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2.
Cochrane Database Syst Rev ; 12: CD007245, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33348436

RESUMO

BACKGROUND: Adjuvant tamoxifen reduces the risk of breast cancer recurrence in women with oestrogen receptor-positive breast cancer. Tamoxifen also increases the risk of postmenopausal bleeding, endometrial polyps, hyperplasia, and endometrial cancer. The levonorgestrel-releasing intrauterine system (LNG-IUS) causes profound endometrial suppression. This systematic review considered the evidence that the LNG-IUS prevents the development of endometrial pathology in women taking tamoxifen as adjuvant endocrine therapy for breast cancer. OBJECTIVES: To determine the effectiveness and safety of the levonorgestrel intrauterine system (LNG-IUS) in pre- and postmenopausal women taking adjuvant tamoxifen following breast cancer for the outcomes of endometrial and uterine pathology including abnormal vaginal bleeding or spotting, and secondary breast cancer events. SEARCH METHODS: We searched the following databases on 29 June 2020; The Cochrane Gynaecology and Fertility Group specialised register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature. We searched the Cochrane Breast Cancer Group specialised register on 4 March 2020. We also searched two trials registers, checked references for relevant trials and contacted study authors and experts in the field to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of women with breast cancer on adjuvant tamoxifen that compared the effectiveness of the LNG-IUS with endometrial surveillance versus endometrial surveillance alone on the incidence of endometrial pathology. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane. The primary outcome measure was endometrial pathology (including polyps, endometrial hyperplasia, or endometrial cancer), diagnosed at hysteroscopy or endometrial biopsy. Secondary outcome measures included fibroids, abnormal vaginal bleeding or spotting, breast cancer recurrence, and breast cancer-related deaths. We rated the overall certainty of evidence using GRADE methods. MAIN RESULTS: We included four RCTs (543 women analysed) in this review. We judged the certainty of the evidence to be moderate for all of the outcomes, due to imprecision (i.e. limited sample sizes and low event rates). In the included studies, the active treatment arm was the 20 µg/day LNG-IUS plus endometrial surveillance; the control arm was endometrial surveillance alone. In tamoxifen users, the LNG-IUS probably reduces the incidence of endometrial polyps compared to the control group over both a 12-month period (Peto odds ratio (OR) 0.22, 95% confidence interval (CI) 0.08 to 0.64, I² = 0%; 2 RCTs, n = 212; moderate-certainty evidence) and over a long-term follow-up period (24 to 60 months) (Peto OR 0.22, 95% CI 0.13 to 0.39; I² = 0%; 4 RCTs, n = 417; moderate-certainty evidence). For long-term follow-up, this suggests that if the incidence of endometrial polyps following endometrial surveillance alone is assumed to be 23.5%, the incidence following LNG-IUS with endometrial surveillance would be between 3.8% and 10.7%.  The LNG-IUS probably slightly reduces the incidence of endometrial hyperplasia compared with controls over a long-term follow-up period (24 to 60 months) (Peto OR 0.13, 95% CI 0.03 to 0.67; I² = 0%; 4 RCTs, n = 417; moderate-certainty evidence). This suggests that if the chance of endometrial hyperplasia following endometrial surveillance alone is assumed to be 2.8%, the chance following LNG-IUS with endometrial surveillance would be between 0.1% and 1.9%. However, it should be noted that there were only six cases of endometrial hyperplasia. There was insufficient evidence to reach a conclusion regarding the incidence of endometrial cancer in tamoxifen users, as no studies reported cases of endometrial cancer. At 12 months of follow-up, the LNG-IUS probably increases abnormal vaginal bleeding or spotting compared to the control group (Peto OR 7.26, 95% CI 3.37 to 15.66; I² = 0%; 3 RCTs, n = 376; moderate-certainty evidence). This suggests that if the chance of abnormal vaginal bleeding or spotting following endometrial surveillance alone is assumed to be 1.7%, the chance following LNG-IUS with endometrial surveillance would be between 5.6% and 21.5%. By 24 months of follow-up, abnormal vaginal bleeding or spotting occurs less frequently than at 12 months of follow-up, but is still more common in the LNG-IUS group than the control group (Peto OR 2.72, 95% CI 1.04 to 7.10; I² = 0%; 2 RCTs, n = 233; moderate-certainty evidence). This suggests that if the chance of abnormal vaginal bleeding or spotting following endometrial surveillance alone is assumed to be 4.2%, the chance following LNG-IUS with endometrial surveillance would be between 4.4% and 23.9%. By 60 months of follow-up, there were no cases of abnormal vaginal bleeding or spotting in either group. The numbers of events for the following outcomes were low: fibroids (n = 13), breast cancer recurrence (n = 18), and breast cancer-related deaths (n = 16). As a result, there is probably little or no difference in these outcomes between the LNG-IUS treatment group and the control group.  AUTHORS' CONCLUSIONS: The LNG-IUS probably slightly reduces the incidence of benign endometrial polyps and endometrial hyperplasia in women with breast cancer taking tamoxifen. At 12 and 24 months of follow-up, the LNG-IUS probably increases abnormal vaginal bleeding or spotting among women in the treatment group compared to those in the control. Data were lacking on whether the LNG-IUS prevents endometrial cancer in these women. There is no clear evidence from the available RCTs that the LNG-IUS affects the risk of breast cancer recurrence or breast cancer-related deaths. Larger studies are necessary to assess the effects of the LNG-IUS on the incidence of endometrial cancer, and to determine whether the LNG-IUS might have an impact on the risk of secondary breast cancer events.


