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1.
World J Surg Oncol ; 17(1): 109, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238922

RESUMO

INTRODUCTION: Villous adenomas are dubiously benign lesions, which are difficult to interpret because of their malignant potential. Distal villous adenomas present with bleeding or mucus discharge. Giant adenomas are not amenable for endoscopic or transanal resection. Only few isolated cases have been reported by laparoscopic resection. We present our case of a circumferential giant villous adenoma of the rectum managed successfully by laparoscopic ultra-low anterior resection with colo-anal anastomosis with a review of literature in regard to their malignant potential. CASE REPORT: A 62-year-old lady presented with complaints of painless bleeding per rectum and a fleshy mass protruding from the anal canal which on digital rectal examination appeared a large soft velvety flat mass with mucus discharge. Colonoscopy showed circumferential irregular, friable, edematous mucosa in rectum extending for 15 cm. Computed tomography showed a large heterogeneously enhancing polypoid mass lesion in the rectal wall involving the entire rectum. The patient underwent laparoscopic low anterior resection with colo-anal anastomosis and protecting loop ileostomy. Histopathological examination of the resected specimen revealed villous adenoma of the rectum with moderate to severe dysplasia. DISCUSSION: Villous adenomas are sessile growths lined by dysplastic glandular epithelium, whose risk of malignancy is especially high up to 50% when greater than 2 cm in size. Large size, villous content, and distal location are all associated with severe dysplasia in colorectal adenomas. Large villous rectal tumors, particularly of circumferential type pose a great challenge for endoscopic or transanal removal. Henceforth, open or laparoscopic surgery is required for these cases. CONCLUSION: Giant rectal villous polyps are usually unresectable by endoscopic methods or transanal endoscopic microsurgery and are associated with a high rate of unsuspected cancer which requires a formal radical oncologic resection. As per current data, the combined risk of dysplasia/malignancy is about 83% with 50% risk of dysplasia and frank malignancy in 33% of cases of giant rectal villous adenomas of more than 8 cm in size. Laparoscopic colorectal resection is safe and effective.


Assuntos
Adenoma Viloso/cirurgia , Canal Anal/cirurgia , Colo/cirurgia , Laparoscopia/métodos , Neoplasias Retais/cirurgia , Adenoma Viloso/epidemiologia , Adenoma Viloso/patologia , Anastomose Cirúrgica/métodos , Feminino , Humanos , Ileostomia , Pessoa de Meia-Idade , Prevalência , Prognóstico , Neoplasias Retais/epidemiologia , Neoplasias Retais/patologia , Reto/diagnóstico por imagem , Reto/patologia , Reto/cirurgia , Resultado do Tratamento
2.
Am J Case Rep ; 20: 655-658, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31061381

RESUMO

BACKGROUND Multiple primary tumors are defined as more than 1 synchronous or metachronous tumor in the same patient. It is important to diagnose each type stage accurately because the treatment is basically directed towards the most advanced and serious primary tumor. CASE REPORT We report a case of advanced mucinous colon cancer and borderline mucinous ovarian tumor that was also implanted with colonic deposits, which presented with acute obstruction. CONCLUSIONS Multiple primary ovarian and colorectal tumors are commonly encountered. In such cases, accurate diagnoses and staging are important. Immunohistochemistry is the most important investigation to differentiate primary cancers in cases of synchronized tumors and metastases.


Assuntos
Adenocarcinoma Mucinoso/patologia , Neoplasias do Colo/patologia , Cistadenoma Mucinoso/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Ovarianas/patologia , Adenocarcinoma Mucinoso/diagnóstico por imagem , Adenoma Viloso/patologia , Neoplasias do Colo/diagnóstico por imagem , Cistadenoma Mucinoso/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Retais/patologia , Tomografia Computadorizada por Raios X
3.
Int J Surg Pathol ; 27(4): 450-456, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30701999

RESUMO

Villous adenomas arising in the bladder following augmentation cystoplasty procedures are exceedingly rare. Even rarer is their occurrence in the native bladder mucosa and the upper urinary tract. In this article, we present a unique case of multifocal recurrent villous adenoma involving native bladder mucosa of an augmented bladder, bilateral ureters, and renal pelvis, with coexistent foci of adenocarcinoma and neuroendocrine carcinoma, in a patient with history of augmentation colocystoplasty. We additionally discuss the pathogenesis of development of carcinoma in the setting of augmentation cystoplasty.


