scholarly journals Slow-Growing Early Adenocarcinoma Arising from Traditional Serrated Adenoma in the Duodenum

2016 ◽  
Vol 10 (2) ◽  
pp. 257-263 ◽  
Author(s):  
Yoon Kyoo Park ◽  
Woo Jin Jeong ◽  
Gab Jin Cheon
Keyword(s):  
Resection Margins ◽  
Tubular Adenocarcinoma ◽  
Solid Organ ◽  
Biopsy Result ◽  
Serrated Adenoma ◽  
Serrated Polyps ◽  
Traditional Serrated Adenoma ◽  
Serrated Polyp ◽  
Type Iv

Serrated polyps are classified into 3 distinct types: hyperplastic polyp, sessile serrated adenoma, or transitional serrated adenoma. A serrated adenoma is a precursor lesion for colorectal carcinoma. Serrated polyps are commonly found in the colorectum but have rarely been described in other parts of the gastrointestinal tract. Serrated adenomas in the small intestine may represent aggressive lesions with high malignant potential, according to some reports. A 66-year-old man with no significant medical history underwent esophagogastroduodenoscopy (EGD) for general examination. He had a 1-cm sized, Yamada type IV polyp, with focal white patch in the second portion of the duodenum. The biopsy result revealed gastric metaplasia and chronic inflammation. He wanted regular follow -up examinations. The follow-up EGDs were done every year. There were no changes in the shape and size of the polyp. The pathologic findings were unchanged. Then, he underwent EGD for general medical check-up again 5 years after the first detection. The size of the polyp was slightly increased. The biopsy result revealed serrated polyp, unclassified. Endoscopic mucosal resection was done. The pathologic result revealed a 0.8 × 0.5-cm sized, well differentiated tubular adenocarcinoma. Carcinomas are multifocally spread on the traditional serrated adenoma, and the proportion of the adenocarcinoma component is approximately 50%. The tumor had invaded the lamina propria but confined to the mucosa. The resection margins were negative, and no lymphovascular invasion or perineural invasion was seen. Abdominal pelvic computed tomography and positron emission tomography showed no other solid organ involvement or metastasis. Surveillance follow-up EGDs were done after 3 months and 1 year. There was no evidence of recurrence.

Implications of different guidelines for surveillance after serrated polyp resection in United States of America and Europe

Endoscopy ◽  
2019 ◽  
Vol 51 (08) ◽  
pp. 750-758 ◽  
Author(s):  
Arne Bleijenberg ◽  
Dagmar Klotz ◽  
Magnus Løberg ◽  
Evelien Dekker ◽  
Hans Olov Adami ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Serrated Adenoma ◽  
Cohen’S Kappa ◽  
Serrated Polyps ◽  
Serrated Polyp ◽  
Cohen's Kappa ◽  
Colonoscopy Screening ◽  
Increased Risk ◽  
Surveillance Interval

Abstract Introduction Because individuals with serrated polyps and adenomas are at increased risk of developing new polyps and colorectal cancer (CRC), surveillance after resection is justified. After adenoma resection, most international guidelines are consistent, but recommendations for surveillance after serrated polyp resection vary. The United States Multi-Society Taskforce on CRC (US-MSTF) base surveillance intervals on serrated polyp subtype (traditional serrated adenoma, sessile serrated polyp, hyperplastic polyps), while the European Society of Gastrointestinal Endoscopy (ESGE) guidelines do not take serrated polyp subtype into account. We evaluated the implications of this difference in a primary colonoscopy screening cohort. Methods We included participants from a large colonoscopy screening trial. In a post-hoc simulation, assuming full protocol adherence, we determined the surveillance interval for each subject based on their polyp burden, using the most recent US-MSTF and ESGE guidelines. Results We included 5323 participants, of whom 1228 had one or more serrated polyps. In 5201 of all participants (98 %; Cohen’s kappa 0.90) and in 1106 of those with serrated polyps (90 %; Cohen’s kappa 0.80), both guidelines recommended identical surveillance intervals. Recommendations for a 3-year surveillance interval were identical between the two guidelines. All 122 subjects with discordant recommendations would receive a follow-up colonoscopy after 10 years using ESGE guidance and after 5 years using US-MSTF guidance. Conclusion Despite the different criteria used to determine surveillance after serrated polyp resection, most individuals are recommended identical colonoscopy surveillance intervals whether following the ESGE or US-MSTF guidelines. This suggests that surveillance recommendations do not need to consider the serrated polyp subtype.

