goals were to develop criteria to characterize HRME images of colorectal mucosa normal, hyperplastic polyps , adenomas, cancer and to determine the accuracy and interobserver variability for the discrimination of neoplastic from non-neoplastic polyps when these criteria were applied by novice and expert microendoscopists.
Using these criteria, HRME expert and novice microendoscopists were shown a set of training images and then tested to determine accuracy and interobserver variability. Kappa values were: experts 0. Using the new criteria, observers achieved high specificity and substantial interobserver agreement for distinguishing benign polyps from neoplasia. Increased expertise in HRME imaging improves accuracy. This low-cost microendoscopic platform may be an alternative to confocal microendoscopy in lower-resource or community-based settings.
Risk factor assessment of endoscopically removed malignant colorectal polyps. Background—Malignant colorectal polyps are defined as endoscopically removed polyps with cancerous tissue which has invaded the submucosa. Various histological criteria exist for managing these patients. Aims—To determine the significance of histological findings of patients with malignant polyps. Methods—Five pathologists reviewed the specimens of 85 patients initially diagnosed with malignant polyps.
High risk malignant polyps were defined as having one of the following: incomplete polypectomy, a margin not clearly cancer-free, lymphatic or venous invasion, or grade III carcinoma. Adverse outcome was defined as residual cancer in a resection specimen and local or metastatic recurrence in the follow up period mean 67months. Results—Malignant polyps were confirmed in 70 cases. In the high risk group, surgery is recommended when either of the two independent risk factors, incomplete polypectomy or a resection margin not clearly cancer-free, is present or if there is a combination of other risk factors.
As lymphatic or venous invasion or grade III cancer did not have an adverse outcome when the sole risk factor, operations in such cases should be individually assessed on the basis of surgical risk. Keywords: malignant polyps ; colon cancer; colonoscopy; polypectomy; histology PMID Gallbladder stones and gallbladder polyps associated with increased risk of colorectal adenoma in men. Most cases of colorectal cancer develop via an adenoma to carcinoma sequence. Gallbladder polyps share some risk factors with colorectal polyps.
Little is known about the relationship between gallbladder diseases and different status of colorectal polyps by gender. This study was to investigate the association of gallbladder stones and polyps with colorectal adenomas by gender in a Taiwanese population. A total of eligible subjects who underwent a total colonoscopy as a part of health check-up between January and August were recruited. Colonoscopic findings were classified into polyp -free, non-neoplastic polyps and colorectal adenomas.
Gallbladder stones and gallbladder polyps were diagnosed based on ultrasonographic findings. There was a significant difference in the status of colon polyps between subjects with and without gallbladder polyps. However, the status of colon polyps was not significantly different between subjects with or without gallbladder stones. After adjusting obesity, fasting plasma glucose, and other variables, there was a positive relationship between gallbladder polyps and colorectal adenomas odds ratio [OR]: 1.
In men, gallbladder polyps OR: 1. In women, neither gallbladder polyps nor gallbladder stones were significantly related to colon polyps. Both gallbladder polyps and gallbladder stones were associated with an increased risk of colorectal adenomas in men but not in women. Gender difference was significant for the association between gallbladder lesions and colorectal polyps. Summers, Ronald M.
Richard; Yao, Jianhua. Student t-test, odds ratio OR , logistic regression and receiver operating characteristic analyses were performed. Malignant colorectal polyps are defined as endoscopically removed polyps with cancerous tissue which has invaded the submucosa. To determine the significance of histological findings of patients with malignant polyps. Five pathologists reviewed the specimens of 85 patients initially diagnosed with malignant polyps.
Adverse outcome was defined as residual cancer in a resection specimen and local or metastatic recurrence in the follow up period mean 67 months. Malignant polyps were confirmed in 70 cases. Associations between dietary fiber and colorectal polyp risk differ by polyp type and smoking status.
The association of dietary fiber intake with colorectal cancer risk is established. However, the association may differ between cigarette smokers and nonsmokers. Dietary fiber intakes were estimated by self-administered food frequency questionnaire.
Analysis also was stratified by cigarette smoking and sex. No inverse association with dietary fiber intake was observed for low-risk ADs, defined as single nonadvanced ADs. Cigarette smoking may modify the association of dietary fiber intake with the risk of colorectal polyps , especially high-risk ADs, a well-established precursor of colorectal cancer. Tests to Detect Colorectal Cancer and Polyps. People are usually not sedated for this test. Studies have shown that people who have regular screening Studies suggest that colonoscopy reduces deaths from colorectal cancer Serrated adenocarcinoma morphology in colorectal mucinous adenocarcinoma is associated with improved patient survival.
Colorectal mucinous adenocarcinoma MAC and serrated adenocarcinoma SAC share many characteristics, including right-side colon location, frequent mucin production, and various molecular features. We assessed the correlation of SAC morphology with clinicopathological parameters, molecular characteristics, and patient prognosis.