Assuntos
Adenoma Viloso/diagnóstico , Carcinoma Neuroendócrino/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Bexiga Urinária/patologia , Derivação Urinária/efeitos adversos , Adenoma Viloso/etiologia , Adenoma Viloso/patologia , Adenoma Viloso/cirurgia , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/cirurgia , Cistoscopia , Humanos , Íleo/cirurgia , Masculino , Pessoa de Meia-Idade , Membrana Mucosa/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias Primárias Múltiplas/etiologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Obstrução Uretral/cirurgia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos
4.
Pathologica ; 110(2): 92-95, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30546144

RESUMO

Intestinal-type adenocarcinoma is a rare primary vaginal carcinoma and considerably more uncommon than metastatic lesions which represent the most frequent malignancy at this anatomic site. Among all malignant tumors, colorectal, breast and female genital tract carcinomas have the tendency to metastasize to the vagina.As morphologic and immunohistochemical features of intestinal-type adenocarcinoma occurring primarily in the vagina are not specific, clinical and radiologic information is crucial to exclude a metastatic lesion.Herein we present a rare case of intestinal-type adenocarcinoma from a villous adenoma, presenting as a polypoid mass in the posterior wall of vaginal introitus of 51-year-old menopausal woman. To the best of our knowledge, only 19 cases of intestinal-type adenocarcinoma of the vagina have been reported in the English literature so far. Notably the origin from a previous villous adenoma has been well documented only in a few cases.


Assuntos
Adenocarcinoma/patologia , Adenoma Viloso/patologia , Neoplasias Vaginais/patologia , Adenocarcinoma/química , Adenocarcinoma/cirurgia , Adenoma Viloso/química , Adenoma Viloso/cirurgia , Biomarcadores Tumorais/análise , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Neoplasias Vaginais/química , Neoplasias Vaginais/cirurgia
5.
BMJ Case Rep ; 20182018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30389742

RESUMO

A 5-year-old boy with metachromatic leukodystrophy, debilitated by spastic quadriparesis presented to us with massive ascites and respiratory distress. A subtotal cholecystectomy was performed on him from another centre for a gall bladder mass a year before he came to us. Imaging revealed a polypoidal frond-like mass arising from the gall bladder fossa which was supplied by a hypertrophied branch of the right hepatic artery. A decision was made to offer surgical resection preceded by embolisation of the feeding vessel. At surgery, a polypoidal frond-like mass in communication with the peritoneal cavity was seen arising from the remnant gall bladder bed with over 4 L of mucoid ascites. The mass along with the remnant gall bladder was removed. Biopsy revealed villous papilloma of the gall bladder. The child is well and asymptomatic at 5-month follow-up.


Assuntos
Vesícula Biliar/diagnóstico por imagem , Leucodistrofia Metacromática/patologia , Papiloma/cirurgia , Adenoma Viloso/complicações , Adenoma Viloso/patologia , Ascite/diagnóstico , Ascite/etiologia , Pré-Escolar , Embolização Terapêutica/métodos , Vesícula Biliar/irrigação sanguínea , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/patologia , Artéria Hepática/cirurgia , Humanos , Leucodistrofia Metacromática/complicações , Leucodistrofia Metacromática/diagnóstico por imagem , Masculino , Papiloma/patologia , Doenças Raras , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
Int J Colorectal Dis ; 33(12): 1695-1701, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30136172

