Management of the colonic polyps referred for surgery: an opportunity for improvement

2021 ◽  
Author(s):  
Cecily Stockley ◽  
Bradley Evans ◽  
Muna Lougheed ◽  
Haley Flemming ◽  
Altaf Taher ◽  
...  
Keyword(s):  
Colonic Polyps

Birt-Hogg-Dubé Syndrome: A Case Report Describing Sonographic Evaluation of Salivary Gland Oncocytomas

2019 ◽  
Vol 2 ◽  
pp. 5
Author(s):  
Kevin Kapcio ◽  
Kamila Skalski ◽  
Vikram Dogra
Keyword(s):  
Salivary Gland ◽  
Case Report ◽  
Renal Cell ◽  
Autosomal Dominant ◽  
Colonic Polyps ◽  
Sonographic Evaluation ◽  
Parathyroid Adenomas ◽  
Pulmonary Cysts ◽  
Renal Screening ◽  
Bhd Syndrome

Birt-Hogg-Dubé (BHD) syndrome is a rare hereditary disorder associated with autosomal dominant hereditary epithelial carcinomas, in which patients have an increased incidence of renal cell carcinomas, scattered hamartomas, pulmonary cysts, and spontaneous pneumothoraces. Other less common findings include lipomas, parathyroid adenomas, salivary gland tumors, and colonic polyps/tumors. Early diagnosis of BHD can help establish renal screening and reduce mortality by early detection and more effective treatment of renal cell carcinoma. This case report describes the sonographic features of salivary gland oncocytomas found in a patient with BHD.

scholarly journals 716. A Case of Symptomatic Intestinal Spirochetosis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S409-S409
Author(s):  
Zhi En Chan ◽  
Jasmine Chung Shimin
Keyword(s):  
Venereal Disease ◽  
Lower Abdominal Pain ◽  
Colonic Polyps ◽  
Local Context ◽  
Brachyspira Pilosicoli ◽  
16S Rna ◽  
Intestinal Spirochetosis ◽  
Mucous Discharge ◽  
Treatable Condition ◽  
Brachyspira Aalborgi

Abstract Background Intestinal spirochetosis (IS) is a condition caused by Brachyspira aalborgi and Brachyspira Pilosicoli. Its clinical significance has long been a point of contention with some debating that these spirochetes are simply colonic commensals. It is a condition that is more prevalent in developing nations as well as patients with HIV and the homosexual population. The epidemiology and prevalence of IS has not been studied in the local context. Methods We reviewed a case of a 37-year-old man who presented with a two month history of persistent lower abdominal pain, hematochezia, and increase in mucous discharge per rectum. He is sexually active with multiple male partners, and was previously treated for gonorrhea, chlamydia, and syphilis. His basic laboratory investigations were unremarkable, Venereal Disease Research Laboratory (VDRL) antibody and human immunodeficiency virus (HIV) screen were both non-reactive. Computed tomography of the abdomen was unremarkable. Endoscopic evaluation revealed multiple discrete ulcers measuring 1-2mm seen only in the rectum. Random biopsies of the cecum, ascending colon, transverse colon and descending colon showed mild acute colitis with IS. There was also mild to moderate acute proctitis in the rectum with spirochetes seen. 16s RNA gene sequencing of the biopsy specimen were confirmatory for Brachyspira aalborgi. Investigation findings. A: Discrete Ulcers found in rectum, B: Hemotoxylin and Eosin stained specimen showing proctitis, C: False brush Border appearance D: Spirochetes on Warthin Starry stain Results The patient received a 10 day course of metronidazole with complete resolution of his symptoms. Conclusion This case demonstrates the existence of a treatable condition that can be diagnosed with current available investigations for patients with similar symptoms. Recognising at risk populations can also raise clinical suspicion for this condition. Some studies have found associations between IS with development of colonic polyps and also certain colorectal cancers. Further studies on this treatable condition and its disease burden in the local context should be further explored. Disclosures All Authors: No reported disclosures

scholarly journals Effects of Somatic Methylation in Colonic Polyps on Risk of Developing Metachronous Advanced Colorectal Lesions

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 246
Author(s):  
Oscar Murcia ◽  
Alejandro Martínez-Roca ◽  
Miriam Juárez ◽  
Mar Giner-Calabuig ◽  
Miren Alustiza ◽  
...  
Keyword(s):  
Cpg Island ◽  
Risk Estimation ◽  
Colonic Polyps ◽  
Cpg Island Methylator Phenotype ◽  
Polyp Size ◽  
Serrated Lesions ◽  
Amplification Technique ◽  
Methylator Phenotype ◽  
The Relationship ◽  
Dependent Probe

