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1.
Eur J Endocrinol ; 182(3): 313-318, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31940279

RESUMO

Objective: Patients with acromegaly are at increased risk of colorectal polyps. However, their risk of colorectal cancer remains unclear. This study aimed to identify the histopathological features of colorectal polyps in patients with acromegaly and compare their risk of colorectal cancer with that in healthy controls. Methods: The study participants were 178 patients who underwent Hardy's operation and perioperative colonoscopy at our hospital between April 2008 and September 2016. For the control group, we randomly selected 356 age- and sex-matched patients who underwent colonoscopy at our hospital during the same period. The incidence, size, location, and histology of the colorectal polyps detected were compared between the groups. Results: Colorectal polyps were detected in 66.8% of the acromegaly group and 24.2% of the control group (P < 0.001). The average number and size of the polyps were 2.44 and 4.74 mm, respectively, in the acromegaly group and 1.77 and 3.89 mm in the control group (P = 0.001). Polyps in the acromegaly group were more likely to be in the rectosigmoid region (P = 0.006). In the acromegaly group, the frequency of polyps ≥5 mm was 34.3% and that for polyps ≥10 mm was 15.2%; the respective values were 7.6% and 2.2% in the control group (P < 0.001). We found no evidence of between-group histopathological differences in the polyp specimens resected by endoscopy. Conclusions: Patients with acromegaly are at an increased risk of colorectal polyps, especially in the rectosigmoid region. However, there is no pathological evidence that they are at greater risk of colorectal cancer than the general population.


Assuntos
Acromegalia/epidemiologia , Adenocarcinoma/epidemiologia , Pólipos Adenomatosos/epidemiologia , Pólipos do Colo/epidemiologia , Neoplasias Colorretais/epidemiologia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adenoma/epidemiologia , Adenoma/patologia , Adenoma/cirurgia , Pólipos Adenomatosos/patologia , Pólipos Adenomatosos/cirurgia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Colonoscopia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa , Feminino , Humanos , Pólipos Intestinais/epidemiologia , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Retais/epidemiologia , Doenças Retais/patologia , Doenças Retais/cirurgia , Fatores de Risco , Carga Tumoral , Adulto Jovem
2.
Pan Afr Med J ; 33: 300, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31693725

RESUMO

Anal fibroepithelial polyp is a benign tumor rarely reported during pregnancy. We here report a case of giant anal fibroepithelial polyp in a 31-year old multiparous woman. It developed progressively over the previous 3 years. Clinical examination showed firm sessile bud formation, at the anal margin. The patient had normal ongoing pregnancy (31 weeks of amenorrhea). Endoanal examination was normal. Surgical resection was preformed under spinal anesthesia. The specimen measured 21x12x7cm and was covered by the skin. Histological examination showed anal fibroepithelial polyp without signs of malignancy. The postoperative course was uneventful.


Assuntos
Doenças do Ânus/diagnóstico , Pólipos Intestinais/diagnóstico , Complicações na Gravidez/diagnóstico , Adulto , Canal Anal/patologia , Canal Anal/cirurgia , Doenças do Ânus/patologia , Doenças do Ânus/cirurgia , Feminino , Humanos , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Gravidez , Complicações na Gravidez/patologia , Complicações na Gravidez/cirurgia
4.
BMC Gastroenterol ; 19(1): 151, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443637

RESUMO

BACKGROUND: With the development and application of endoscopic technology, most pedunculated polyps can be absolutely resected with a complete specimen by hot snare polypectomy (HSP). Brunner's gland hamartoma (BGH) is a rare benign small bowel tumor. The majority of BGH measuring about 2 cm in diameter, rarely larger than 5 cm. Most patients are asymptomatic, some may present with gastrointestinal hemorrhage or intestinal obstruction. Symptomatic larger lesions leading to bleeding or obstruction should be excised either endoscopically or surgically. Whether it is safe and effective that removing a BGH measuring about 7 cm by HSP is not known. CASE PRESENTATION: Here, we reported a rare case of a proximal duodenum pedunculated mass measuring about 7 cm which was responsible for the patient's severe anemia. we treated it as a pedunculated polyp. After being pretreated the stalk with an endoloop which was placed around the base of the mass to prevent post-polypectomy bleeding (PPB), the pedunculated BGH was removed by HSP completely. The stalk of the mass was negative. We achieved a curative resection. CONCLUSION: It is a safe and effective for our patient to treat the pedunculated BGH measuring about 7 cm as a pedunculated polyp and remove it by HSP. And future prospective studies in larger cohorts are needed to confirm it.