RESUMO

PURPOSE: Very few data are available about the clinical relevance of magnetic resonance (MR) imaging in preoperative evaluation of rectal villous adenoma. The aim is to evaluate the impact of MR imaging for the surgical management of rectal villous adenoma treated by transanal endoscopic microsurgery (TEM). METHODS: All patients with histologically proven rectal villous tumours operated by TEM who had a preoperative MR imaging between 2009 and 2017 were retrospectively reviewed. All patients underwent TEM because preoperative evaluation suggested systematically usT0 or usT1 tumour. Pathological stage was blindly compared to preoperative MR imaging (location according to the anal verge and the peritoneal reflection, amount of circumferential involvement, tumour size and staging) and preoperative transrectal ultrasonography (TRUS) results. RESULTS: Forty-five patients were included (24 men, mean age 65 ± 8 years) with TRUS data available only in 37. Pathologic results were pT0-pTis in 32, pT1 in 10 and pT2 in 3. TRUS diagnosed correctly 36/37 lesions (97%) and understaged one pT2 tumour. A significant correlation between TRUS and pathologic results was noted (r = 0.99; p = 0.01). MR imaging diagnosed correctly 19/42 pTis-T1 and 1/3 pT2 tumours (46%). Overstaging by MR imaging was noted in 25 cases (54%). No correlation between MR imaging and pathologic results was noted (r = 0.7; p = 0.3). CONCLUSION: Preoperative evaluation of rectal villous adenoma is overstaged by MRI in more than half of the patients. This study suggests that the indication of local excision by TEM for rectal villous adenoma should be based on TRUS rather than on MRI.


Assuntos
Adenoma Viloso/diagnóstico por imagem , Adenoma Viloso/cirurgia , Imagem por Ressonância Magnética , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgia , Microcirurgia Endoscópica Transanal , Adenoma Viloso/patologia , Idoso , Feminino , Humanos , Masculino , Neoplasias Retais/patologia , Ultrassonografia
8.
Radiographics ; 38(5): 1370-1384, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30059275

RESUMO

Villous lesions are advanced adenomas that manifest most commonly in the colon; however, they can develop throughout the gastrointestinal tract. The duodenum is the most common small-bowel site of these lesions. Although in most cases these are isolated lesions that occur sporadically, patients with certain specific colorectal cancer syndromes, including familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, may develop multiple advanced adenomas. Villous lesions are important because although they are histologically benign, they may harbor dysplasia and have potential for malignancy. These characteristics make them a primary target for colorectal cancer screening with optical and virtual colonoscopy. However, these lesions can also be symptomatic and detected at diagnostic imaging when patients present for examination. They have characteristic features at a variety of imaging examinations, including barium fluoroscopy, CT, MRI, and endoscopic US. It is important for radiologists to be aware of these lesions, their potential morphologies, and their typical appearances at multimodality imaging. Although villous tumors can be detected at imaging and confirmed with biopsy, owing to limitations in identifying dysplasia and foci of malignancy with the above modalities alone and the potential for malignancy, referral for surgical resection of these lesions ultimately is required. ©RSNA, 2018.


Assuntos
Adenoma Viloso/diagnóstico por imagem , Neoplasias Gastrointestinais/diagnóstico por imagem , Imagem Multimodal , Adenoma Viloso/patologia , Neoplasias Gastrointestinais/patologia , Humanos , Síndrome
10.
Gulf J Oncolog ; 1(26): 61-63, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29607825

RESUMO

Transanal Minimally Invasive Surgery (TAMIS) is a one of new platform used to help and achieve better outcome in using transanal approach for the treatment of rectal neoplasm. High definition camera and high tech equipment are used to perform this kind of surgery. The main benefit of using this approach is to provide the best outcome or the patient compared to the traditional transanal approach. This platform can be used for a variety of cases, benign and malignant tumor and for the benign condition. We report the first TAMIS perfo b rmed in the Kuwait and probably in the Middle East with 2 years of follow up. We had no complication and patient returned home and to normal activity in next day. More studies needed to validate this technique.