Our results show that two MAC groups with distinct features can be identified using Makinen's criteria, and suggest a favorable prognostic role for the serrated neoplastic pathway in colorectal MAC. Wide-field piecemeal cold snare polypectomy of large sessile serrated polyps without a submucosal injection is safe.
A thin-wire snare was used in all cases. Submucosal injection was not performed. High definition imaging of the defect margin was used to ensure the absence of residual serrated tissue. Adverse events were assessed at 2 weeks and surveillance was planned for between 6 and 12 months. The median procedure duration was 4. There was no evidence of perforation or significant intraprocedural bleeding.
At 2-week follow-up, there were no significant adverse events, including delayed bleeding and post polypectomy syndrome. This could reduce the burden of removing SSPs on patients and healthcare systems, particularly by avoidance of delayed bleeding. Traditional serrated adenoma TSA : morphological questions, queries and quandaries. Traditional serrated adenoma TSA is an uncommon type of serrated adenoma that can be a precursor to biologically aggressive colorectal cancer that invokes the serrated accelerated pathway.
The purpose of this review is to address some of the more contentious issues around nomenclature, diagnostic criteria, histological variants, coexistence with other polyp types, the occurrence of dysplasia and the differential diagnosis. While the vast majority of TSAs are exophytic villiform polyps composed of deeply eosinophilic cells, flat top luminal serrations and numerous ectopic crypt foci, histological variants include flat TSA, filiform TSA and one composed of large numbers of mucin-containing cells.
It is unlikely that there is any biological difference between the histological variants. There is a contention that TSAs are not dysplastic ab initio and that the majority do not show cytological atypia. Two types of dysplasia are associated with TSA. Serrated dysplasia is less well recognised and less commonly encountered than adenomatous dysplasia.
TSA is a characteristic polyp that may be extremely exophytic, flat or composed of mucin-rich cells and is typified by numerous ectopic crypt foci. They may coexist with other serrated polyps and conventional adenomas. High-definition endoscopy with digital chromoendoscopy for histologic prediction of distal colorectal polyps.
Distal diminutive colorectal polyps are common and accurate endoscopic prediction of hyperplastic or adenomatous polyp histology could reduce procedural time, costs and potential risks associated with the resection. Within this study we assessed whether digital chromoendoscopy can accurately predict the histology of distal diminutive colorectal polyps according to the ASGE PIVI statement. In this prospective cohort study, consecutive patients undergoing screening or surveillance colonoscopy were included.
Real time histology of diminutive distal colorectal polyps was evaluated using high-definition endoscopy with digital chromoendoscopy and the accuracy of predicting histology with digital chromoendoscopy was assessed. The overall accuracy of digital chromoendoscopy for prediction of adenomatous polyp histology was Sensitivity, specificity, positive and negative predictive values were In high-confidence predictions, the accuracy increased to High-definition endoscopy in combination with digital chromoendoscopy allowed real-time in vivo prediction of distal colorectal polyp histology and is accurate enough to leave distal colorectal polyps in place without resection or to resect and discard them without pathologic assessment.
This approach has the potential to reduce costs and risks associated with the redundant removal of diminutive colorectal polyps. ClinicalTrials NCT A prospective comparison of cold snare polypectomy using traditional or dedicated cold snares for the resection of small sessile colorectal polyps. Dwyer, Jeremy P. The aim of this study was to assess the completeness of resection and safety of cold snare polypectomy, using either traditional or dedicated cold snares. In the first phase, all patients had polyps removed by traditional snare without diathermy.
In the second phase, all patients had polyps removed by dedicated cold snare. Complete endoscopic resection was determined from histological examination of quadrantic polypectomy margin biopsies. Immediate or delayed bleeding within 2 weeks was recorded. Patient demographics and procedure indications were similar between groups. A novel pit pattern identifies the precursor of colorectal cancer derived from sessile serrated adenoma. Consequently, colonoscopic identification of SSAs has important implications for preventing CRCs, but accurate endoscopic diagnosis is often difficult.
Our aim was to clarify which endoscopic findings are specific to SSAs. The morphological, histological and molecular features of specimens from colorectal tumors were analyzed. Surface microstructures were analyzed using magnifying endoscopy. Natural history of diminutive colorectal polyps : long-term prospective observation by colonoscopy. Endoscopic removal of colorectal adenomatous polyps effectively prevents cancer. Understanding the natural history of diminutive polyps is a prerequisite to their effective management.
We prospectively examined the natural history of diminutive polyps by long-term surveillance colonoscopy. A total of polyps detected in patients from December through March were studied. To avoid potential effects on size and morphological characteristics, all polyps were selected randomly and were followed without biopsy.
Polyp size was estimated by comparing the lesion with the diameter of a biopsy forceps. Mean follow up was 7. Twenty-four polyps were resected endoscopically, and the histopathological diagnosis was mucosal high-grade neoplasia Category 4 for one polyp , and mucosal low-grade neoplasia Category 3 for 23 polyps. Mean linear size of the polyps was 3. We clarified the natural history of diminutive polyps by long-term follow-up colonoscopy. The benign course of diminutive polyps should be considered in the design of treatment strategies.
Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps. The ideal method to remove small colorectal polyps is unknown. We compared removal by colon snare transection without electrocautery cold snare polypectomy with conventional electrocautery snare polypectomy hot polypectomy in terms of procedure duration, difficulty in retrieving polyps , bleeding, and post-polypectomy symptoms.
Patients with colorectal polyps up to 8 mm in diameter were randomized to polypectomy by cold snare technique cold group or conventional polypectomy conventional group. The principal outcome measures were abdominal symptoms within 2 weeks after polypectomy. Secondary outcome measures were the rates of retrieval of colorectal polyps and bleeding.
The patients' demographic characteristics and the number and size of polyps removed were similar between the two techniques. Procedure time was significantly shorter with cold polypectomy vs. No bleeding requiring hemostasis occurred in either group. Abdominal symptoms shortly after polypectomy were more common with conventional polypectomy i. Cold polypectomy was superior to conventional polypectomy in terms of procedure time and post-polypectomy abdominal symptoms.
The two methods were otherwise essentially identical in terms of bleeding risk and complete polyp retrieval. Cold polypectomy is therefore the preferred method for removal of small colorectal polyps. Karger AG, Basel. Interobserver agreement in the histologic diagnosis of colorectal polyps. Current clinical practice guidelines for patients with colorectal polyps are mainly based on the histologic characteristics of their lesions.
However, interobserver variability in the assessment of specific polyp characteristics was evaluated in very few studies. The purpose of this study was to evaluate the interobserver agreement of four pathologists in the diagnosis of histologic type of colorectal polyps and in the degree of dysplasia and of infiltrating carcinoma in adenomas. A stratified random sample of polyps was obtained from the 4, polyps resected within the Multicentre Adenoma Colorectal Study SMAC , and the slides were blindly reviewed by the four pathologists.
Agreement was analyzed using kappa statistics. A median kappa of 0. The agreement in the diagnosis of tubular, tubulovillous, and villous type, was given by median kappa values of 0. The median kappa for the diagnosis of infiltrating carcinoma was 0. Agreement on diagnosis of adenoma histologic subtypes, degrees of dysplasia, or infiltrating carcinoma in adenoma was moderate. A simpler classifications might help to better identify patients at different risk of colorectal cancer.
WNT pathway activation may also occur, however, to what extent this is owing to APC mutation is unknown. WNT pathway activation was seen to a lesser extent in serrated pathway lesions. We conclude that increased WNT signaling is important in the transition to malignancy in the serrated pathway but that APC mutation is less common and the spectrum of mutations is different than in conventional colorectal carcinogenesis. Here, we attempted to identify a possible association between miR and epigenetic features in serrated pathway, and hypothesized that miR supports the " colorectal continuum" concept.
We evaluated miR expression, BRAF mutation and epigenetic features including CIMP status in serrated lesions and non- serrated adenomas and examined associations between them and tumor location rectum; sigmoid, descending, transverse and ascending colon and cecum. Our data also suggested that miR plays an important role in SSA evolution and may be a molecule supporting the colorectal continuum.
However, it is unclear whether the ADR should be calculated using data from screening and surveillance examinations. There are few data available to compare ADRs from surveillance vs screening colonoscopies. We used a population-based registry to compare ADRs from screening vs surveillance colonoscopies.
The serrated polyp detection rate SDR , a potential new quality indicator, also was examined. METHODS By using data from the statewide New Hampshire Colonoscopy Registry, we excluded incomplete and diagnostic colonoscopies, and those performed in patients with inflammatory bowel disease, familial syndromes, or poor bowel preparation. We calculated the ADR and SDR number of colonoscopies with at least 1 adenoma or serrated polyp detected, respectively, divided by the number of colonoscopies from colonoscopies.
By using data from the statewide New Hampshire Colonoscopy Registry, we excluded incomplete and diagnostic colonoscopies, and those performed in patients with inflammatory bowel disease, familial syndromes, or poor bowel preparation. The effect of colon preparation quality on adenoma detection rates ADRs is unclear, partly because of lack of uniform colon preparation ratings in prior studies.
The New Hampshire Colonoscopy Registry collects detailed data from colonoscopies statewide, by using a uniform preparation quality scale after the endoscopist has cleaned the mucosa. To compare the overall and proximal ADR and serrated polyp detection rates SDR in colonoscopies with differing levels of colon preparation quality.
New Hampshire statewide registry. Patients undergoing colonoscopy. We examined colon preparation quality for 13, colonoscopies, graded by using specific descriptions provided to endoscopists. The overall detection rates in examinations with fair colon preparation quality SDR 8. This finding also was observed for rates in the proximal colon. A logistic regression model including withdrawal time found that proximal ADR was statistically lower in the poor preparation category odds ratio 0.
A systematic review. The purpose of the present systematic review is to identify whether an association between gallbladder polyps and colorectal adenoma or neoplasia exists. We conducted a systematic review searching the Medline , Scopus , ClinicalTrials. All prospective and retrospective observational cohort studies were included. Four studies were finally included which included 17, patients.