Assuntos
Glândulas Duodenais/patologia , Duodenopatias , Endoscopia/métodos , Hamartoma , Pólipos Intestinais , Dissecação/métodos , Duodenopatias/patologia , Duodenopatias/fisiopatologia , Duodenopatias/cirurgia , Feminino , Hamartoma/patologia , Hamartoma/fisiopatologia , Hamartoma/cirurgia , Humanos , Pólipos Intestinais/patologia , Pólipos Intestinais/fisiopatologia , Pólipos Intestinais/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento , Carga Tumoral
5.
Int J Colorectal Dis ; 34(10): 1801-1803, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31463556

RESUMO

BACKGROUND: Osseous metaplasia of the gastrointestinal tract is exceedingly rare. Associated with colorectal cancer, juvenile polyps , and inflammatory polyps, the exact etiology is still unknown. We present a case report on a young male with recurrent rectal polyps and rectal bleeding. Histopathology revealed an inflammatory polyp with focal osseous metaplasia. CASE PRESENTATION: A 30-year-old male without significant past medical history but with a significant smoking history of 10 pack-years. He initially presented to the colorectal clinic approximately 8 months prior with complaints of rectal pain and bleeding. The patient subsequently underwent colonoscopy which demonstrated a friable 2-cm mass at the dentate line. He was taken to the operating room for a transanal mass excision which, at the time, pathologic examination demonstrated a hyperplastic polyp with no evidence of dysplasia or malignancy. The patient returned to the clinic 8 months later with similar complaints of rectal bleeding. He denied any constitutional symptoms, weight loss, abdominal pain, diarrhea, or constipation. Upon rectal examination, he was noted to have a soft palpable mass blood on digital rectal exam. The patient was taken for repeat colonoscopy and was found to have a recurrent mass at the dentate line. Given the recurrent mass, the patient was taken for a re-excision in the operating room. Histopathology returned showing a 1.8 × 1.5 × 1.5 cm inflammatory polyp with focal osseous metaplasia. CONCLUSION: Osseous metaplasia of the gastrointestinal tract is a rare occurrence that can be associated with benign polyps or malignancy. Certain markers have been shown to be linked to this process and polypectomy remains the gold standard of treatment; however, further research is warranted.


Assuntos
Ossificação Heterotópica/patologia , Reto/patologia , Adulto , Humanos , Pólipos Intestinais/patologia , Masculino , Metaplasia , Recidiva
6.
Acta Gastroenterol Belg ; 82(2): 257-260, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31314185

RESUMO

It has recently been shown that duodenal foveolar gastric metaplasia (FGM) sometimes presents as a polyp. The mechanism by which FGM develops into a polypoid lesion is unknown and it is unclear whether this form of FGM is indistinguishable from other polypoid lesions or whether endoscopists do not recognize it because they are unfamiliar with it. We identified and retrieved archival cases of FGM endoscopically suspicious for adenomatous polyp and examined their pathological, clinical and endoscopic features. Endoscopic features of the 13 identified FGMs presenting as polyps were heterogeneous and overlapping with those of adenomatous polyps. FGM was frequently associated with mucosal and submucosal Brunner's glands, but defining and recognizing hyperplasia of these glands remains difficult. Other pathological features could not explain the development of a polypoid lesion. The endoscopic features of FGM polyps are non-specific, overlapping with those of adenomatous polyps. FGM polyps probably acquire their polypoid aspect due to association with Brunner's gland hyperplasia (BGH), which also arises due to chronic inflammation and damage. Because BGH is ill-defined and difficult to recognize, while FGM is diagnosed easily, this type of polypoid lesions has until now only been recognized based on the presence of FGM, although FGM is most likely a secondary phenomenon and not the primary cause of the polyp.