Assuntos
Adenoma Viloso/cirurgia , Canal Anal/cirurgia , Pólipos Intestinais/cirurgia , Neoplasias Retais/cirurgia , Cirurgia Endoscópica Transanal/métodos , Adenoma Viloso/patologia , Canal Anal/patologia , Feminino , Humanos , Pólipos Intestinais/patologia , Pessoa de Meia-Idade , Prognóstico , Neoplasias Retais/patologia
11.
G Chir ; 39(1): 63-66, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29549684

RESUMO

Lipomas of the digestive tract are rare benign tumours which, in most cases, are totally asymptomatic. Because of their localization within the intestinal wall, endoscopy may be completely negative so contrast-enhanced computed tomography (CT) is very important for detecting and typing these lesions. The case of a 49-year-old man with abdominal pain is presented. Colonoscopy and biopsy of a polypoid lesion on the right colonic flexure concluded for tubulovillous adenoma. The subsequent CT showed a polylobate lesion of 5 cm in diameter with predominant fat density causing luminal sub-stenosis. Histological examination of the surgical specimen confirmed the presence of a voluminous submucosal lipoma. CT allows to diagnose lipomas of the large bowel thanks to the density measurement (between -40 and -120 Hunsfield Units) with an accurate detection of the site and nature of lumen stenosis.


Assuntos
Adenoma Viloso/cirurgia , Neoplasias do Colo/cirurgia , Lipoma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Dor Abdominal/etiologia , Adenoma Viloso/diagnóstico por imagem , Adenoma Viloso/patologia , Biópsia , Colectomia/métodos , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/patologia , Colonoscopia , Humanos , Lipoma/diagnóstico por imagem , Lipoma/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Tomografia Computadorizada por Raios X
12.
APMIS ; 126(3): 191-200, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29399882

RESUMO

Villous adenoma and urothelial carcinoma with villoglandular differentiation (UCVGD) are rare urothelial tumours showing villous morphology, the former being a preneoplastic entity and the latter being a malignant one. The detailed immunohistochemistry of these entities is previously not described in the literature. Moreover, a limited biopsy sample of UCVGD or a villous adenoma with or without adenocarcinoma may be difficult to distinguish on the basis of the histomorphology alone. An immunohistochemical panel comprising of GATA3, p63, ß-catenin, CK7 and CK20 was performed on five cases of UCVGD and three cases of villous adenoma with the aim of studying the expression of the proteins thereby aiding in the diagnosis of these entities in a limited surgical pathology specimen. The mean age of UCVGD was 66.8 years and all the patients were male. All the cases of UCVGD were associated with high grade papillary urothelial carcinoma with lamina propria invasion. The immunohistochemical panel showed strong nuclear GATA3 expression in the urothelial component of UCVGD. Interestingly, the high grade and the low grade villoglandular components of UCVGD also expressed GATA3 (nuclear) with a progressive loss of expression from the high grade to the low grade component. The villous adenomas showed negativity or aberrant cytoplasmic positivity for GATA3. The ß-catenin showed a gradual loss of membranous expression from villous adenoma to low grade and high grade villoglandular components of UCVGD with a patchy membranous expression in the urothelial component of the UCVGD. p63 showed strong nuclear positivity in the urothelial component and uniform negativity in the villous adenoma and villoglandular component of UCVGD irrespective of its grade, thereby distinguishing the villoglandular component from the urothelial component. The urothelial component of UCVGD showed strong membranous CK7 expression and was higher than the CK20 expression in the urothelial component. In contrast, CK20 expression was higher in villous adenoma as compared to CK7. There was no difference in the expression of CK7 and CK20 in the villoglandular components and low grade and high grade villoglandular areas. The above-mentioned immunohistochemical pattern may help to distinguish the UCVGD from the villous adenoma.


Assuntos
Adenoma Viloso/diagnóstico , Fator de Transcrição GATA3/metabolismo , Queratina-7/metabolismo , Proteínas de Membrana/metabolismo , Neoplasias Urológicas/diagnóstico , beta Catenina/metabolismo , Adenoma Viloso/patologia , Idoso , Biomarcadores Tumorais/metabolismo , Feminino , Hematúria/patologia , Humanos , Imuno-Histoquímica , Queratina-20/metabolismo , Masculino , Pessoa de Meia-Idade , Neoplasias Urológicas/patologia , Urotélio/patologia
14.
Colorectal Dis ; 20(6): 502-508, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29205835

