Primary Adenocarcinoma at Colostomy Site: Report of a Clinical Case

Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer in the United States and it is found in 17% of patients thought to have complicated diverticular disease. However, primary adenocarcinoma rarely occur in the colostomy site and the risk of developing malignancy is similar to that of any other colonic segment. Polyps found in CRC screenings can be divided into the following types: hyperplastic polyps, polyps with no malignant potential, adenomatous polyps, polyps with malignant potential, and malignancies. Local complications of the colostomy can appear in the immediate, early, or late postoperative period, with an incidence ranging from 15 to 30%; neoplasia is even less common.

A case of osseous metaplasia in a gastric hyperplastic polyp: An unexpected finding in a common polyp

Introduction/Objective Foveolar hyperplastic polyp is a common gastric polyp characterized by foveolar hyperplasia with erosion, acute and chronic inflammation, granulation tissue formation, and smooth muscle strands extending from the muscularis mucosae. Although foveolar hyperplastic polyps may rarely contain foci of dysplasia or invasive carcinoma, osseous metaplasia/heterotopic bone formation in foveolar hyperplastic polyps of the stomach is extremely rare with a few case reports. Methods/Case Report A 63-year-old female with a history of hypertension, sick sinus syndrome, and Hashimoto’s thyroiditis was referred to our facility for evaluation of a mass in segment eight of the liver. The liver biopsy showed a moderately differentiated adenocarcinoma, most consistent with intrahepatic cholangiocarcinoma. A screening gastrointestinal endoscopy revealed a 7-mm sessile polyp in the antrum. The polyp was removed with a cold snare. No other abnormalities were identified in the stomach. Sections of the polyp showed fragments of antral-type gastric mucosa with foveolar hyperplasia, erosion, acute and chronic inflammation, and focal granulation tissue formation. In addition, multiple foci of woven bone formation without bone marrow surrounding dilated gastric foveolae were identified. No Helicobacter infection, intestinal metaplasia, dysplasia or malignancy was identified histologically. Osseous metaplasia/heterotopic bone formation is a well-known finding reported in various neoplastic and non- neoplastic conditions. However, osseous metaplasia in foveolar hyperplastic polyps of the stomach is extremely rare. There have been only four previous case reports published in English language. Our current case shows clinicopathologic features similar to those of the previous case reports including the findings of small-sized polyp found incidentally in middle-aged patients with no clinical history of hypercalcemia or any other abnormalities causing heterotopic bone formation. Results (if a Case Study enter NA) N/A Conclusion Although the pathogenesis of osseous metaplasia in a gastric hyperplastic polyp remains unknown, the finding of osseous metaplasia in a gastric hyperplastic polyp is very intriguing.

Endoscopic and Histopathological Characteristics of Polypoid and Non-Polypoid Colorectal Lesions in Patients of a Social Security Hospital of Lambayeque, Peru

Objective: To describe the endoscopic and histopathological characteristics of polypoid and non-polypoid colorectal lesions at the Luis Heysen Inchaustegui hospital, Peru, 2017-2018. Materials and methods: Descriptive-analytical cross-sectional study. We study epidemiological, endoscopic and histopathological variables. location, Size and shape of the lesions taking into account the Paris classification. Results: Endoscopically, of a total of 81 colorectal lesions, the majority were non-polypoid (71.6%). Lesions smaller than 10mm represented 90.1% in non-polypoid lesions and 56.5 % in polypoid lesions. Histopathologically, non-adenomatous lesions predominated (53.0%). Conclusions: The most frequent lesions were non-polypoid, the main location being the rectum; while in polypoid lesions, the transverse colon. Regarding size, lesions smaller than 10mm predominated in both non-polypoid and polypoid lesions. Histopathologically, the most frequent were non-adenomatous lesions (hyperplastic polyps); for its part, the predominant adenoma subtype was tubular. Keywords: Adenomas; Polyps; Intestinal Polyps; Colon (source: DeCS BIREME).