Assuntos
Glândulas Duodenais/diagnóstico por imagem , Úlcera Duodenal/patologia , Endoscopia do Sistema Digestório , Hamartoma/patologia , Pólipos Intestinais , Metaplasia , Glândulas Duodenais/patologia , Duodenopatias/diagnóstico por imagem , Duodenopatias/patologia , Hamartoma/diagnóstico por imagem , Humanos , Pólipos Intestinais/diagnóstico por imagem , Pólipos Intestinais/patologia , Metaplasia/diagnóstico por imagem , Metaplasia/patologia
7.
Cancer Sci ; 110(8): 2520-2528, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31215118

RESUMO

Iodothyronine deiodinase 2 (DIO2) converts the prohormone thyroxine (T4) to bioactive T3 in peripheral tissues and thereby regulates local thyroid hormone (TH) levels. Although epidemiologic studies suggest the contribution of TH to the progression of colorectal cancer (CRC), the role of DIO2 in CRC remains elusive. Here we show that Dio2 is highly expressed in intestinal polyps of ApcΔ716 mice, a mouse model of familial adenomatous polyposis and early stage sporadic CRC. Laser capture microdissection and in situ hybridization analysis show almost exclusive expression of Dio2 in the stroma of ApcΔ716 polyps in the proximity of the COX-2-positive areas. Treatment with iopanoic acid, a deiodinase inhibitor, or chemical thyroidectomy suppresses tumor formation in ApcΔ716 mice, accompanied by reduced tumor cell proliferation and angiogenesis. Dio2 expression in ApcΔ716 polyps is strongly suppressed by treatment with the COX-2 inhibitor meloxicam. Analysis of The Cancer Genome Atlas data shows upregulation of DIO2 in CRC clinical samples and a close association of its expression pattern with the stromal component, consistently with almost exclusive expression of DIO2 in the stroma of human CRC as revealed by in situ hybridization. These results indicate essential roles of stromal DIO2 and thyroid hormone signaling in promoting the growth of intestinal tumors.


Assuntos
Proliferação de Células/fisiologia , Neoplasias Colorretais/metabolismo , Neoplasias Colorretais/patologia , Iodeto Peroxidase/metabolismo , Polipose Adenomatosa do Colo/tratamento farmacológico , Polipose Adenomatosa do Colo/metabolismo , Polipose Adenomatosa do Colo/patologia , Animais , Proliferação de Células/efeitos dos fármacos , Neoplasias Colorretais/tratamento farmacológico , Ciclo-Oxigenase 2/metabolismo , Inibidores de Ciclo-Oxigenase 2/farmacologia , Modelos Animais de Doenças , Humanos , Pólipos Intestinais/tratamento farmacológico , Pólipos Intestinais/metabolismo , Pólipos Intestinais/patologia , Camundongos , Camundongos Knockout , Neovascularização Patológica/metabolismo , Neovascularização Patológica/patologia , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/fisiologia , Hormônios Tireóideos/metabolismo , Regulação para Cima/efeitos dos fármacos , Regulação para Cima/fisiologia
9.
Virchows Arch ; 475(3): 383-389, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31250201

RESUMO

Gastric hyperplastic polyps are common and generally regarded as benign lesions, whereas gastric adenocarcinomas infrequently occur from gastric hyperplastic polyps. Although gastric hyperplastic polyps have received a lot of attention because of their association with malignant transformation, it remains unclear whether gastric hyperplastic polyps are neoplastic lesions that have sporadic genetic changes similar to colorectal hyperplastic polyps. We performed genome-wide analyses of two gastric adenocarcinomas with hyperplastic polyp components. The interface between "adenocarcinoma" and "hyperplastic polyp" components was fairly sharp, and the adenocarcinoma components had copy number alterations and TP53 mutations, whereas the hyperplastic polyp components had only single nucleotide polymorphisms, which were also found in adenocarcinoma components. We did not detect any somatic changes in the hyperplastic polyp components, even in genome-wide analyses, which was in contrast to the adenocarcinoma components. However, due to the small number of cases examined herein, further genetic analyses of more cases are needed.