Assuntos
Neoplasias da Mama/prevenção & controle , Hiperplasia Endometrial/prevenção & controle , Neoplasias do Endométrio/prevenção & controle , Dispositivos Intrauterinos Medicados , Levanogestrel/administração & dosagem , Recidiva Local de Neoplasia/prevenção & controle , Adenocarcinoma/induzido quimicamente , Adenocarcinoma/prevenção & controle , Antineoplásicos Hormonais/efeitos adversos , Neoplasias da Mama/química , Neoplasias da Mama/mortalidade , Quimioterapia Adjuvante , Intervalos de Confiança , Anticoncepcionais Femininos/administração & dosagem , Hiperplasia Endometrial/induzido quimicamente , Hiperplasia Endometrial/epidemiologia , Neoplasias do Endométrio/induzido quimicamente , Neoplasias do Endométrio/epidemiologia , Feminino , Humanos , Levanogestrel/efeitos adversos , Recidiva Local de Neoplasia/mortalidade , Pólipos/induzido quimicamente , Pólipos/epidemiologia , Pólipos/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Tamoxifeno/efeitos adversos , Hemorragia Uterina/induzido quimicamente , Hemorragia Uterina/epidemiologia , Útero/efeitos dos fármacos
3.
Wiad Lek ; 73(9 cz. 2): 2004-2009, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33148849

RESUMO

OBJECTIVE: The aim: To conduct a comparative analysis of the results of ultrasound and hysteroscopic examinations with further histopathological findings and the clinical and anamnestic features of patients with hyperproliferative pathology in order to determine the etiopathogenetic mechanisms of the development of endometrial pathological processes. PATIENTS AND METHODS: Materials and methods: We studied 119 medical records of patients of the Gynecological Department of Minipal Non-Commercial Enterprise "Ternopil Municipal City Hospital No. 2", who applied for medical assistance because of benign endometrial hyperplasia in the reproductive age with a verified diagnosis of "uterine polyp" during 2017-2018. The control group consisted of 30 patients of the same age group, with menstrual disorders with no signs of hyperplastic processes of endometrium. With the consent of the patients, they were treated with diagnostic hysteroscopy in order to study evacuated material from the uterus. The results of the histological study confirmed the absence of signs of hyperplastic processes of endometrium. The results of diagnostic methods were evaluated by comparing the material's histological data with the results of ultrasound and hysteroresectoscopy. RESULTS: Results: Taking into account the results of our research, women with hyperplastic processes of endometrium have the risk of the pathology of the nervous system is in 2.71 times higher (OR=2.71, CI-0.88: 8.33), cardiovascular pathology-in 2.04 (OR=2.04, CI-0.57:7.34), vascular diseases of the lower extremities-in 1.81 times (OR=1.81, CI-0.21:15.32) compared with the control group. While the risk of pathology of the urinary system and organs of vision is only-OR=0.48, CI-0.11:2.03 and OR=0.75, CI-0.08:7.48, respectively. Analyzing the results of the study using ultrasound examination, it was found that endometrial polyposis in combination with uterine leiomyoma was not detected in 3 women (15%), while all the results of hysteroscopy were confirmed by histopathological studies. When the endometrial hyperplastic processes were combined with adenomyosis- according to ultrasound examination a false positive result was obtained in 2 patients (13.3%), and in a hysteroscopic study we determined -1 false positive result. In patients the diagnosis of "endometrial polyp" according to the results of hysteroscopy was not confirmed in 2 women (2 false positive results 2.99%) and in 5 cases of ultrasound examination (5 false negative results 7.46%). The use of ultrasound examinations in patients with endometrial hyperplastic changes, according to our data, made it possible to identify pathology in 88.39% of cases, while the information content of the hysteroscopy was 98.21% (p<0.001). CONCLUSION: Conclusions: Thus, the results of the subjective examination of patients in the gynecological department: complaints, anamnestic data on gynecological and extragenital pathology should be used to identify etiopathogenetic factors and the formation of risk groups for the occurrence of hyperplastic processes of endometrium. Women with cervical erosion, uterine myoma and episodes of herpetic rash on the mucous membranes in past medical history have a higher likelihood of hyperplastic processes of endometrium. The vast majority of patients (63.87%) with polyps of the body of the uterus have a combined hyperproliferative pathology, which requires an individual approach to planning the scope of diagnostic examination and the choice of treatment method. Visualization of endometrium with hysteroscopy is more informative than ultrasound for diagnosing hyperproliferative processes, including uterine polyps. Hysteroscopic polypectomy has a high level of both clinical and economic benefits as well as diagnostic value in patients with hyperplastic processes of endometrium.