Gastric Polyps: A 10-Year Analysis Of 18496 Upper Endoscopies

Background/Aims: Gastric polyps (GPs) are usually asymptomatic lesions of the upper gastrointestinal tract observed in 1-3% of esophagogastroduodenoscopies (EGD). The majority of polyps are benign. The aim of this study was to precise the frequency of different types of gastric polyps in our population, and to analyze their possible association with other factors.Materials and Methods: A total of 18496 consecutive patients undergoing EGD over a ten-year period (between 2007 and 2018) in a tertiary hospital were retrospectively reviewed. Eighty-six patients diagnosed with gastric polyps were analysed. Demographics, medical history of the patients, and indication for gastroscopy were collected. Morphological, histological characteristics of polyps, and therapeutic management data were also collected.Results: GPs were found in 86 out of 18496 (0.46%) reviewed EGD, corresponding to a total of 141 polyps. There were 64 female (74.4%) and 22 male patients (25.6%) with a sex ratio (M/F) of 0.34. The average age was 58.1 years. One hundred and forty one polyps were included, and histopathology was obtained on 127 GPs. The most common location was the fundus (59.6%) and 48.9% were smaller than 5 mm. The polyp was unique in 75.6% of cases. According to Paris classification, 80% of the polyps were sessile (Is). Hyperplastic polyps were the most common (55.9%) were hyperplastic polyps, followed by sporadic fundic gland polyps in 23 patients (18.1%), 7 (5.5%) were adenomas, and 4 (3.1%) were neuroendocrine tumors type 1. The following factors were associated with hyperplastic polyps: anemia (p= 0.022), single polyp (p= 0.025) and size ≥ 5mm (p= 0.048). Comparing hyperplastic polyps biopsies to resected polyps, no difference was found in the evolutionary profile of the 2 groups. A size less than 10 mm (p=0.013) was associated with fundic gland polyps. Sixty polyps (47.2%) were treated by cold forceps, 19 (15%) treated by a mucosal resection and 15 (11.8%) with diathermic snare. Five procedural bleeding incidents were observed (3.9%). Only the use of anticoagulant treatment was associated with a high bleeding risk (p= 0.005). The comparative histological study between specimens of biopsied GPs and endoscopic polypectomy led to an overall agreement of 95.3%.Conclusion: In our study, the GPs frequency was 0.36%. Hyperplastic polyps and fundic gland are the most common gastric polyps in our country. The high frequency of Helicobacter pylori infection in our patients and in our area may explain the high frequency of HP.

Analysis of pathological characteristics and nursing intervention of patients with gastric polyps based on image stitching algorithm and endoscopy

Original Article Linzhen Zhu1, Linlin Zhu2, Weihua Yu3 ABSTRACTObjectives: The paper uses image stitching algorithm to understand the clinical and pathological characteristics of gastric polyps under gastroscope, and provides objective basis for the clinical diagnosis and treatment of gastric polyps and nursing intervention. Methods: The endoscopic, pathological data and surgical conditions of 111 patients with gastric polyps detected in the hospital from January 2017 to August 2019 were retrospectively analyzed. Results: The elderly patients (≥60 years old) in this group were those with high incidence of gastric polyps (56.8%); 80 patients with single polyps (72.1%), 31 patients with multiple polyps (27.9%); polyps were mainly located in the stomach (53.2%); polyps diameter ≤0.5cm are more common (69.4%); polyps are mainly hyperplastic polyps (40.5%) and inflammatory polyps in 37 cases (33.3%). Polyps were removed by biopsy forceps in 30 cases, endoscopic submucosal injection of 0.9% NaCl solution combined with high-frequency electrosurgical removal of 54 cases, endoscopic mucosal resection (EMR) in 6 cases, and endoscopic submucosal dissection (ESD) in treatment of the 4 cases, the remaining 17 cases were treated with surgery, and 12 patients were followed up, 2 of whom relapsed. Conclusion: Gastric polyps are small in diameter and mostly single; polyps are mainly located in the stomach body, mainly hyperplastic polyps; treatment methods are mostly endoscopic resection, and there is a possibility of recurrence after polypectomy, and follow-up should be strengthened. Full preparation before the operation, close cooperation during the operation, and careful postoperative care are important links to ensure the safety of the operation and reduce complications such as upper gastrointestinal bleeding. KEYWORDS: Pathological characteristics; Nursing; Gastric polyps; Image stitching algorithm; Endoscopy. doi: https://doi.org/10.12669/pjms.37.6-WIT.4854How to cite this:Zhu L, Zhu L, Yu W. Analysis of pathological characteristics and nursing intervention of patients with gastric polyps based on image stitching algorithm and endoscopy. Pak J Med Sci. 2021;37(6):1620-1624. doi: https://doi.org/10.12669/pjms.37.6-WIT.4854 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