Assuntos
Pólipos Adenomatosos/patologia , Pólipos Intestinais/patologia , Neoplasias Gástricas/genética , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Transformação Celular Neoplásica/patologia , Hibridização Genômica Comparativa/métodos , Variações do Número de Cópias de DNA/genética , Feminino , Estudo de Associação Genômica Ampla/métodos , Humanos , Hiperplasia , Polimorfismo de Nucleotídeo Único/genética , Pólipos/patologia , Neoplasias Gástricas/patologia , Proteína Supressora de Tumor p53/genética
11.
Ann R Coll Surg Engl ; 101(8): 558-562, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31233327

RESUMO

BACKGROUND: Polyp assessment is multimodal and is vital prior to endoscopic mucosal resection. The size, morphology, site and access (SMSA) score has been validated in specialist endoscopic institutions. this study investigated the ability of this score to predict incomplete endoscopic resection of large colorectal polyps in a district general hospital. METHODS: Consecutive patients undergoing endoscopic mucosal resection of large (≥ 20 mm) colorectal polyps at Worthing Hospital. Clinical, endoscopic and histological data were taken from prospective databases. The primary outcome of the study was to investigate the correlation of the SMSA score with incomplete endoscopic resection. RESULTS: Between February 2015 and August 2018, 114 patients underwent colorectal endoscopic mucosal resection. Of these, 67 (59%) were male. The median (interquartile range) age of the study population was 72 years (65-78 years). Some 17 lesions (15%) were pedunculated, 76 (67%) were sessile and 21 were (18%) flat; 84 polyps (77%) were located in the left colon/rectum, with the remainder in the right colon; 51 lesions (45%) were 20-30 mm, 27 (24%) were 30-40 mm and 36 (31%) were greater than 40 mm in diameter. When reclassified into the SMSA score, 9 of the polyps (8%) were level 2, 64 (56%) were level 3 and 41 (36%) were level 4. Incomplete resection was clinically diagnosed in 9/114 (8%). The SMSA score was positively correlated with incomplete endoscopic resection, but not with additional procedure usage, complications or advanced histology. CONCLUSIONS: Many patients with large polyps can be managed outside of specialist units. This study has validated that the SMSA score was associated with incomplete endoscopic mucosal resection for large polyps in a district general hospital setting.


Assuntos
Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Pólipos Intestinais/cirurgia , Idoso , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Bases de Dados Factuais , Ressecção Endoscópica de Mucosa/efeitos adversos , Feminino , Hospitais Gerais , Humanos , Pólipos Intestinais/patologia , Masculino , Complicações Pós-Operatórias , Estudos Prospectivos , Índice de Gravidade de Doença
12.
J Clin Pathol ; 72(8): 562-565, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31097491

RESUMO

AIMS: This case series intends to expand currently limited knowledge regarding the existence and diagnostic significance of intramucosal fat in colorectal polyps. METHODS: Clinicopathological features of nine such polyps were reported following histopathological review, including S100 and EMA immunohistochemistry. RESULTS AND CONCLUSIONS: Such review subdivided seven polyps into three groups: (1) mucosal perineurioma/serrated polyps with fat among the perineurial stroma (three cases); (2) submucosal lipomas with adipose tissue extending into the overlying mucosa (two cases) and (3) polyps with intramucosal adipose tissue only, that is, the newly described but less-recognised entity known as intramucosal lipoma (two cases). The two remaining polyps of this series did not include submucosa but, from assessing their muscularis mucosae, were favoured to represent intramucosal lipomas. The first two phenomena are formally described for the first time by this case series. The last of these three diagnoses should prompt investigations for Cowden syndrome, but intramucosal lipomas are more often sporadic/non-syndromic.


Assuntos
Tecido Adiposo/patologia , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Mucosa Intestinal/patologia , Pólipos Intestinais/patologia , Lipoma/patologia , Doenças Retais/patologia , Idoso , Pólipos do Colo/química , Neoplasias Colorretais/química , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Mucosa Intestinal/química , Pólipos Intestinais/química , Lipoma/química , Masculino , Pessoa de Meia-Idade , Mucina-1/análise , Valor Preditivo dos Testes , Doenças Retais/metabolismo , Proteínas S100/análise
13.
Dig Liver Dis ; 51(6): 774-781, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31014942