scholarly journals Coexistent adenoma and serrated polyps on index colonoscopy and the risk of metachronous advanced colorectal neoplasia

2019 ◽  
Vol 07 (12) ◽  
pp. E1748-E1754 ◽  
Author(s):  
Soo-Kyung Park ◽  
Hak-Soo Kim ◽  
Hyo-Joon Yang ◽  
Yoon Suk Jung ◽  
Jung Ho Park ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Colorectal Neoplasia ◽  
Advanced Adenoma ◽  
Serrated Adenoma ◽  
Serrated Polyps ◽  
Advanced Colorectal Neoplasia ◽  
Significant Difference ◽  
The Family ◽  
Risk Patients

Abstract Background and aims The family of serrated polyps (SP) includes hyperplastic polyps (HP), sessile serrated adenomas/polyps, and traditional serrated adenoma. We investigated whether SP synchronous with adenoma at index colonoscopy is associated with metachronous advanced colorectal neoplasia (CRN). Methods Patients with ≥ 1 adenoma on index colonoscopy and who had undergone a follow-up colonoscopy were included. The patients were divided into four groups according to the presence of SP and advanced adenoma (AA) on index colonoscopy (non-AA, non-AA + SP, AA, AA + SP). The cumulative incidence of metachronous advanced CRN at surveillance colonoscopy was compared between groups. Results Among a total of 2209 patients, the numbers of patients in the non-AA, non-AA + SP, AA, and AA + SP groups were 922, 441, 625, and 221, respectively. The cumulative incidence of metachronous advanced CRN was higher in patients in the AA + SP group than that in the AA group (P<0.001), and there was no significant difference between the non-AA + SP group and the non-AA group (P = 0.06). The cumulative incidence of metachronous advanced CRN at 3 years was 17.9 % [95 % confidence interval (CI) 8.0–27.6], 10.7 % [95 %CI 7.7–3.6], 3.5 % [95 %CI 1.3–5.6], and 3.4 % [95 %CI 2.0–4.7] in the AA + SP, AA, non-AA + SP, and non-AA group, respectively. In a multivariate analysis, overall SP [hazard ratio (HR) 2.24; 95 %CI 1.38–3.64, P = 0.001], proximal SP (HR 2.31; 95 %CI 1.32–4.08), and HP (HR 2.19; 95 %CI 1.35–3.57) were risk factors for metachronous advanced CRN in patients with AA on index colonoscopy. Conclusions Coexistent AA and SP on index colonoscopy significantly increased the risk of metachronous advanced CRN compared with AA alone. Further large prospective studies are needed to confirm whether more intensive follow-up improves outcomes in these high risk patients.

A Historical Perspective and Exposé on Serrated Polyps of the Colorectum

2016 ◽  
Vol 140 (10) ◽  
pp. 1079-1084 ◽  
Author(s):  
Eun-Young Karen Choi ◽  
Henry D. Appelman
Keyword(s):  
Historical Perspective ◽  
Hyperplastic Polyp ◽  
Colorectal Polyps ◽  
Hyperplastic Polyps ◽  
Sessile Serrated Adenoma ◽  
Serrated Adenoma ◽  
Serrated Polyps ◽  
The Third ◽  
The Past ◽  
Serrated Polyp

This article offers a historical perspective on the discovery of 3 types of serrated colorectal polyps recognized in the past 60 years. The first to be discovered was the hyperplastic polyp, which is still the most commonly encountered serrated polyp. In the past 20 years, the carcinoma-associated sessile serrated adenoma/polyp has been recognized, but its diagnosis can be difficult owing to overlapping histologic features with hyperplastic polyps. Less is known about the third type, the traditional serrated adenoma, because it is far less common than the other 2 types, and its association with cancer is currently under investigation.

scholarly journals A retrospective study on pathological and clinical characteristics of 52 cases with the colorectal serrated polyp

2018 ◽  
Vol 35 (1) ◽  
Author(s):  
Xu Li Hua ◽  
Li Qian Jun ◽  
Shen Xiao Feng ◽  
Da Jing ◽  
Zhu Ya Wen
Keyword(s):  
Retrospective Study ◽  
Clinical Characteristics ◽  
Endoscopic Examination ◽  
Malignant Potential ◽  
Sessile Serrated Adenoma ◽  
Serrated Adenoma ◽  
Serrated Polyps ◽  
Creative Commons ◽  
Serrated Polyp ◽  
Open Access Article