Assuntos
Leiomioma , Pólipos , Doenças Uterinas , Endométrio/diagnóstico por imagem , Endométrio/patologia , Feminino , Humanos , Histeroscopia , Leiomioma/patologia , Pólipos/diagnóstico por imagem , Pólipos/patologia , Gravidez , Doenças Uterinas/diagnóstico por imagem
4.
Surg Clin North Am ; 100(6): 1049-1067, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128879

RESUMO

Polyps in the upper and lower gastrointestinal tract can be premalignant or malignant lesions that can be treated endoscopically in early stages to prevent morbidity and more invasive procedures. This article critically reviews the techniques available and provides recommendations for endoscopic polypectomy.


Assuntos
Endoscopia Gastrointestinal/métodos , Endoscopia Gastrointestinal/normas , Neoplasias Gastrointestinais/cirurgia , Pólipos/cirurgia , Endoscopia Gastrointestinal/instrumentação , Neoplasias Gastrointestinais/diagnóstico , Trato Gastrointestinal/anatomia & histologia , Trato Gastrointestinal/cirurgia , Humanos , Assistência Perioperatória/normas , Pólipos/diagnóstico , Guias de Prática Clínica como Assunto/normas
5.
Niger J Clin Pract ; 23(10): 1339-1344, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047689

RESUMO

Backround: Ultrasonography is difficult to distinguish between endometrial pathologies and often requires curettage. ARFI (Acoustic Radiation Force-Based Elasticity Imaging) is a new ultrasonography elastography method. Using ARFI, it is possible to obtain information about the likelihood of the tissue benign or malignant. Aim: The aim of this study is to evaluate the contribution of ARFI to differentiate endometrial pathologies in hysterectomy specimens. Subjects and Methods: Our study was prospectively, January-May 2017, performed in randomly 45 cases of 41-91 years of age (mean 58.3 years) who have decided to have hysterectomy. Hysterectomy was performed for uterine prolapse and endometrial hyperplasia in elderly patients and menorrhagia in young patients. Pathology results were compared with ARFI values and endometrial thickness. ANNOVA test was used for the comparison of ARFI values. Results: Pathology revealed 14 cases of endometrial atrophy, 11 cases of proliferative phase, 10 cases of polyp, 6 cases of endometrial hyperplasia, and 4 cases of endometrium cancer. There is a statistically significant difference between mean ARFI values of endometrium, subendometrium, and myometrium of the groups (P < 0.05). There was a statistically significant difference between the mean endometrial thickness of the groups (P < 0.05). Conclusion: Endometrium ARFI contributes to the differential diagnosis of endometrial pathologies. Subendometrial and myometrial ARFI values decrease in polyps and increase in hyperplasia. Our study shows that the addition of subendometrium ARFI to gray-scale sonography before deciding on invasive procedures in endometrial pathologies may improve diagnostic accuracy. We concluded that further in vivo studies will establish the usefulness of this technique for preoperative diagnostic measures.


Assuntos
Hiperplasia Endometrial/cirurgia , Endométrio/diagnóstico por imagem , Histerectomia , Menorragia/cirurgia , Prolapso Uterino/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Imagem por Elasticidade/métodos , Hiperplasia Endometrial/patologia , Neoplasias do Endométrio , Feminino , Humanos , Menorragia/patologia , Pessoa de Meia-Idade , Pólipos/patologia , Ultrassonografia/métodos , Prolapso Uterino/patologia
6.
PLoS One ; 15(10): e0241230, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33095843

RESUMO

Optical coherence tomography angiography (OCTA) is a novel, non-invasive imaging tool used to detect vascular flow. The absence of a flow signal in OCTA in polyps revealed by indocyanine green angiography (ICGA) in patients with polypoidal choroidal vasculopathy (PCV) may indicate slow or compromised filling of blood flow from choroidal vessels. Naïve patients with PCV treated with intravitreal injections of aflibercept (IVI-A) were enrolled in this study to validate the hypothesis that baseline flow may affect the outcome of polyp regression in ICGA. The flow signal of polyps in OCTA was detected by manual segmentation in the corresponding location by ICGA. Polyps were defined as high-flow if both OCTA and ICGA showed positive findings, and low-flow if OCTA showed a negative flow signal in 3 consecutive horizontal scans at the polyp area shown in ICGA. A total of 24 polyps were identified in 13 PCV patients at baseline. Of these 24 polyps, 22 (91.7%) were high-flow and 2 (8.3%) were low-flow. After 3 monthly IVI-A, all low-flow polyps had complete regression in ICGA. Among 17 (77%) high-flow polyps at baseline that had regression after treatment, 10 (58.8%) became low-flow, while 5 (22.7%) persistent polyps remained high-flow. Flow signal of polyps as detected by OCTA could be a predictive factor for treatment response in patients with PCV. Monitoring changes in flow signal after treatment is clinically relevant.