The association between gallbladder polyps and colorectal adenoma or even neoplasia is not unanimously supported. However, a possible association is clearly depicted. However, the impact of size of gallbladder polyps was not investigated in the remaining studies. According to the results of our systematic review there is some evidence to support the hypothesis that gallbladder polyps might adequately predict future risk of colorectal neoplasia.
At present, however, current knowledge is very limited and the available data scarce. In this context further studies are necessary to be carried out, before the presence of gallbladder polyps on ultrasound can be recommended as an indication to perform a screening colonoscopy on the same patient. Published by Elsevier Ltd. Richard; Summers, Ronald M. Pericolonic fat was measured on CTC in a band surrounding the colon. Visceral adipose tissue volume was measured at the L2-L3 levels.
Student t-tests, odds ratio, logistic regression, binomial statistics and weighted-kappa were performed to ascertain associations with the incidence of colorectal polyps. Polyps tended to occur more commonly in parts of the colon that had more PFVF than the spatially-adjusted average for patients in the highest quintile of VFVF. Chemoprevention of polyp recurrence with curcumin followed by silibinin in a case of multiple colorectal adenomas.
Chemoprevention is a practical approach to reduce the risk of various cancers including colorectal cancer CRC. The goal is to reduce the incidence of pre-neoplastic adenomatous polyps and prevent its progression to CRC. Curcumin and silibinin prevent intestinal polyp formation in mice. Curcumin sensitizes silymarin to exert synergistic anticancer activity in colon cancer cells.
Four subsequent colonoscopies showed continuous development of adenomatous polyps treated by polypectomy for the most part and some with heat. After the treatment with curcumin for 3 months and a half followed by silibinin for 9 months, we find many less polyps than in the previous colonoscopies, going from the finding of 40 adenomas of mm in the pre-treatment colonoscopy to 3 polyps after treatment. Epidemiology of goblet cell and microvesicular hyperplastic polyps.
Serrated polyps compromise both typical hyperplastic polyps as well as sessile serrated adenomas and dysplastic serrated polyps. The particular risk factors that are associated with development of the types of hyperplastic polyps have not been previously studied. The purpose of this study is to characterize the associations between particular risk factors and the development of goblet cell or microvesicular hyperplastic polyps. We conducted a cross-sectional analysis of 3, asymptomatic, mostly average risk patients 50 and 79 years of age undergoing open-access screening colonoscopy between March and January Each patient was given a survey regarding 25 reputed risk factors for colorectal neoplasia and the responses were correlated with findings at colonoscopy.
Right-sided rhabdoid colorectal tumors might be related to the Serrated Pathway. Background Rhabdoid colorectal tumor RCT is a rare, highly aggressive neoplasm recurrent in elderly patients, commonly at the caecum. The molecular mechanisms underlying RCT pathogenesis remain poorly elucidated. The differential diagnosis is with the malignant rhabdoid tumors of infancy characterized by genetic inactivation of SMARCB1 INI1 or deletions of chromosome 22q12 locus.
Materials and methods To shed light on RCT pathogenesis, we investigated genetic and epigenetic alterations in two cases of pure and composite RCT and compared them with the profiles of matched adenomas and normal mucosa. Rearrangement of the 22q12 locus was found only in pure RCT. Conclusions Right-sided RCT could be characterized by epigenetic events and molecular features likely similar to those occurring in the serrated pathway and associated with epithelial-mesenchymal transition.
These extremely rare tumors may benefit from the use of new biological molecules specific for colorectal carcinoma. A comparison of blood vessel features and local binary patterns for colorectal polyp classification. Colorectal cancer is the third leading cause of cancer deaths in the United States of America for both women and men. Polyps can to be grouped into three different classes: hyperplastic, adenomatous, and carcinomatous polyps. Hyperplastic polyps are benign and are not likely to develop into cancer.
Adenomas, on the other hand, are known to grow into cancer adenoma-carcinoma sequence. Carcinomas are fully developed cancers and can be easily distinguished from adenomas and hyperplastic polyps. A recent narrow band imaging NBI study by Tischendorf et al.
We designed a computer-aided system for the differentiation between hyperplastic and adenomatous polyps. Our development aim is to provide the medical practitioner with an additional objective interpretation of the available image data as well as a confidence measure for the classification. We propose classification features calculated on the basis of the extracted blood vessel structure.
We use the combined length of the detected blood vessels, the average perimeter of the vessels and their average gray level value. The results indicate that the implemented features are superior to LBP. UK guidance for the pathological reporting of serrated lesions of the colorectum. Bowel cancer screening programmes have highlighted to endoscopists and clinicians the spectrum of serrated colorectal lesions. One of the most significant developments has been the recognition that sessile serrated lesions SSLs , while bearing histological resemblance to hyperplastic polyps HPs , may be associated with the enhanced development of epithelial dysplasia and colorectal adenocarcinoma.