Background and Objective: Colorectal serrated polyp is considered as histologically heterogeneous lesions with malignant potential. The aim of the study was to evaluate the endoscopic, clinic and pathologic characteristics of colorectal serrated polyps. Methods: The endoscopic, clinic and pathologic characteristics of 52 cases with colorectal serrated polyps between January 2014 and May 2018 in our hospital were analyzed. retrospectively. Results: The prevalence of serrated polyps was 0.39% (52/13,346). The proportions of hyperplastic polyp (HP), sessile serrated adenoma/polyp (SSA/P), and traditional serrated adenoma (TSA) of all serrated polyps were 61.5%, 17.3%, and 21.2%, respectively, which showed a lower proportion of TSA and SSA/P and a higher proportion of HP. Conclusions: The overall detection rate of colorectal serrated polyps was relatively low, and it is necessary to discriminate between SSAPs and HPs during endoscopic examination because of the malignant potential. How to cite this:Hua XL, Jun LQ, Feng SX, Jing D, Wen ZY. A retrospective study on pathological and clinical characteristics of 52 cases with the colorectal serrated polyp. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.238 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

TRADITIONAL SERRATED ADENOMA – SIGNS OF SERRATED AND NONSERRATED TYPES OF COLON POLYPS

2019 ◽  
Author(s):  
N Ageykina ◽  
N Oleynikova ◽  
P Malkov ◽  
E Fedorov ◽  
N Danilova ◽  
...  
Keyword(s):  
Colon Polyps ◽  
Serrated Adenoma ◽  
Traditional Serrated Adenoma

scholarly journals Colorectal resection in endometriosis patients: correlation between histopathological findings and postoperative outcome

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Peter Tschann ◽  
Nikola Vitlarov ◽  
Martin Hufschmidt ◽  
Daniel Lechner ◽  
Paolo N. C. Girotti ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colorectal Resection ◽  
Postoperative Outcome ◽  
Resection Margins ◽  
Pain Level ◽  
Histopathological Findings ◽  
Vas Score ◽  
Reduction Of Pain

Abstract Introduction Endometriosis is associated with a high number of chronic pelvic pain and reduced quality of life. Colorectal resections in case of bowel involvement of endometriosis are associated with an unneglectable morbidity in young and healthy patients. There is no linear correlation established between the degree of symptoms and stage of endometriosis. The aim of this study was to correlate the histological findings to preoperative pain scores in colorectal resected patients with endometriosis. Methods Twenty-five patients who underwent laparoscopic colorectal resection for endometriosis between 2014 and 2019 were included in this retrospective study. Pain level was assessed preoperatively and postoperatively via phone call in May 2020. Histopathology was correlated to preoperative symptoms and postoperative outcome. Results Average follow-up time was 38.68 months (± 19.92). Preoperative VAS-score was 8.32 (± 1.70). We observed a significant reduction of pain level in all patients after surgery (p ≤ 0.005). Pain levels were equal regarding the presence of satellite spots and various degrees of infiltration depth. The resection margins were clear in all patients. Postoperative complications occurred in 6 cases (24%) and anastomotic leakage was observed in 3 patients (12%). Average VAS-score at time of follow-up was 1.70 (± 2.54). Conclusion Our data demonstrate that adequate colorectal resection leads to reduction of pain and an increase of quality of life irrespective of histopathological findings. An experienced team is necessary to improve intraoperative outcome and to reduce postoperative morbidity in case of complication.

scholarly journals Outcomes of one-stage reconstruction for chronic multiligament injuries of knee

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Tarun Goyal ◽  
Souvik Paul ◽  
Sushovan Banerjee ◽  
Lakshmana Das
Keyword(s):  
Cruciate Ligament ◽  
Lysholm Score ◽  
Activity Level ◽  
Type Ii ◽  
Hamstring Tendons ◽  
Peroneus Longus ◽  
Type Iii ◽  
Type Iv ◽  
Ikdc Score