RESUMO

AIM: In the UK Bowel Scope Screening Programme (BSSP), patients progress to colonoscopy based on high-risk features on flexible sigmoidoscopy (FS). We aim to assess the practice of colonoscopy conversion and predictors of detection of additional adenomas on colonoscopy. METHOD: The Bowel Cancer Screening database was interrogated and collated with endoscopic and histological findings from patients undergoing colonoscopy following FS between August 2013 and August 2016. Multivariate analysis was performed to identify predictors of new adenomas. RESULTS: FS was performed on 11 711 patients, with an adenoma detection rate (ADR) of 8.5% and conversion to colonoscopy in 421 (3.6%). The additional ADR at colonoscopy was 35.2%, with one additional malignant diagnosis (0.26%). The adenoma miss rate was 3.6%. On multivariate analysis, a polyp ≥ 10 mm was the only high-risk indication associated with additional ADR at colonoscopy (OR 3.68, 95% CI 1.51-3.65, P < 0.001), in addition to male gender (OR 2.36, 95% CI 1.46-3.83, P < 0.001). Predictors of detection of a new adenoma ≥ 10 mm included: villous adenoma (P = 0.002), polyp ≥ 10 mm (P = 0.007) and male gender (P = 0.039). The presence of any conversion criterion was associated with the detection of any proximal adenoma (P < 0.001) and adenoma ≥ 10 mm (P = 0.031). CONCLUSION: Male gender, polyps ≥ 10 mm and villous-preponderant histology at FS were predictors of adenomas < 10 mm and ≥ 10 mm at colonoscopy. Further data are required to assess the role for gender-based stratification of conversion criteria.


Assuntos
Adenoma/diagnóstico , Carcinoma/diagnóstico , Pólipos do Colo/diagnóstico , Colonoscopia , Neoplasias Colorretais/diagnóstico , Erros de Diagnóstico/estatística & dados numéricos , Sigmoidoscopia , Adenoma/patologia , Adenoma Viloso/diagnóstico , Adenoma Viloso/patologia , Carcinoma/patologia , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Fatores Sexuais , Carga Tumoral , Reino Unido
15.
Am J Gastroenterol ; 113(2): 303-306, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29231190

RESUMO

OBJECTIVES: Although large polyps are known to harbor more advanced neoplasia than small polyps, the extent of the relationship between size and type is not fully known. The study aim was to establish benchmarks for the prevalence of different histologic polyp types among varying size categories. METHODS: The Miraca Life Sciences Database is an electronic repository of histopathologic patient records from private practices throughout the United States. We extracted the records of 483,998 unique patients who underwent colonoscopy with polypectomy between January 2008 and December 2014. A total of 550,811 polyps were stratified by their endoscopic size measurement. Polyps of each size were further stratified as hyperplastic polyp (HP), tubular adenoma (TA), tubulovillous adenoma (TVA), sessile serrated adenoma/polyp, and adenocarcinoma. RESULTS: Of all 550,811 polyps, 447,343 (81%) were 1-9 mm in size, and 103,517 (19%) were 10 mm or larger. A fraction of 18,591/550,811 polyps (3.4%) harbored histologic features of advanced adenoma, such as TVA, high-grade dysplasia, or cancer. Of these, 4,725/18,591 (25%) occurred in polyps 1-9 mm and 13,868/18,591 (75%) occurred in polyps 10 mm or larger. The fractions of advanced adenoma were 0.6% (0.5-0.6%) in 1-5 mm polyps and 2.1% (2.0-2.2%) in 6-9 mm polyps, as compared to 13.4% (13.2-13.6%) in polyps 10 mm or larger. The frequency of HP significantly decreased with increasing polyp size, whereas the frequency of TA remained largely unaffected by polyp size. CONCLUSIONS: While advanced histopathology was found more frequently in colorectal polyps of larger than smaller size, one quarter of all advanced histopathology existed in polyps of <10 mm.