The utility of molecular markers for predicting the risk of metachronous advanced colorectal lesions (MACLs) remains poorly investigated. We examined the relationship between somatic hypermethylation in polyps at baseline and the risk of developing MACL. This retrospective cohort study included 281 consecutive patients with colonic polyps who were enrolled between 2007 and 2009 and followed-up until 2014. MACLs were defined as adenomas of >10 mm, high-grade dysplasia, or with a villous component; and serrated lesions of >10 mm or with dysplasia. In total, 595 polyps were removed at baseline colonoscopy and analyzed for pathological characteristics and CpG island methylator phenotype (CIMP) using the MS-MLPA (Methylation-Specific -- Multiplex Ligation-dependent Probe Amplification) technique. Forty-five patients (16.0%) showed at least one CIMP+ polyp. MACL risk was higher in patients with CIMP+ polyps (odds ratio (OR), 4.50; 95% CI, 1.78–11.4; p = 0.002). Patients with CIMP+ polyps also exhibited shorter time to MACL development (33.8 months vs. 50.1 months; p < 0.001), even with adjustment for polyp size and number (OR, 2.40; 95% CI, 1.33–4.34). Adding CIMP analysis improved the sensitivity (57.0% to 70.9%), negative predictive value (71.1% to 77.3%), and overall accuracy (49.8% to 52.0%) for MACL risk estimation. These results highlight that CIMP may be a useful marker for endoscopic surveillance.

scholarly journals Solid-pseudopapillary neoplasm of the pancreas in a patient with familial adenomatous polyposis: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Daishi Naoi ◽  
Koji Koinuma ◽  
Hideki Sasanuma ◽  
Yasunaru Sakuma ◽  
Hisanaga Horie ◽  
...  
Keyword(s):  
Familial Adenomatous Polyposis ◽  
Pancreatic Tumor ◽  
Laparoscopic Resection ◽  
Tumor Development ◽  
Colonic Polyps ◽  
Pancreatic Tumors ◽  
Beta Catenin ◽  
Adenomatous Polyposis ◽  
Solid Pseudopapillary Neoplasm ◽  
Extracolonic Manifestations

Abstract Background Familial adenomatous polyposis (FAP) is characterized by the presence of hundreds to thousands of colonic polyps, and extracolonic manifestations are likely to occur. Pancreatic tumors are rare extracolonic manifestations in patients with FAP, among which solid-pseudopapillary neoplasm (SPN) are extremely rare. We report here a patient with an SPN of the pancreas found during the follow-up of FAP. Case presentation A 20-year-old woman was diagnosed with FAP 3 years previously by colonoscopy which revealed less than 100 colonic polyps within the entire colon. She complained of left upper abdominal pain and a 10-cm solid and cystic pancreatic tumor was found by computed tomography scan. Solid and cystic components within the tumor were seen on abdominal magnetic resonance imaging. Simultaneous laparoscopic resection of the distal pancreas and subtotal colectomy was performed. Histopathological findings confirmed the pancreatic tumor as an SPN without malignancy. Abnormal staining of beta-catenin was observed by immunohistochemical study. Multiple polyps in the colorectum were not malignant. Molecular biological analysis from peripheral blood samples revealed a decrease in the copy number of the promoter 1A and 1B region of the APC gene, which resulted in decreased expression of the APC gene. Conclusions A rare association of SPN with FAP is reported. The genetic background with relation to beta-catenin abnormalities is interesting to consider tumor development. So far, there are few reports of SPN in a patient with FAP. Both lesions were treated simultaneously by laparoscopic resection.

scholarly journals Clinical and financial impacts of introducing an endoscopic mucosal resection service for treatment of patients with large colonic polyps into a regional tertiary hospital

2019 ◽  
Vol 07 (11) ◽  
pp. E1386-E1392
Author(s):  
Thomas Worland ◽  
Oliver Cronin ◽  
Benjamin Harrison ◽  
Linda Alexander ◽  
Nik Ding ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Surgical Procedures ◽  
Colonic Polyps ◽  
Tertiary Hospital ◽  
Safe Alternative ◽  
Intention To Treat ◽  
Mucosal Resection ◽  
Regional Center ◽  
Financial Benefits ◽  
Number Of Patients

Abstract Background and study aims Endoscopic mucosal resection (EMR) of large sessile or laterally spreading colonic lesions is a safe alternative to surgery. We assessed reductions in Surgical Resection (SR) rates and associated clinical and financial benefits following the introduction of an EMR service to a large regional center. Patients and methods Ongoing prospective intention-to-treat analysis of EMR was undertaken from time of service inception in 2009 to 2017. Retrospective data for SR of large sessile/laterally spreading colonic lesions were collected for the period 4 years before commencement of the EMR service (2005 – 2008) and 9 years after its introduction (2009 – 2017). Results From 2005 to 2008, 32 surgical procedures were performed for non-malignant colonic neoplasia (50 % male, median age 68 years, median Length of Stay (LoS) 10 days). Following the introduction of the EMR service, there was a 56 % reduction in the number of patients referred for surgery (32 surgical procedures, 47 % male, median age 70 years, median LoS 8.5 days). During this period, EMR was successfully performed in 183 patients with 216 lesions resected (60 % male, median age 68 years, median LoS 1 day). Compared to the SR group, the EMR cohort had a lower peri-procedural complication rate (7.7 % vs 54.7 %, P < 0.0001), and shorter average LoS (1 vs 9 days, P < 0.0001). A cost saving of AUD $ 19 543.5 was seen per lesion removed with EMR compared to SR. Conclusions The introduction of a dedicated EMR service into a large regional center as an alternative to SR can lead to a substantial decrease in unnecessary surgery with subsequent clinical and financial benefits.

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