Furthermore, the spectrum of terminology used to describe the entire range of serrated lesions is wide. This variability has impaired interobserver agreement during their histopathological assessment. Here, we provide guidance for the histopathological reporting of serrated lesions, including a simplified nomenclature system.
It is hoped that this standardisation of nomenclature will facilitate studies of the biological significance of serrated lesions in terms of the relative risk of disease progression. Detection of flat colorectal polyps at screening CT colonography in comparison with conventional polypoid lesions.
Although the screening of small, flat polyps is clinically important, the role of CT colonography CTC screening in their detection has not been thoroughly investigated. To evaluate the detection capability and usefulness of CTC in the screening of flat and polypoid lesions by comparing CTC with optic colonoscopy findings as the gold standard.
Four types of reconstruction images including multiplanar reconstruction, volume rendering, virtual gross pathology, and virtual endoscopic images were used for visual analysis. We compared the abilities of the four reconstructions for polyp visualization. Detection sensitivity for flat polyps was The overall sensitivity for flat lesions Virtual endoscopic imaging showed best visualization among the four reconstructions.
Colon cancers were detected in eight patients by optic colonoscopy, and CTC detected colon cancers in all eight patients. CTC using row multidetector CT is useful for colon cancer screening to detect colorectal polyps while the detection of small, flat lesions is still challenging.
Serrated lesions of the appendix: a morphologic and immunohistochemical appraisal. We performed a histologic and immunohistochemical assessment of 53 noninvasive appendiceal epithelial proliferations, appropriating terminology and using markers shown useful in differentiating serrated colorectal polyps. Serrated appendiceal lesions can be categorized using colorectal terminology. It is unclear how objective risk factors influence the factors associated with colorectal cancer CRC risk perception.
The goals of this study were to investigate factors associated with perceived risk of CRC and to explore how these relationships were modified by personal history of polyps or family history of CRC. The study involved a mailed…. Endoscopic mucosal resection for middle and large colorectal polyps with a double-loop snare. This study aimed to analyze the endoscopic mucosal resection EMR with a novel uniquely shaped, double-loop snare Dualoop, Medico's Hirata Inc.
First, the firmness of various snares including 'Dualoop' was experimentally analyzed with a pressure gauge. Five hundred and eighty nine consecutive polyps that underwent EMR with 'Dualoop' were compared to polyps with the standard round snare.
Lesion characteristics, en bloc resection, and complications were analyzed. The average tumor size was 9. The rate of en bloc resection for middle polyps mm in diameter was significantly higher with the 'Dualoop' than that with the round snare Higher age, larger tumor size, and superficial polyps were associated with the failure of en bloc resection.
EMR with 'Dualoop' was effective for resecting both middle and large polyps en-bloc. Sessile serrated adenoma SSA vs. The morphologic distinction between various serrated polyps of the colorectum may be challenging. The distinction between sessile serrated adenoma SSA and traditional serrated adenoma TSA may be difficult using currently available criteria mostly based on cytologic characteristics. We have evaluated 66 serrated polyps including 29 SSA, 18 TSA, and 19 hyperplastic polyps for overall shape of the polyps , architectural features of individual crypts, the presence of eosinophilic cytoplasm, size and distribution of the proliferation and maturation zones, as well as Ki and CK20 expression.
The extent of the expression of CK20 and Ki could not distinguish between the 3 types of serrated polyps , but the distribution of their expression was very helpful and differences were statistically significant. SSA had irregular, asymmetric, and highly variable expression of Ki TSA had low Ki expression, which was limited to "ectopic crypts" and admixed tubular adenomalike areas. In serrated polyps , ectopic crypt formation ECF defined by the presence of ectopic crypts with their bases not seated adjacent to the muscularis mucosae was nearly exclusive to TSA and was found in all cases, while the presence of cytologic atypia and eosinophilia of the cytoplasm were characteristic, but not limited to TSA.
The presence of the ECF defines TSA in a more rigorous fashion than previous diagnostic criteria and also explains the biologic basis of exuberant protuberant growth associated with TSA and the lack of such growth in SSA.
Recognition of this phenomenon may also help in exploring the genetic and molecular basis for differences between. Whereas few adenomas become cancer, most colorectal cancers arise from adenomas. Telomere length is a recognized biomarker in multiple cancers, and telomere maintenance mechanisms TMM are exploited by malignant cells.
We sought to determine whether telomere length and TMM distinguish cancer-associated adenomas from those that are cancer-free. Tissues were identified as cancer-adjacent polyp CAP -residual adenoma contiguous with cancer-and cancer-free polyp CFP -adenomas without malignancy. Telomere length, TMM, and expression were measured in tissues including peripheral blood leukocytes PBLs , normal colon epithelium, adenoma, and cancer in CAP cases from 31 patients.
Adenomas that progress to cancer exhibit distinct telomere length and TMM profiles. We report for the first time that PBL telomeres differ in patients with polyps that become malignant, and therefore may have clinical value in adenoma risk assessment and management.