RESUMO

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) is commonly used to treat early-stage digestive cancer because it results in a higher frequency of en-bloc resection and a lower frequency of local recurrence. However, the efficacy and safety of duodenal ESD remain unclear. Therefore, present study is aimed at evaluating clinical outcomes of duodenal ESD. METHODS: To evaluate the efficacy and safety of duodenal ESD, electronic databases (MEDLINE, CENTRAL and EMBASE) were searched by two independent reviewers. The authors were contacted for additional information. A meta-analysis was performed to evaluate the efficacy and safety of duodenal ESD. RESULTS: A total of 7 studies (203 patients) were included in the quantitative synthesis analysis. The pooled proportions of the frequencies of en-bloc resection, need for surgical intervention, bleeding, intraoperative perforation and delayed perforation were 87%, 4%, 2%, 15% and 2%, respectively. The quality of evidence regarding on surgical intervention outcomes was rated as moderate, whereas that of en-bloc resection was rated as low because of its marked inconsistency. CONCLUSIONS: Duodenal ESD produced acceptable outcomes in terms of the en-bloc R0 resection, but the incidence of procedure-related adverse events is high (PROSPERO register, CRD42017057110).


Assuntos
Duodeno/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Mucosa Intestinal/cirurgia , Pólipos Intestinais/cirurgia , Duodeno/patologia , Humanos , Mucosa Intestinal/patologia , Pólipos Intestinais/patologia , Complicações Pós-Operatórias/etiologia
14.
Int J Surg Pathol ; 27(6): 693-696, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31006344

RESUMO

Myxomas are benign mesenchymal neoplasms of unknown etiology that most commonly occur in the cardiac atrium; however, other reported sites include the skin, joints, skeletal muscles, maxillofacial bones, and sinonasal tract. Myxomas involving the gastrointestinal (GI) tract are rare and are limited to a few published case reports. We are presenting, to our knowledge, the first case report of a mucosal myxoma in the colon presenting as a colonic polyp. A 49-year-old woman underwent a screening colonoscopy and was found to have a 0.2-cm sessile polyp in the cecum. Histologically, the polyp was composed of bland spindled cells in the lamina propria set in a hypocellular, myxoid stroma. The lesion was relatively well-demarcated from the surrounding mucosa. The overlying colonic epithelium showed no dysplasia. S-100 immunohistochemical stain showed only focal nonspecific positivity, while CD34, CD117, SMA, EMA, and desmin were all negative. Alcian blue special stain showed positive staining, supporting the diagnosis of myxoma. Myxomas in the GI tract are very rare, with this being the first reported case of a polypoid colonic mucosal myxoma. Previous reports of GI myxomas are limited to examples in the stomach, small bowel, and one recently reported case in the colon, all of which were submucosal lesions and not limited to the mucosa. In some of the prior reports, the patients had synchronous cardiac atrial myxomas. Mucosal colonic myxoma represents a newly identified mesenchymal polyp of the colon and pathologists should be aware of this diagnostic entity.


Assuntos
Neoplasias do Ceco/diagnóstico , Ceco/patologia , Mucosa Intestinal/patologia , Pólipos Intestinais/diagnóstico , Mixoma/diagnóstico , Biópsia , Neoplasias do Ceco/patologia , Ceco/diagnóstico por imagem , Colonoscopia , Feminino , Humanos , Mucosa Intestinal/diagnóstico por imagem , Pólipos Intestinais/patologia , Programas de Rastreamento , Pessoa de Meia-Idade , Mixoma/patologia
15.
Gastroenterology ; 157(2): 451-461.e2, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30981791

RESUMO

BACKGROUND & AIMS: Endoscopic mucosal resection (EMR) with submucosal injection is an established method for removing colorectal polyps, although the en bloc resection rate decreases when polyp size exceeds 10 mm. Piecemeal resection increases local recurrence. Underwater EMR (UEMR) is an effective technique for removal of sessile colorectal polyps and we investigated whether it is superior to conventional EMR (CEMR). METHODS: We conducted a multicenter randomized controlled trial at 5 institutions in Japan. Patients with endoscopically diagnosed, intermediate-size (10-20 mm) sessile colorectal lesions were randomly assigned to undergo UEMR or CEMR. Only the most proximal lesion was registered. The UEMR procedure included immersion of the entire lumen in water and snare resection of the lesion without submucosal injection of normal saline. We analyzed outcomes of 108 colorectal lesions in the UEMR group and 102 lesions in the CEMR group. R0 resection was defined as en bloc resection with a histologically confirmed negative resection margin. The primary endpoint was the difference in the R0 resection rates between groups. RESULTS: The proportions of R0 resections were 69% (95% confidence interval [CI] 59%-77%) in the UEMR group vs 50% (95% CI 40%-60%) in the CEMR group (P = .011). The proportions of en bloc resections were 89% (95% CI 81%-94%) in the UEMR group vs 75% (95% CI 65%-83%) in the CEMR group (P = .007). There was no significant difference in median procedure time (165 vs 175 seconds) or proportions of patients with adverse events (2.8% in the UEMR group vs 2.0% in the CEMR group). CONCLUSIONS: In a multicenter randomized controlled trial, we found that UEMR significantly increased the proportions of R0 resections for 10- to 20-mm sessile colorectal lesions without increasing adverse events or procedure time. Use of this procedure should be encouraged. Trials registry number: UMIN000018989.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Mucosa Intestinal/patologia , Pólipos Intestinais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Prevenção Secundária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colo/diagnóstico por imagem , Colo/patologia , Colo/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Feminino , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/cirurgia , Pólipos Intestinais/diagnóstico por imagem , Pólipos Intestinais/patologia , Japão , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Reto/diagnóstico por imagem , Reto/patologia , Reto/cirurgia , Resultado do Tratamento , Água
16.
Gastrointest Endosc ; 90(1): 55-63, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30926431