Assuntos
Pólipos/tratamento farmacológico , Fluxo Sanguíneo Regional , Processamento de Sinais Assistido por Computador , Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/tratamento farmacológico , Feminino , Angiofluoresceinografia , Humanos , Verde de Indocianina , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Pólipos/diagnóstico por imagem , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/administração & dosagem , Proteínas Recombinantes de Fusão/farmacologia , Proteínas Recombinantes de Fusão/uso terapêutico , Fluxo Sanguíneo Regional/efeitos dos fármacos , Tomografia de Coerência Óptica , Resultado do Tratamento , Fatores de Crescimento do Endotélio Vascular/metabolismo
8.
PLoS One ; 15(10): e0240882, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33079974

RESUMO

The optimal timing of frozen-thawed blastocyst transfer following hysteroscopic polypectomy is an important and unanswered clinical question. In this study, we conducted a retrospective survey of cases from an infertility center at an academic hospital. We reviewed the charts of all patients who received in-vitro fertilization and frozen-thawed blastocyst transfers (FBT) at the center from January 2009 to November 2019. One hundred and two patients with prior diagnosis of endometrial polyp that were treated with hysteroscopic polypectomy before received their first FBT at the center were identified as cases. Patients without prior diagnosis of endometrial polyp, and who received their first FBT at the center were defined as controls. Controls were enrolled at a 1-to-1 ratio to the cases. The cases and controls did not show differences in baseline characteristics, endometrial thickness, or the number of good blastocysts transferred. The clinical pregnancy rates and live birth rates were similar. Regarding the optimal interval between polypectomy and FBT, a cut-off of 120 days was identified from the ROC curve. A stratified analysis showed that when FBT was performed within an interval of 120 days after polypectomy, there were higher biochemical pregnancy rates (73.2%, 45.2%; OR 3.3; P = .007) and clinical pregnancy rates (64.8%, 41.9%; OR 2.54; P = .032), when compared with intervals greater than 120 days. There were no significant differences in implantation and live birth rates. In conclusion, pregnancy rates following FBT in patients who had received prior endometrial polypectomy were comparable to pregnancy rates after FBT in patients without endometrial polyp. Subgroup analysis showed that an interval greater than 120 days between hysteroscopic polypectomy and FBT was associated with decreased pregnancy rates. Patients who wish to receive embryo transfer after polypectomy should wait no longer than 120 days.


Assuntos
Transferência Embrionária/métodos , Endométrio/cirurgia , Histeroscopia/métodos , Pólipos/cirurgia , Adulto , Estudos de Casos e Controles , Feminino , Congelamento , Humanos , Nascimento Vivo/epidemiologia , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Fatores de Tempo
9.
Wiad Lek ; 73(8): 1600-1604, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33055318

RESUMO

OBJECTIVE: The aim of the study was to analyze the level of Ig M- and Ig G-antibody (Ab) for cytomegalovirus (CMV) and herpes simplex virus type 2 (HSV-2) in serum of women with non-atypical endometrial hyperproliferative pathology. PATIENTS AND METHODS: Materials and methods: The analysis of immunoglobulin indices to CMV and HSV-2 in serum of women with non-atypical endometrial hyperproliferative pathology. In women with uterine body polyps the presence of CMV in the uterine cavity was found in 54.8% of cases, in women with non-atypical endometrial hyperplasia in 38.3% of cases. The levels of Ig G-Ab and Ig M-Ab to CMV in serum have a clear dependence on the degree of antigen expression in endometrial tissue. HSV-2 antigens were determined in 22.58 ± 5.31% of women with uterine body polyps and in 8.33 ± 3.57% of patients with non-atypical endometrial hyperplasia while increasing serum specific antibodies to HSV-2. RESULTS: Results: The results indicate that there is a clear link between viral infection of hyperproliferatively altered endometrium and the determination of positive immunoglobulin levels in peripheral blood, which may be a reliable marker of chronic persistent viral infection in a woman's body. CONCLUSION: Conclusions: In women with uterine body polyps, the presence of CMV in the uterine cavity was found in 54.84 ± 6.32% of cases, in women with non-atypical endometrial hyperplasia in 38.33 ± 6.28% of cases. The levels of Ig G-Ab and and Ig M-Ab to CMV in serum have a clear dependence on the degree of antigen expression in endometrial tissue. HSV-2 antigens were determined in 22.58 ± 5.31% of women with uterine body polyps and in 8.33 ± 3.57% of patients with non-atypical endometrial hyperplasia while increasing serum specific antibodies to HSV-2. The results indicate that there is a clear link between viral infection of the target tissue (hyperproliferatively altered endometrium) and the determination of a positive level of peripheral blood immunoglobulin, which may be a reliable marker of chronic persistent viral infection in a woman.