Inflammatory myoglandular colorectal polyps : a series of seven cases and review of literature. Inflammatory myoglandular polyp is an unusual but distinct, non-neoplastic type of colorectal polyp , commonly with a distal localization at the recto-sigmoidian level.
It was first described in by Nakamura and his colleagues and it is considered to have few particular histological features. We report a series of seven cases two male and five female patients of myoglandular polyps with different localization from 15 to 40 cm from anus.
Only four out of seven cases presented with rectal bleeding, the others polyps we incidentally discovered. The polyps varied between 4 and 30 mm in the maximum diameter. Grossly, they had firm consistency and smooth reddish surface. Histological examination of the specimens revealed hyperplastic glands with occasional cystic dilatation, proliferation of smooth muscle with no regular distribution, a variable amount of granulation tissue usually minimal and no evidence of epithelial dysplasia.
All the lesions were removed endoscopically without any complications. Inflammatory myoglandular polyps are distinct histopathological entities, with insufficiently investigated pathogenesis that can include local trauma, mucosal prolapse or ischemia. Being benign they can be removed endoscopically, surgical treatment being reserved in selected cases. Physical activity reduces risk for colon polyps in a multiethnic colorectal cancer screening population.
Background Identifying modifiable factors that influence the epidemiology of colorectal cancer incidence among multiethnic groups might be informative for the development of public health strategies targeting the disease.
Minimal data exists describing the impact of physical activity on colorectal polyp risk in United States minority populations. The aim of this study is to evaluate the relationship of exercise on the prevalence of polyps in a multiethnic colorectal cancer screening population. Patients who reported exercising one or more hours weekly had a lower prevalence of any polyps Black and Hispanic patients and those who were overweight or obese also had lower prevalence of polyps if they led an active lifestyle.
Conclusions Exercising one hour per week was associated with a lower prevalence of polyps and adenomas when compared to those who exercised less or not at all. An active lifestyle provides benefits to groups who are at risk for colorectal cancer, such as Blacks. It also provides significant protection to overweight and obese individuals. Public health initiatives should promote physical activity as a cancer prevention tool in multiethnic populations.
Trial registration none PMID Clinical significance of peripheral circulating tumor cell counts in colorectal polyps and non-metastatic colorectal cancer. The presence of peripheral circulating tumor cells indicates the possible existence of a tumor in vivo; however, low numbers of circulating tumor cells CTCs can be detected in peripheral blood of healthy individuals as well as patients with benign tumors.
It is not known whether peripheral CTC counts differ between patients with benign colorectal disease and those with colorectal cancer. Comparative analysis of preoperative peripheral circulating tumor cells counts was completed in patients with benign colorectal disease colorectal polyps and non-metastatic cancer of the colon and rectum. The results of this analysis showed that patients with colorectal cancer had higher CTC counts than patients with colorectal polyps 3.
Colorectal polyp patients with polyps in the rectum showed the highest CTC counts 2. The differences in CTC counts suggest that anatomical location of colorectal tumors may affect blood vessel metastasis. Circulating tumor cells can be detected in the peripheral blood of colorectal.
Narrow-band imaging is an image-enhanced form of endoscopy used to observed microstructures and capillaries of the mucosal epithelium which allows for real-time prediction of histologic features of colorectal polyps. However, narrow-band imaging expertise is required to differentiate hyperplastic from neoplastic polyps with high levels of accuracy.
We developed and tested a system of computer-aided diagnosis with a deep neural network DNN-CAD to analyze narrow-band images of diminutive colorectal polyps. We collected images of neoplastic polyps and images of hyperplastic polyps , obtained from the picture archiving and communications system database in a tertiary hospital in Taiwan.
Histologic findings from the polyps were also collected and used as the reference standard. The images and data were used to train the DNN. A test set of images 96 hyperplastic and neoplastic polyps , smaller than 5 mm , obtained from patients who underwent colonoscopies from March through August , was then used to test the diagnostic ability of the DNN-CAD vs endoscopists 2 expert and 4 novice , who were asked to classify the images of the test set as neoplastic or hyperplastic.
Their classifications were compared with findings from histologic analysis. The primary outcome measures were diagnostic accuracy, sensitivity, specificity, positive predictive value PPV , negative predictive value NPV , and diagnostic time. Extended cold snare polypectomy for small colorectal polyps increases the R0 resection rate.
Despite widespread use of cold snare polypectomy CSP , the R0 resection rate is not well documented. Serrated polyps are important contributors to the burden of colorectal cancers CRC. These factors represent unique challenges that require a meticulous approach to their management. The concept of CIMP as a molecular carcinogenesis mechanism was consolidated by the identification of the serrated neoplasia pathway, in which CIMP participates in the initiation and progression of serrated adenomas.
CIMP-H CRCs arise in sessile or traditional serrated adenomas and thus tend to display the morphological characteristics of serrated adenomas, including epithelial serration , vesicular nuclei, and abundant cytoplasm. In this review, we present an overview of the literature documenting the relevant findings of CIMP-H CRCs and their relationships with the serrated neoplasia pathway.
