Rectal aberrant crypt foci (ACF) as a predictor of benign and malignant neoplastic lesions in the large intestine.

BACKGROUND: The importance of ACF is not fully explained, however, their number may be a good predictor of synchronous and metachronic adenoma or other polyps whose removal reduces the risk of CRC. Due to the epidemiological and genetic association of ACF with pre-cancer lesions, they may be a potential CRC biomarker. The aim of our study was to show that the number and type of rectal ACF may be a good predictive factor for the presence of polyps located proximally from the splenic flexure and that the type and number of ACF can correlate with the number and specific types of polyps in the large intestine. METHODS: The study included 131 patients who underwent colonoscopy combined with rectal mucosa staining with 0.25% methylene blue. The number of rectal ACF was determined and bioptats were sampled for histopathological examination to assess the type of ACF. Endoscopic ACF assessment criteria given by L. Roncucci were used. The obtained material was subjected to statistical analysis using probability distribution, U-test, t-student test, and chi 2 as well as the Statistica 7.1 software package. RESULTS: The study population was divided into three subgroups according to the number of ACF observed, i.e. ACF < 5, 5-10 and > 10. ACF < 5 were found in 35 patients (29.41%), 5-10 ACF in 70 (58.82%) and ACF > 10 in 14 individuals (11.76%). The study revealed the presence of normal ACF (p = 0.49), hyperplastic ACF (p = 0.34), dysplastic ACF (p = 0.11), and mixed ACF (p = 0.06). A single type of ACF was most commonly observed (n = 88, p = 0.74). In the researched group a larger number of ACF is concurrent with adenomas and hyperplastic polyps. The number of ACF clearly correlates with the dysplasia advancement in the adenoma and the number of polyps found. CONCLUSIONS: Rectal ACF are a useful marker for the presence of cancerous lesions in the proximal and distal sections of the large intestine.

Occurrence of colorectal aberrant crypt foci depending on age and dietary patterns of patients.

BACKGROUND: Aberrant crypt foci (ACF) are commonly considered the early pre-cancerous lesions that can progress to colorectal cancer (CRC). The available literature data reveal that age, dietary factors and lifestyle can affect the development of several dozen percentages of malignant tumours, including CRC. In the present study, an attempt was made to assess the incidence and growth dynamics of ACF and to determine whether the type of diet affected the development and number of AFC. METHODS: Colonoscopy combined with rectal mucosa staining with 0.25% methylene blue was performed in 131 patients. On the day of examination, each patient completed a questionnaire regarding epidemiological data. According to their numbers, colorectal ACF were divided into three groups. The findings were analysed statistically. The Student's t test and the U test were applied in order to determine the significance of differences of means and frequency of events in both groups. Statistica 7.1 and Excel 2010 were used. RESULTS: The single ACF occur in the youngest individuals (ACF < 5). Since the age of 38 years, the number of ACF gradually increases to show a decreasing tendency since the age of 60 years. The number of 5 < ACF < 10 occurs slightly later, since the age of 50 years, and dynamically increases reaching the maximum at the age of 62 years, subsequently the increase is proportional. ACF > 10 occur at a more advanced age (55 years) and their number gradually increases with age. The maximum number is observed at the age of 77 years. In individuals not using high-fibre diets and with high intake of red meat, the probability of higher numbers of ACF increases. The probability of higher numbers of ACF (5 < ACF10) was observed in patients with colon diverticula. In patients with higher BMI, the number of ACF is higher. CONCLUSION: Age significantly affects the number of colorectal ACF. The types of foods consumed can considerably increase the risk of colorectal ACF, which is particularly visible in individuals who do not regularly use high-fibre diets, those obese and with colon diverticula.

Chromoendoscopy with a Standard-Resolution Colonoscope for Evaluation of Rectal Aberrant Crypt Foci.

Colorectal cancer (CRC) is the second most common cause of death worldwide. According to the theory by Vogelstein, colorectal carcinogenesis involves a series of successive changes in the normal colonic mucosa, starting with excessive proliferation and focal disorders of intestinal crypts, followed by adenoma and its subsequent malignant transformation. The first identifiable changes in CRC carcinogenesis are aberrant crypt foci (ACF). ACF are invisible during routine colonoscopy yet are well identifiable in chromoendoscopy using methylene blue or indigo carmine. High-resolution colonoscopes are used for assessment of ACF. The aim of the present study was to evaluate the usefulness of standard-resolution colonoscopy for identification of rectal ACF. The following parameters were evaluated: duration of chromoendoscopy of a given rectal segment, type of ACF, sensitivity and specificity of endoscopy combined with histopathological evaluation. The mean duration of colonoscopy and chromoendoscopy was 26.8 min. In the study population, typical ACF were found in 73 patients (p = 0.489), hyperplastic ACF in 49 (p = 0.328), and dysplastic ACF in 16 patients (p = 0.107). Mixed ACF were observed in 11 individuals (p = 0.073). The sensitivity of the method was found to be 0.96 whereas its specificity 0.99. Identification of rectal ACF using standard-resolution colonoscopy combined with rectal mucosa staining with 0.25% methylene blue is characterised by high sensitivity and specificity.