Assuntos
Infecções por Citomegalovirus , Herpes Genital , Pólipos , Endométrio , Feminino , Humanos , Soro
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2412-2415, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018493

RESUMO

Polyps, represented as abnormal protuberances along intestinal track, are the main biomarker to diagnose gastrointestinal cancer. During routine colonoscopies such polyps are localized and coarsely characterized according to microvascular and surface textural patterns. Narrow-band imaging (NBI) sequences have emerged as complementary technique to enhance description of suspicious mucosa surfaces according to blood vessels architectures. Nevertheless, a high number of misleading polyp characterization, together with expert dependency during evaluation, reduce the possibility of effective disease treatments. Additionally, challenges during colonoscopy, such as abrupt camera motions, changes of intensity and artifacts, difficult the diagnosis task. This work introduces a robust frame-level convolutional strategy with the capability to characterize and predict hyperplastic, adenomas and serrated polyps over NBI sequences. The proposed strategy was evaluated over a total of 76 videos achieving an average accuracy of 90,79% to distinguish among these three classes. Remarkably, the approach achieves a 100% of accuracy to differentiate intermediate serrated polyps, whose evaluation is challenging even for expert gastroenterologist. The approach was also favorable to support polyp resection decisions, achieving perfect score on evaluated dataset.Clinical relevance- The proposed approach supports observable hystological characterization of polyps during a routine colonoscopy avoiding misclassification of potential masses that could evolve in cancer.


Assuntos
Gastroenterologistas , Pólipos , Colonoscopia , Humanos , Hiperplasia , Imagem de Banda Estreita , Pólipos/diagnóstico por imagem
11.
Medicine (Baltimore) ; 99(43): e22903, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120842

RESUMO

Laparoscopic cholecystectomy is the routine method to treat gallbladder polyps. Nowadays, endoscopic ultrasound (EUS)-guided cholecystostomy as a bridge for per-oral transmural endoscopic resection of gallbladder polyps is introduced because preservation of gallbladder is increasingly getting attention. The aim of our study was to evaluate the approach in the treatment of patients with gallbladder polyps and symptomatic gallstones.EUS-guided cholecystostomy with the placement of a lumen-apposing metal stent (LAMS) was performed for those patients with accompanying gallbladder polyps and symptomatic gallstones. Several days after the cholecystostomy with LAMS, a gastroscope was introduced into the gallbladder to remove gallbladder polyps.All patients were successfully performed with the procedures of EUS-guided cholecystoduodenostomy (n = 3) or cholecystogastrostomy (n = 1) and endoscopic resection of gallbladder polyps. One patient experienced severe peritonitis. During the follow-up at 3 months, 1 patient was performed with laparoscopic cholecystectomy because ultrasonography examination showed the reappeared gallstones. No stone recurrence was found in other patients. During the follow-up of 3 to 15 months, no polyp recurrence was found in all the patients.The approach is novel for performing EUS-guided gallbladder fistulization, which can subsequently allow procedures of per-oral transmural endoscopic resection of gallbladder polyps to avoid cholecystectomy in the patients with gallbladder polyps and gallstones. However, further studies are needed before clinical recommendation because of the complications and stone recurrence.


Assuntos
Colecistostomia/métodos , Endossonografia/métodos , Vesícula Biliar/diagnóstico por imagem , Pólipos/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Duodenostomia/métodos , Feminino , Seguimentos , Vesícula Biliar/patologia , Cálculos Biliares/cirurgia , Gastrostomia/métodos , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Ultrassonografia de Intervenção/instrumentação
12.
PLoS One ; 15(9): e0237979, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915805