RESUMO

Recent breakthroughs in artificial intelligence (AI), specifically via its emerging sub-field "deep learning," have direct implications for computer-aided detection and diagnosis (CADe and/or CADx) for colonoscopy. AI is expected to have at least 2 major roles in colonoscopy practice-polyp detection (CADe) and polyp characterization (CADx). CADe has the potential to decrease the polyp miss rate, contributing to improving adenoma detection, whereas CADx can improve the accuracy of colorectal polyp optical diagnosis, leading to reduction of unnecessary polypectomy of non-neoplastic lesions, potential implementation of a resect-and-discard paradigm, and proper application of advanced resection techniques. A growing number of medical-engineering researchers are developing both CADe and CADx systems, some of which allow real-time recognition of polyps or in vivo identification of adenomas, with over 90% accuracy. However, the quality of the developed AI systems as well as that of the study designs vary significantly, hence raising some concerns regarding the generalization of the proposed AI systems. Initial studies were conducted in an exploratory or retrospective fashion by using stored images and likely overestimating the results. These drawbacks potentially hinder smooth implementation of this novel technology into colonoscopy practice. The aim of this article is to review both contributions and limitations in recent machine-learning-based CADe and/or CADx colonoscopy studies and propose some principles that should underlie system development and clinical testing.


Assuntos
Adenocarcinoma/diagnóstico , Adenoma/diagnóstico , Inteligência Artificial , Pólipos do Colo/diagnóstico , Colonoscopia , Neoplasias Colorretais/diagnóstico , Diagnóstico por Computador , Adenocarcinoma/patologia , Adenocarcinoma/prevenção & controle , Adenocarcinoma/cirurgia , Adenoma/patologia , Adenoma/cirurgia , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Aprendizado Profundo , Humanos , Pólipos Intestinais/diagnóstico , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Garantia da Qualidade dos Cuidados de Saúde
17.
Histopathology ; 75(1): 81-87, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30825335

RESUMO

AIMS: Sessile serrated lesions (SSL) with dysplasia are uncommon polyps with a high risk of rapid malignant transformation. Most of these lesions have a BRAF mutation and 75% show loss of MLH1 expression in their dysplastic component. Different morphological patterns of dysplasia occurring in these polyps have recently been described. We hypothesised that a subset of SSLs with dysplasia mimicking the dysplasia seen in conventional adenoma (adenomatous dysplasia) may represent a collision lesion between an ordinary SSL and a conventional adenoma. METHODS AND RESULTS: We selected 80 SSLs with dysplasia, including 19 with adenomatous dysplasia, 18 with serrated dysplasia and 43 with dysplasia not otherwise specified (NOS). BRAF mutation analysis was performed using molecular testing (allelic discrimination) and the mutation-specific BRAF-V600E immunohistochemistry (clone VE1). The overall BRAF-V600E mutation rate was 84% in all lesions, 68% in SSLs with adenomatous dysplasia, 89% in SSLs with serrated dysplasia and 88% in SSLs with dysplasia NOS. From the 63 SSLs with dysplasia that were positive for the BRAF-V600E mutation, a negative BRAF-V600E immunostaining was observed in the dysplastic component of 83% of SSLs with adenomatous dysplasia, 0% of SSLs with serrated dysplasia and 3% of SSLs with dysplasia NOS (P < 0.001). CONCLUSIONS: These findings suggest that SSLs with adenomatous dysplasia may not represent advanced SSLs, but instead may be a collision between a non-dysplastic SSL and a conventional adenoma.