Diagnosis, treatment, and prognosis in patients with liver metastases from follicular thyroid carcinoma (FTC).

Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer (TC) and accounts for approximately 10% of all TC cases. Liver metastases are a rare presentation in 0.5-1% of follicular thyroid cancers, usually occurring in the setting of widely disseminated FTC disease, and their presence is associated with poor prognosis. Until now, there have been only 30 cases of FTC liver metastases described in the literature. Herein, we review publications and describe diagnostic tools that may be used in the diagnosis and follow-up of FTC metastases to the liver, including biopsy and imaging techniques like US, CT, MRI, SPECT, PET, and radioiodine scintigraphy. We also present and discuss current methods of treatment, e.g. TSH suppressive therapy with levothyroxine, surgery, radiofrequency ablation (RFA), transarterial embolisation (TAE), liver transarterial chemoembolisation (TACE), chemotherapy with cisplatin and doxorubicin, treatment with Indium- 111-octreotide (or its analogues), and tyrosine kinase inhibitors (sorafenib, sunitinib). At the end we describe the course, results of diagnostics, and treatment in a patient with large multiple FTC metastases to the liver. (Endokrynol Pol 2016; 67 (3): 332-347).

Assessment of gastric secretory function by 24-hour pH-metry in patients with hepatic cirrhosis due to HBV infection, before and after non-shunt type Sugiura procedure.

BACKGROUND: Assessment of gastric secretory function by 24-hour pH-metry in patients with hepatic cirrhosis due to HBV infection, before and after non-shunt type Sugiura procedure. AIM OF THE STUDY: Advanced chronic hepatopathies are very often accompanied by pathologic changes in the stomach as well as functional disturbances affecting the upper gastrointestinal tract. They include ulceration, erosions, and congestive (portal) gastropathy, reported with increasing frequency. Some of these patients undergo surgical treatment to prevent recurrent esophageal variceal bleeding. Because of considerable differences in gastric hydrochloric acid secretion, its assessment was attempted in patients with hepatic cirrhosis and portal hypertension before (group II) and after (group III) non-shunt type surgical procedure. MATERIAL/METHODS: The study was carried out in two groups of patients, consisting of 11 patients each, and a control group of 15 healthy volunteers. Subjects over 65 years of age, with concurrent chronic conditions, history of surgical procedures (except for Sugiura procedure) and treated with drugs affecting gastric secretion were excluded from the study. All the subjects qualified for the study underwent pH-metry with a DL70 pH-meter equipped with a glass electrode. Median pH (Me) and mean pH values (arithmetic mean, AM) from 24 h were used in analysis. RESULTS: The following results were obtained--in the control group Me 1.57, AM. 1.97; in group II Me 2.04, AM 2.53. In the group of patients after Sugiura procedure Me was 2.83 and AM 3.12. No statistically significant differences in gastric secretion were found between the studied groups in statistical analysis using Cochran, Cox and Student-t tests. CONCLUSION: There are no statistically significant differences in gastric secretion determined by 24-hour pH-metry in patients with hepatic cirrhosis due to HBV infection and portal hypertension before and after non-shunt type Sugiura procedure.

Assessment of correlation between histopathologic changes of gastric mucosa according to Whitehead's classification and extent of liver damage according to Knodell's scale in patients with chronic hepatopathy.

AIM OF THE STUDY: Patients with chronic liver damage often suffer from functional disturbances and pathologic changes in the stomach, including ulceration, erosions and chronic gastritis. It was attempted to establish whether there is a correlation between histopathologic abnormalities of the gastric mucosa and the extent of histopathologic changes in liver bioptates, i.e. inflammatory activity and fibrosis (Knodell's index) in patients with chronic hepatopathy. MATERIAL/METHODS: The study was carried out in 4 groups of patients: groups I--10 subjects with autoimmune hepatitis, group II--9 patients with chronic toxic liver damage, group III--11 patients with chronic hepatitis caused by HBV, and group IV--36 patients with chronic hepatitis caused by HCV. All the patients underwent gastroscopy with collection of gastric mucosa bioptates (from the antrum and the gastric body) as well as liver biopsy. RESULTS: The most frequent gastroscopy finding in all the studied groups were signs of gastritis: in group I--90%, in group II--78%, in group III--64% and in group IV--99%. Gastric mucosa histopathology assessed according to Whitehead's classification most frequently led to the diagnosis of gastritis chronica profunda (Group I--80%, Group II--78%, Group III--73% and Group IV--58%). No correlation was found between inflammatory activity in the liver assessed according to Knodell's scale and the extent of changes in histopathology of the gastric mucosa (p = 0.1). A negative correlation which, however, does not reach significance level (p = 0.054), is observed between the extent of fibrosis in liver bioptates and histopathologic abnormalities in the gastric mucous membrane. CONCLUSION: No statistically significant correlation between the extent of gastric mucosa damage and severity of inflammatory lesions and hepatic fibrosis was found.