Assuntos
Adenocarcinoma/patologia , Adenoma/patologia , Neoplasias do Colo/patologia , Pólipos do Colo/patologia , Mucosa Intestinal/patologia , Lesões Pré-Cancerosas/patologia , Adenoma Viloso/patologia , Pólipos Adenomatosos/patologia , Idoso , Colonoscopia , Feminino , Humanos , Hiperplasia/patologia , Masculino , Pessoa de Meia-Idade , Carga Tumoral
16.
Ann Ital Chir ; 62017 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-29018180

RESUMO

BACKGROUND: A high rate of association between neuroendocrine tumors (NETs) and secondary primary malignancy (SPM) has been described in literature and this association can occur either in a synchronous or a metachronous presentation. A wide range of hypothesis has been postulated to explain the high rate of association between NETs and SPM, without definitive conclusions. CASE PRESENTATION: We report a case of an ileal neuroendocrine tumor found incidentally at the histologic examination of the surgical specimen in a 72 years old male underwent to right hemi colectomy for two colic adenomatous polips with high grade dysplasia. CONCLUSION: Large multicentric epidemiological studies should be considered to assess the association between NETs and SPM. KEY WORDS: Neuroendocrine tumors (NETs), Progression-Free Survival (PFS), Secondary primary malignancy (SPM).


Assuntos
Pólipos Adenomatosos/epidemiologia , Tumor Carcinoide/epidemiologia , Neoplasias do Colo/epidemiologia , Pólipos do Colo/epidemiologia , Neoplasias do Íleo/epidemiologia , Neoplasias Primárias Múltiplas/epidemiologia , Adenoma Viloso/patologia , Adenoma Viloso/cirurgia , Pólipos Adenomatosos/patologia , Pólipos Adenomatosos/cirurgia , Idoso , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/secundário , Tumor Carcinoide/cirurgia , Causalidade , Neoplasias do Ceco/patologia , Neoplasias do Ceco/cirurgia , Colectomia/métodos , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Colonoscopia , Comorbidade , Predisposição Genética para Doença , Humanos , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/cirurgia , Incidência , Achados Incidentais , Metástase Linfática , Masculino , Gradação de Tumores , Neoplasias Primárias Múltiplas/diagnóstico
20.
Gastrointest Endosc ; 86(4): 666-672, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28257791

RESUMO

BACKGROUND AND AIMS: Eradication of sporadic nonampullary duodenal adenomas (SNADAs) is essential because of their high rate of malignant transformation. EMR techniques are the alternative to the traditional surgical treatments of SNADAs. There are very limited data on the safety and efficacy of cap-assisted EMR (C-EMR) in the treatment of SNADA. METHODS: The medical records of patients who underwent C-EMR for SNADAs between July 2002 and April 2013 were retrospectively reviewed. Eradication was defined as no residual adenoma on follow-up or en bloc resection on pathology. Recurrence was defined as finding adenoma after a negative follow-up. RESULTS: Fifty-nine C-EMR sessions were performed on 49 SNADAs (flat, 46; sessile, 3); 39 polyps were treated in piecemeal fashion and 10 polyps with en bloc resection. The polyp histology was tubular adenoma (63.3%) and tubulovillous adenoma (36.7%), with 16.3% of lesions showing high-grade dysplasia. Initial eradication rate was 90.5%; residual adenomas were successfully treated with repeat C-EMR/snare, resulting in 100% ultimate eradication rate without any recurrences (median follow-up of 17 months). The overall adverse events rate was 16.9%: intraprocedural bleeding (10.2%), delayed GI bleeding (5.1%), and perforation (1.7%). Among large polyps (≥15 mm), the initial and ultimate eradication rates were 87.9% and 100%, respectively, and the adverse event rate was 17%. Initial eradication rate for small polyps was higher than in large polyps (100% vs 87.9%, respectively; P = .02). CONCLUSION: C-EMR is a highly efficient and safe method for the treatment of SNADAs. We recommend that endoscopists should learn C-EMR on esophageal, gastric, rectal, or left-sided colonic lesions before attempting C-EMR in the duodenum.


Assuntos
Adenoma/cirurgia , Neoplasias Duodenais/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Pólipos Intestinais/cirurgia , Adenoma/patologia , Adenoma Viloso/patologia , Adenoma Viloso/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Neoplasias Duodenais/patologia , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Perfuração Intestinal/epidemiologia , Pólipos Intestinais/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Carga Tumoral
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