RESUMO

BACKGROUND: Different perspectives exist regarding the clinicopathologic characteristics, biology and management of gallbladder polyps. Size is often used as the surrogate evidence of polyp behavior and size of ≥1cm is widely used as cholecystectomy indication. Most studies on this issue are based on the pathologic correlation of polyps clinically selected for resection, whereas, the data regarding the nature of polypoid lesions from pathology perspective -regardless of the cholecystectomy indication- is highly limited. METHODS: In this study, 4231 gallbladders -606 of which had gallbladder carcinoma- were reviewed carefully pathologically by the authors for polyps (defined as ≥2 mm). Separately, the cases that were diagnosed as "gallbladder polyps" in the surgical pathology databases were retrieved. RESULTS: 643 polyps identified accordingly were re-evaluated histopathologically. Mean age of all patients was 55 years (range: 20-94); mean polyp size was 9 mm. Among these 643 polyps, 223 (34.6%) were neoplastic: I. Non-neoplastic polyps (n = 420; 65.4%) were smaller (mean: 4.1 mm), occurred in younger patients (mean: 52 years). This group consisted of fibromyoglandular polyps (n = 196) per the updated classification, cholesterol polyps (n = 166), polypoid pyloric gland metaplasia (n = 41) and inflammatory polyps (n = 17). II. Neoplastic polyps were larger (mean: 21 mm), detected in older patients (mean: 61 years) and consisted of intra-cholecystic neoplasms (WHO's "adenomas" and "intracholecystic papillary neoplasms", ≥1 cm; n = 120), their "incipient" version (<1 cm) (n = 44), polypoid invasive carcinomas (n = 26) and non-neoplastic polyps with incidental dysplastic changes (n = 33). In terms of size cut-off correlations, overall, only 27% of polyps were ≥1 cm, 90% of which were neoplastic. All (except for one) ≥2 cm were neoplastic. However, 14% of polyps <1 cm were also neoplastic. Positive predictive value of ≥1 cm cut-off -which is widely used for cholecystectomy indication-, was 94.3% and negative predictive value was 85%. CONCLUSIONS: Approximately a third of polypoid lesions in the cholecystectomies (regardless of the indication) prove to be neoplastic. The vast majority of (90%) of polyps ≥1 cm and virtually all of those ≥2 cm are neoplastic confirming the current impression that polyps ≥1 cm ought to be removed. However, this study also illustrates that 30% of the neoplastic polyps are <1 cm and therefore small polyps should also be closely watched, especially in older patients.


Assuntos
Neoplasias da Vesícula Biliar/patologia , Vesícula Biliar/patologia , Pólipos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Bases de Dados Factuais , Humanos , Pessoa de Meia-Idade , Curva ROC , Adulto Jovem
13.
Vestn Otorinolaringol ; 85(4): 77-79, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32885642

RESUMO

Hairy polyp is a rare congenital anomaly, pharynx mass, that causes respiratory and swallowing disorders, and sometimes threatens child's life. A 6 mounths old girl with this pathology was examined and surgically treated at the Department of Otorhinolaryngology, Pediatric Faculty, N.I. Pirogov Russian National Research Medical University. Epipharingoscopy and computed tomography (CT scan) were used during diagnosis. The surgery was performed under endotracheal anesthesia using ERBE VIO electrosurgical complex.


Assuntos
Transtornos de Deglutição , Otolaringologia , Pólipos , Criança , Feminino , Humanos , Lactente , Federação Russa , Tomografia Computadorizada por Raios X
14.
Artigo em Chinês | MEDLINE | ID: mdl-32911888

RESUMO

Objective: To explore and analyze the clinical characteristics, diagnosis and treatment of infant hairy polyp. Methods: A retrospective analysis was made on 13 cases of hairy polyp confirmed by pathology, who were admitted to the Children's Hospital of Hebei Province from January 2010 to September 2019, including 4 males and 9 females, with a male-female ratio of 1∶2.25. The age ranged from 3 hours to 1 year, and the median age was 1 month. Twelve of the 13 children were found to have difficulty breathing or feeding. All the children received coblation resection under general anesthesia. The root pedicle of the mass was found in the lateral nasopharyngeal wall in 8 cases, in the junction of palatine and palatopharyngeal arch of tonsil and the tongue and esophageal entrance in 1 case, respectively. Nasal septum was found in 2 cases, including 1 case located between two incisors. The wound at the root pedicle was ablated and the bleeding was stopped completely. Results: Postoperative follow-up lasted from 3 months to 2 years, and there was no recurrence in 12 cases. Fibrolaryngoscope showed a mass of the right eustachian tube and pharyngeal mouth in 1 case 2 years after the surgery, which was considered recurrence of hairy polyps and lost after that. Conclusion: Hairy polyps in infants is a rare clinical disease, and its main symptom is upper respiratory tract obstruction. Early diagnosis and radical surgery are the key to the treatment of the disease.


Assuntos
Pólipos , Tuba Auditiva/patologia , Feminino , Humanos , Lactente , Masculino , Nasofaringe/patologia , Faringe/patologia , Pólipos/diagnóstico , Pólipos/patologia , Pólipos/cirurgia , Estudos Retrospectivos
15.
Hinyokika Kiyo ; 66(9): 303-306, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32988167

RESUMO

A 56-year-old woman presented with left flank pain. Computed tomography revealed hydronephrosis and a 35 mm mass in the left renal pelvis. Ureteroscopy revealed a white elevated lesion in the left renal pelvis. Tissue biopsy was performed and the histological findings showed no evidence of malignancy. Urine cytology was class III. Based on these results, we could not completely rule out malignancy. Left retroperitoneoscopic nephroureterectomy was performed and a pedunculated white mass was found in the renal pelvis. The pathological diagnosis was a fibroepithelial polyp of the renal pelvis. Fibroepithelial polyps in the urinary tract are relatively rare, and those in the renal pelvis even more so. When the preoperative diagnosis shows no malignant findings, fibroepithelial polyps should be considered as a differential diagnosis.