Assuntos
Adenoma/genética , Adenoma/patologia , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Pólipos Intestinais/genética , Pólipos Intestinais/patologia , Proteínas Mutantes/genética , Proteínas Proto-Oncogênicas B-raf/genética , Adenoma/metabolismo , Pólipos Adenomatosos/genética , Pólipos Adenomatosos/metabolismo , Pólipos Adenomatosos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Transformação Celular Neoplásica/genética , Transformação Celular Neoplásica/metabolismo , Transformação Celular Neoplásica/patologia , Neoplasias Colorretais/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Pólipos Intestinais/metabolismo , Masculino , Pessoa de Meia-Idade , Proteínas Mutantes/metabolismo , Proteínas Proto-Oncogênicas B-raf/metabolismo , Estudos Retrospectivos
18.
J Gastrointestin Liver Dis ; 28(1): 117-120, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30851180

RESUMO

Gastric heterotopia is defined as the presence of morphologically normal gastric tissue at a non-physiological site, coexisting with the original tissue. Although it is not uncommon to see it in the esophagus, duodenum or small intestine, it is exceptionally rare to discover gastric mucosa in the rectum. Here we report the case of a 46-year old male with a 10-year history of ulcerative colitis in whom the surveillance rectosigmoidoscopy detected a Mayo score of 1 for ulerative colitis activity and a middle rectal sessile polyp. Pathological examination revealed an active chronic colitis, and rectal mucosa with heterotopic gastric mucosa composed of oxyntic glands was depicted. A month later, the patient was reevaluated and endoscopic mucosal resection was performed. Histology confirmed the gastric body type mucosa co-mingling with rectal mucosa.


Assuntos
Coristoma/complicações , Colite Ulcerativa/complicações , Mucosa Gástrica , Mucosa Intestinal/patologia , Pólipos Intestinais/complicações , Doenças Retais/complicações , Anti-Inflamatórios/uso terapêutico , Biópsia , Coristoma/patologia , Coristoma/cirurgia , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/patologia , Ressecção Endoscópica de Mucosa , Humanos , Mucosa Intestinal/cirurgia , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Retais/patologia , Doenças Retais/cirurgia , Resultado do Tratamento
20.
Gastrointest Endosc ; 90(1): 105-111, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30684600

RESUMO

BACKGROUND AND AIMS: Cold snare polypectomy (CSP) and jumbo forceps polypectomy (JFP) have been shown to be effective for removing diminutive colorectal polyps (DCPs) (≤5 mm). However, no study has compared complete resection rates between CSP and JFP for DCPs. The aim of this study was to compare the efficacy and safety of JFP with CSP for the removal of DCPs. METHODS: This was a prospective randomized controlled trial from 2 tertiary-care referral centers. A total of 1003 patients were screened, and 169 patients with 196 DCPs were enrolled. The main outcome was complete polyp resection rate. RESULTS: Of 196 diminutive polyps, 177 (90.3%) were adenomatous polyps. The overall complete resection rate was 92.1% (163/177). The complete resection rate was not significantly different between JFP and CSP groups (92.0% vs 92.2%; P = .947). JFP achieved complete resection rates comparable with CSP for polyps >3 mm (90.3% vs 89.8%; P = .928). Polypectomy procedure time, tissue retrieval rate, and rate of postpolypectomy adverse events were not significantly different between the 2 groups. CONCLUSIONS: Both JFP and CSP achieved complete resection rates of >90% for DCPs. Thus, JFP may be considered for polypectomy of DCPs. (International clinical trial registry number: KCT0002805.).


Assuntos
Pólipos Adenomatosos/cirurgia , Pólipos do Colo/cirurgia , Colonoscopia/instrumentação , Neoplasias Colorretais/cirurgia , Pólipos Adenomatosos/patologia , Idoso , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Feminino , Humanos , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Instrumentos Cirúrgicos , Resultado do Tratamento , Carga Tumoral
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