Should hot biopsy forceps be abandoned for polypectomy of diminutive colorectal polyps? Standardized approach to polypectomy of diminutive colorectal polyps DCPs is lacking since cold biopsy forceps have been associated with high levels of recurrence, hot biopsy forceps are considered inadequate and risky and cold snaring is currently under investigation for its efficacy and safety.
This has led to confusion and a gap in clinical practice. This article discusses the usefulness and contemporary practical applicability of hot biopsy forceps and provides well-intentioned criticism of the new European guidelines for the treatment of DCPs. Diminutive colorectal polyps are a source of frustration for the endoscopist since their small size is accompanied by a considerable risk of premalignant neoplasia and a small but non-negligible risk of advanced neoplasia and even cancer.
Since the proportion of diminutive colorectal polyps is substantial and exceeds that of larger polyps , their effective removal poses a considerable workload and a therapeutic challenge. During the last decade, the introduction of cold snaring to routine endoscopy practice has attempted to overcome the use of prior techniques, such as hot biopsy forceps. It is important to recognize that with the exception of endoscopic methods that are obviously unsafe and inadequate to serve their purpose, all other interventional endoscopic methods are operator-dependent in the sense that specific expertise and training are obligatory for the success of any therapeutic intervention.
Since relevant publications on hot biopsy forceps are still in favor of its careful use, as it has not yet demonstrated inferiority compared with newer techniques, it would be prudent for any medical practitioner to evaluate the available tools and judge any new proposed technique based on the evidence before it is adopted. Fatty liver is the hepatic manifestation of metabolic syndrome MetS and is a known risk factor for colorectal neoplasia CRN.
However, studies evaluating CRN risk according to fatty liver severity and the presence of GB polyps are rare. A retrospective cross-sectional study was performed on 44, participants undergoing colonoscopy and abdominal ultrasonography US as part of a health-screening program. Of the participants, fatty liver was diagnosed as mild in Mean age of participants was Adjusted odd ratios for overall CRN and non-advanced CRN comparing participants with mild, moderate, and severe fatty liver to participants without fatty liver were 1.
CRN risk increased with worsening fatty liver severity. However the association between GB polyp and CRN was not significant in the presence of other variables. Considering that many people undergo noninvasive abdominal US as a health screen, our study will contribute to colonoscopy screening strategies in people undergoing abdominal US.
Colorectal cancer CRC is a leading cause of cancer deaths worldwide. Correctly detecting and predicting polyp type during colonoscopy allows endoscopists to resect and discard the tissue without submitting it for histology, saving time, and costs. Nevertheless, human visual observation of early stage polyps varies. Therefore, this paper aims at developing a fully automatic algorithm to detect and classify hyperplastic and adenomatous colorectal polyps.
Adenomatous polyps should be removed, whereas distal diminutive hyperplastic polyps are considered clinically insignificant and may be left in situ. A novel transfer learning application is proposed utilizing features learned from big nonmedical datasets with 1. The endoscopic images we collected for experiment were taken under random lighting conditions, zooming and optical magnification, including endoscopic nonpolyp images taken under both white-light and narrowband imaging NBI endoscopy and NBI endoscopic polyp images, of which images were hyperplasia and were adenoma as confirmed by histology.
The proposed method identified polyp images from nonpolyp images in the beginning followed by predicting the polyp histology. When compared with visual inspection by endoscopists, the results of this study show that the proposed method has similar precision In conclusion, automatic algorithms can assist endoscopists in identifying polyps that are adenomatous but have been incorrectly judged as hyperplasia and, therefore, enable timely resection of these polyps at an early stage before they develop into invasive cancer.
Sessile serrated adenomas with dysplasia: morphological patterns and correlations with MLH1 immunohistochemistry. Sessile serrated adenomas with dysplasia are rarely encountered and represent an intermediate step to malignant progression, frequently associated with loss of MLH1 expression. Accurate diagnosis of these lesions is important to facilitate appropriate surveillance, particularly because progression from dysplasia to carcinoma can be rapid.
The current World Health Organization classification describes two main patterns of dysplasia occurring in sessile serrated adenomas, namely, serrated and conventional. However, this may not adequately reflect the spectrum of changes seen by pathologists in routine practice. Furthermore, subtle patterns of dysplasia that are nevertheless associated with loss of MLH1 expression are not encompassed in this classification.
We performed a morphological analysis of sessile serrated adenomas with dysplasia with concurrent MLH1 immunohistochemistry with the aims of better defining the spectrum of dysplasia occurring in these lesions and correlating dysplasia patterns with MLH1 expression.
Minimal deviation dysplasia is defined by minor architectural and cytological changes that typically requires loss of MLH1 immunohistochemical expression to support the diagnosis. This morphological classification of sessile serrated adenomas with dysplasia may represent an. Colorectal polyp cancers present clinicians with a treatment dilemma. Decisions regarding whether to offer segmental resection or endoscopic surveillance are often taken without reference to good quality evidence.