Assuntos
Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Pólipos/diagnóstico por imagem , Pólipos/diagnóstico , Pólipos/cirurgia , Neoplasias Cutâneas , Feminino , Humanos , Pelve Renal/diagnóstico por imagem , Pelve Renal/cirurgia , Pessoa de Meia-Idade , Ureteroscopia
16.
Womens Health (Lond) ; 16: 1745506520952003, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833600

RESUMO

Administration of Dienogest prior to hysteroscopic polypectomy is empirically performed, but the physiological effects of Dienogest on endometrial polyps are unclear. We aimed to investigate the effects of Dienogest on the proliferation and inflammation of endometrial polyps. We conducted a retrospective case study on 40 menstruating women who underwent hysteroscopic polypectomy at our hospital. We collected clinical data, and the polyps were divided by morphological appearance. The specimens obtained were immunostained for Ki67 as a marker of cellar proliferation and CD138 as a marker of plasmacytes, which are a hallmark of chronic endometritis. Dienogest significantly suppressed the proliferation status of EPs because Dienogest treatment prior to the operation significantly reduced the Ki67 index (41.25 ± 16.85 vs 7.18 ± 9.82, p < 0.01). We found that sessile-type polyps showed a significantly lower Ki67 index than the pedunculated type (12.28 ± 11.12 vs 2.09 ± 2.73, p = 0.026). The presence of CD138-positive cells was more pronounced in sessile-type polyps than in pedunculated polyps (p = 0.018). However, Dienogest treatment showed no apparent effect on inflammation status, as detected by CD138-positive cells. We revealed that Dienogest suppressed cellular proliferation, and morphological classification of endometrial polyps could be used to predict the responsiveness to Dienogest. However, Dienogest might not affect cellular inflammation.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Proliferação de Células/efeitos dos fármacos , Endométrio/efeitos dos fármacos , Nandrolona/análogos & derivados , Pólipos/tratamento farmacológico , Adulto , Endométrio/patologia , Feminino , Humanos , Histeroscopia , Pessoa de Meia-Idade , Nandrolona/uso terapêutico , Estudos Retrospectivos , Doenças Uterinas/patologia
17.
Artigo em Chinês | MEDLINE | ID: mdl-32791777

RESUMO

Objective: To investigate whether laryngopharyngeal reflux(LPR) is an independent risk factor for vocal fold polyps and to analyze the potential mechanism. Methods: Case control survey was designed. Subjects who came to the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Chongqing Medical University from September 2018 to December 2019, including 152 cases with vocal fold polyps and 176 cases with normal vocal folds, were selected. All the subjects filled in a questionnaire and were assessed by the reflux symptom index (RSI) and the reflux finding score (RFS) scale. RSI>13 and(or) RFS>7 were classified as LPR. Chi-square test, univariate and multivariate unconditional logistic regression models were used for statistical analysis. Results: The incidence of LPR and throat clearing in vocal fold polyps group (47.37%, 73.68%) was significantly higher than that in control group (27.27%, 59.09%), with statistically significant difference (P<0.001, P=0.005, respectively). The incidence of troublesome cough, indigestion or stomach acid coming up was no difference between the two groups(P=0.672, P=0.099). Multivariate unconditional logistic regression analysis showed that LPR (OR=1.815, 95%CI:1.061-3.103), occupational exposure(OR=2.655, 95%CI:1.397-5.042), spicy food(OR=1.958, 95%CI:1.142-3.355) were risk factors for vocal fold polyps. Conclusion: LPR, occupational exposure, spicy food are independent risk factors for vocal fold polyps. Frequent throat clearing caused by LPR may be the main cause of vocal ford polyps. In order to prevent vocal fold polyps, we need to take action to treat laryngopharyngeal reflux disease actively.