BİR EĞİTİM ARAŞTIRMA HASTANESİNDE ALT GASTROİNTESTİNAL SİSTEM BULGULARININ DEĞERLENDİRİLMESİ

Patients with complaints about colorectal region refer to general surgery, gastroenterology and other outpatient clinics with an increasing frequency. Rectal bleeding, abdominal pain, unexplained anemia, changes in bowel habit, occult blood positivity in stool can be a sign of serious colon disease. In this study, patients under the age of 65 who underwent AGIS endoscopy in the endoscopy unit of the Research and Application Hospital in Central Anatolia Region between 2015 and 2018 were examined. The data were reviewed retrospectively. 214 patients under the age of 65 were included in the study. Colitis in 37 (17.29%), hyperplastic polyp in 38 (17.76%), tubular adenoma in 86 (40.19%), tubular adenoma in 40 (18.69%), Adenocarcinoma was detected in 13 (6.7%) of results. Tubular adenoma, tubulovillose adenoma and adenocarcinomas were more common at the age of fifties, with colitis and hyperplastic polyps detected in the mean age of forties. Adenocarcinomas were found to be more common in female sex, unlike other results. Lower gis endoscopy has an important place in the diagnosis and treatment of colorectal cancer. In our study, in which the results of AGIS endoscopy were examined, tubular adenoma was high in individuals under 65 years of age. Keywords: Tubulovillous Adenoma, Colitis, Hyperplastic Polyp

The Association between Serum Vitamin D Concentration and Colon Polyp: A Cross-Sectional Study Using Health Care Screening Database in a Tertiary Hospital in Korea

Background: As indoor activity increases with modern lifestyles changes, reduced exposure to sunlight may lead to reduced vitamin D synthesis. Previous studies demonstrated that increased vitamin D level is associated with decreased risk of colon cancer; therefore, this study attempted to determine the association between vitamin D and colon polyps, which may be precancerous lesions, in participants who underwent colonoscopy exams.Methods: A total of 31,004 participants who underwent routine health checkups, including vitamin D level and colonoscopy, at Samsung Medical Center in South Korea from 2010 to 2018 were included in the study. Colorectal polyps were diagnosed through biopsy after performing colonoscopy exams. Participants were categorized into three groups according to level of vitamin D (deficient: <20 ng/mL), insufficient: 20≤ vitamin D <30 ng/mL, and sufficient: ≥30 ng/mL). We analyzed the presence of colorectal polyps according to vitamin D level, and performed multiple logistic regression analyses for the association between vitamin D level and colorectal polyps.Results: About 50% of participants had colorectal polyps (hyperplastic polyp, n=4,864; adenomatous polyp, n=10,470; adenocarcinoma, n=24). There were no significant associations between vitamin D categories and colorectal polyp and colorectal cancer. However, when further analyzing by type of polyp, the risk of hyperplastic polyps significantly decreased with increasing vitamin D levels (P for trend=0.006).Conclusion: We did not find evidence for an association between vitamin D and overall colorectal polyps; however, we observed a trend for decreased odds of hyperplastic polyps with increased vitamin D levels in comparison to vitamin D deficient subjects.

Retrospective Review of Multitarget Stool DNA as a Screening Test for Colorectal Cancer

Objectives To review the effectiveness of noninvasive multitarget stool DNA testing as a screening test for colorectal cancer. Methods We performed a retrospective review of patients referred to 2 high volume outpatient procedural centers for colonoscopy for positive Cologuard test. Positive findings for colorectal cancer based on pathologic findings and also advanced adenomas were recorded. Positive predictive value (PPV) was assessed. Results Of the 1585 patients evaluated and referred for colonoscopy from January 1, 2018 to November 1, 2019, for ICD-10 codes R19.5 (other fecal abnormalities) and K92.1 (melena), 84 were referred for a positive Cologuard test. Out of the 84, 6 were excluded based on family history of colon cancer in first degree relative or personal history of inflammatory bowel disease. Of the remaining 78 patients, 1 patient (1.3%) had colorectal cancer and 5 (6.4%) had advanced adenomas (>1 cm size, high grade dysplasia or villous). Postive predictive value for colorectal cancer was 1.3% and for precancerous lesions plus colorectal cancer was 7.7%. A total of 53 (68.0%) patients had either totally normal colonoscopy or hyperplastic polyps. Out of the 78 individuals in our study, 70 (89.7%) had normal findings, hyperplastic polyps, or non-advanced adenomas. Conclusions Multitarget stool DNA testing carries an unacceptably low PPV to be utilized as a screening test for colorectal cancer. The study fails to detect both adenomas and colon cancer at a higher rate than screening colonoscopy in selected studies. The advantage of being noninvasive has been noted to increase colorectal cancer screening in otherwise non-compliant Medicare patients.