Abstract Purpose This article aims to evaluate patterns of chronic multiligament injuries and outcomes of treatment with single-stage reconstruction using autografts. Methods All patients with clinicoradiologically diagnosed multiligament knee injury (MKI) were included in this prospective observational study. As the time since injury was more than 6 weeks in all of the patients, they were categorized as having chronic MKI. Patients were assessed clinically for laxity, and the diagnosis was confirmed radiologically. Ipsilateral hamstring tendons were used for medial collateral ligament (MCL) or posterolateral corner reconstruction in a patient with Schenck knee dislocation (KD) type III. In these cases, the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) were reconstructed by using the peroneus longus and contralateral hamstring tendons respectively. Ipsilateral hamstring tendons were used for ACL reconstruction and an ipsilateral peroneus longus tendon graft was used for reconstruction of the PCL in a KD type II injury. In two cases of KD type IV injury, the lateral laxity was only grade II and was managed conservatively; the rest of the ligaments were addressed like a KD type III injury. Outcome evaluation was done using a visual analogue scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity level, preoperatively and postoperatively at 2 years’ follow-up. Results A total of 27 patients of mean age 33.48 ± 9.9 years with MKI were included in the study. The patients were classified as eight KD type II, 17 KD type III, and two KD type IV. The majority of the patients had associated meniscal (59.2%) or chondral (40.7%) injuries. At the 2 years’ follow-up visit, there were significant improvements in VAS score (p = 0.0001) IKDC score (p = 0.0001), Lysholm score (p = 0.0001), and range of motion (p = 0.001). None of the patients had residual laxity on clinical examination of the knee joint at the 2 years’ follow-up. All but two of the patients went back to their previous activity level. These two patients had progressive knee arthritis and needed knee arthroplasty. Conclusion Single-stage surgical reconstruction for chronic MKI has favourable functional outcomes. Level of evidence Level IV, case series.

scholarly journals Long-Term Incidence of Advanced Colorectal Neoplasia in Patients with Serrated Polyposis Syndrome: Experience in a Single Academic Centre

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1066
Author(s):  
Daniel Rodríguez-Alcalde ◽  
Guillermo Castillo-López ◽  
Jorge López-Vicente ◽  
Luis Hernández ◽  
Mercedes Lumbreras-Cabrera ◽  
...  
Keyword(s):  
Total Colectomy ◽  
Colorectal Neoplasia ◽  
Elevated Risk ◽  
Advanced Adenoma ◽  
Polyposis Syndrome ◽  
Serrated Polyp ◽  
Advanced Colorectal Neoplasia ◽  
Median Interval

Serrated polyposis syndrome (SPS) implies a slightly elevated risk of colorectal cancer (CRC) during endoscopic follow-up, but its natural course is still not well known. The main objective of this study was to describe the long-term risk of developing advanced neoplasia (AN) in these patients. Until October 2020, individuals who fulfilled 2010 WHO criteria I and/or III for SPS were retrospectively recruited. We selected those under endoscopic surveillance after resection of all lesions >3 mm in a high-quality colonoscopy. We excluded patients with total colectomy at diagnosis and those with any interval between colonoscopies >3.5 years. We defined AN as advanced serrated polyp (≥10 mm and/or with dysplasia), advanced adenoma, or CRC. In 109 patients, 342 colonoscopies were performed (median = 3, median interval = 1.8 years) during a median follow-up after colonic clearance of 5.0 years. Five-year cumulative incidences of AN were 21.6% globally, and 5.6%, 10.8%, and 50.8% in patients who fulfilled criterion I, III, and both, respectively (p < 0.001). No CRC was diagnosed and only 1 (0.9%) patient underwent surgery. In conclusion, cumulative incidences of AN could be lower than previously described, at least in patients who fulfil the 2010 WHO criterion III alone. Therefore, low-risk individuals might benefit from less stringent surveillance.

MRI analysis and surgical treatment of Wassel Type IV duplicated thumbs

2021 ◽  
pp. 175319342098321
Author(s):  
Anyuan Wang ◽  
Jian Ding ◽  
Long Wang ◽  
Tinggang Chu ◽  
Zhipeng Wu ◽  
...  
Keyword(s):  
Type A ◽  
Surgical Reconstruction ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Type D ◽  
Type Iv ◽  
Secondary Operations ◽  
Type C

We present the MRI findings for 39 Wassel Type IV duplicated thumbs in 38 patients. We found that MRI revealed the morphology of the cartilaginous connection between the thumb anlages and the location of the deviation corresponding to the classification of Horii, which allowed precise preoperative planning of corrective osteotomies. All 39 thumbs were available for follow-up after surgical reconstruction at a mean of 29 months (range 25 to 39). Four out of nine Horii Type A cases and all 12 Type B, as well as the six Type C and the six Type D cases, achieved good results according to the Tada scoring system. Five Type A cases achieved fair results with residual stiffness of the interphalangeal joint. No secondary operations were needed. We conclude that MRI proved useful in subclassifying Wassel Type IV duplicated thumbs and may aid in planning the osteotomies needed for their reconstruction. Level of evidence: IV

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