Assuntos
Doenças da Laringe , Refluxo Laringofaríngeo , Pólipos , Prega Vocal/patologia , Estudos de Casos e Controles , Humanos , Doenças da Laringe/etiologia , Doenças da Laringe/patologia , Refluxo Laringofaríngeo/complicações , Pólipos/patologia , Fatores de Risco , Inquéritos e Questionários
18.
Ceska Gynekol ; 85(2): 84-93, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32527101

RESUMO

OBJECTIVE: The aim of our study was to analyze a group of patients referred for endometrial biopsy. To evaluate the ultrasound finding of hyperplasia/polyp, the symptomatology of patients related to the result of definitive histology, to determine the severity of individual variables in connection with the detection of precancerosis/cancer. Due to the complexity of information identify women who are suitable for conservative approach. DESIGN: Unicentric retrospective observational study. SETTING: Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno. METHODS: All patients over 50 years who underwent surgical endometrial biopsy at our department in the period of 2017-2018 (n = 754) were included. We were interested in reasons of indication, the age of patients at the time of the procedure and at the menopause, the presence of risk factors for development precancerosis/cancer (hypertension, diabetes mellitus, using of tamoxifen), number of deliveries and pregnancies, symptomatology, the description of ultrasound scans, the result of histology examination, peroperative and postoperative complications. RESULTS: Perimenopause - the median of endometrial thickness in both benign and malignant histology was 8 mm (p = 0.448), the median of the largest polyp dimension was 18 mm. All patients with precancerosis/malignancy were symptomatic with irregular/excessive bleeding, no carcinoma was found in polyp. Postmenopause - the median of endometrial thickness in benign histology was 7 mm versus 16 mm in precancerosis/malignancy (p < 0.001), the median of the largest polyp dimension was the same in both histologies (13 mm, p = 0.274). The risk of malignancy was more than threefold in bleeding versus asymptomatic patients with both hyperplasia and polyp (OR 3.39, 3.79). In asymptomatic patients the risk of cancer was similar for selected cut-offs (5, 8 and 12 mm), statistically significant only for 12 mm (OR 3.54), while in symptomatic patients the risk was high for all cut-offs, however with wide confidence intervals, statistically significant for cut-offs of 8 mm (minimum 3.58) and 12 mm (minimum 4.94). CONCLUSION: We have shown that symptomatology is a strong risk factor for the presence of precancerosis/malignancy in patients with endometrial hyperplasia or polyp. The thickness of the endometrium or polyp size in asymptomatic patients does not play a major role. Ultrasound alone does not have sufficient accuracy for detection or even screening of endometrial cancer. We recommend a conservative procedure, monitoring changes in the ultrasound scan and symptomatology of the patient over time.


Assuntos
Hiperplasia Endometrial/patologia , Neoplasias do Endométrio/patologia , Pólipos/patologia , Biópsia , Endométrio , Feminino , Humanos , Histeroscopia , Gravidez , Estudos Retrospectivos , Ultrassonografia , Hemorragia Uterina
19.
J Pediatr Adolesc Gynecol ; 33(5): 581-585, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32544515

RESUMO

BACKGROUND: Polypoid endometriosis (PEM) is a rare type of endometriosis, frequently mimicking a malignant tumor. We report on a patient with PEM over a 10-year span who had symptoms at age 16. CASE: A 20-year-old woman presented with massive vaginal hemorrhage and spontaneous abortion, having symptoms of dysmenorrhea, anal distending pain, and vaginal bleeding since adolescence. Imaging showed multiple polypoid neoplasms of the rectum and vagina connecting to the huge mass in a cul de sac. After exploration and excision, the pathology revealed PEM.


Assuntos
Endometriose/patologia , Cistos Ovarianos/patologia , Doenças Retais/patologia , Doenças Vaginais/patologia , Diagnóstico Diferencial , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/cirurgia , Pólipos/patologia , Gravidez , Doenças Retais/diagnóstico , Doenças Retais/cirurgia , Ultrassonografia Doppler , Hemorragia Uterina/etiologia , Doenças Vaginais/diagnóstico , Doenças Vaginais/cirurgia , Adulto Jovem
20.
Khirurgiia (Mosk) ; (6): 49-52, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573532

RESUMO

OBJECTIVE: To study the incidence of gallbladder polyps and the possibilities of modern methods of diagnosis and surgical treatment of this disease. MATERIAL AND METHODS: There were 42 laparoscopic cholecystectomies in patients with diagnosed gallbladder polyps. The polyps were diagnosed preoperatively. Intraoperative diagnosis during surgery for gallstone disease was observed in 3 cases. A comparative analysis of preoperative examination did not reveal any advantages of certain diagnostic approach. RESULTS: Hyperplastic polyp was the most common type (n=20, 47.6%), adenomatous polyps occurred in 19 (45.3%) cases, cholesteric polyps - in 3 (7.1%) patients. All patients had signs of chronic inflammation of the gallbladder wall with its infiltration by lymphocytes and histiocytes. CONCLUSION: Further studies with clear criteria for the diagnosis of gallbladder polyps including ones for determining true polyps, precancerous and malignant polyps are required.


Assuntos
Doenças da Vesícula Biliar/cirurgia , Pólipos/cirurgia , Colecistectomia Laparoscópica , Colecistite/cirurgia , Doença Crônica , Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Pólipos/diagnóstico , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/cirurgia
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