The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers. This national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between and Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient.
These data were used to develop a clinically relevant treatment algorithm. The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp OR 5. When patients undergoing segmental resection or endoscopic surveillance were considered together, the risk of adverse events was significantly higher in patients with incomplete excision OR Consideration of segmental resection should be reserved for those with incomplete excision or evidence of lymphovascular invasion.
Evaluation of promoter methylation status of MLH1 gene in Iranian patients with colorectal tumors and adenoma polyps. The aim of this study was to evaluate the methylation status of the promoter region of MLH1 gene in colorectal cancer CRC and its precursor lesions as well as elucidate its association with various clinicopathological characteristics among Iranian population.
Epigenetic silencing of mismatch repair genes, such as MLH1 , by methylation of CpG islands of their promoter region has been proved to be an important mechanism in colorectal carcinogenesis. Fifty colorectal cancer and polyp tissue samples including 13 Primary colorectal tumor and 37 Adenoma polyp samples were enrolled in this study.
Promoter methylation of MLH1 gene was detected in 5 out of 13 tumor tissues and 4 out of 37 adenoma polyp. No significant association was observed between MLH1 promoter methylation and clinicopathological characteristics of the patients. Our findings indicated that methylation of MLH1 promoter region alone cannot be considered as a biomarker for early detection of CRC. Colorectal polyps are common in Thailand, particularly in the northeastern region.
The present study aimed to determine any correlation between Helicobacter pylori-associated gastritis and colorectal polyps in the Thai population. A total of patients undergoing esophagogastroduodenoscopy with colonoscopy for investigation of chronic abdominal pain participated in this study from November to October A diagnosis of Helicobacter pylori associated gastritis was made if the bacteria were seen on histopathological examination and a rapid urease test was positive.
Reportlinker finds and organizes the latest industry data so you get all the market research you need - instantly, in one place. Florida Panthers assistant general manager Brett Peterson joined the Yahoo Sports Hockey Podcast to talk about his experience in hockey, the NHL's inclusivity issues, his transition from agent to executive, and the hot start in Sunrise. He was The parade will be held on the Hillsborough River near downtown Tampa. Mayor Jane Castor is again emphasizing that people attending the parade must wear masks outdoors and observe social distancing rules.
After Tampa Bay's win over the Kansas City Chiefs in Sunday's title game, throngs of people gathered in the city's entertainment districts. Many were seen maskless despite the ordinances requiring them. Brian Ford, chief operating officer of the Buccaneers, said in video announcement that fans should heed the rules as they celebrate the team's victory.
The Associated Press. Houston Texans president Jamey Rootes has resigned after more than 20 years, the team's latest move in an off-season of upheaval. The announcement was made Wednesday and said that Rootes was leaving to pursue interests as a writer, public speaker, consultant and professor at the University of Houston. Rootes was hired in as the Texans began preparations for their expansion season in He was responsible for all of the team's business functions, including stadium naming rights and sponsorships, ticket sales and co-ordinating radio and TV broadcasting relationships.
His departure continued the Texans' off-season turnover. The team hired coach David Culley and general manager Nick Caserio last month to replace Bill O'Brien, who held both jobs and was fired after an start. The Texans also face uncertainty on the field with star quarterback Deshaun Watson requesting a trade last month. Houston finished last season after reaching the playoffs in the previous two years.
The organization has co-ordinated the many events at NRG Stadium since that time, including the Texas Bowl, the Texas Kickoff and many international soccer events. I want to thank my teammates as we could not have had so many successes without their hard work and dedication to the team," he said.
Alleah Taylor said Chad Wheeler was "sipping on a smoothie" when he told her "wow, you're still alive. Serena Williams is in prime form to start Australian Open play. The Chiefs will have to deal with the Super Bowl loser's hangover next season. Diaz's record was not acquired by kicking tomato cans down the road, but rather by beating serious competition time in and time out.
Texas Tech head coach Chris Beard actually sat on the floor and mimicked an opposing player during a ridiculous on-court meltdown. Florida Panthers assistant general manager Brett Peterson has had a largely positive experience at every stage of his hockey career, and he believes the game is taking the right steps forward to ensure that for all individuals. Britt Reid remains under investigation for a crash that left a 5-year-old girl in critical condition with brain injuries.
Gronk had a lot to say about the Super Bowl streaker, because of course he did. The Liberty acquired that pick from Phoenix by sending Kia Nurse and Megan Walker to the Mercury for the sixth pick this year and their first-round pick next year. The No. The Wings become the first team in WNBA history to hold the first and second overall picks in the same draft.
In addition, Dallas also holds the fifth, seventh and 13th selections in The year-old forward won titles in Minnesota in and Seattle in and last season. Whitcomb was a key member of the Storm's franchise the last few years. The year-old is a solid 3-pointer shooter. She led the team in scoring the past two seasons.
Walker was drafted ninth by New York last season and averaged 3. New York, which had seven rookies last season, still has the No.
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