The Incidence of and Risk Factors for Local Recurrence With Malignancy After Endoscopic Resection of Large Colon Polyps With High Grade Dysplasia

Introduction. Colon biopsies are among the most frequently examined specimens by pathologists. Many pathology practices, ours included, review upfront levels on all gastrointestinal biopsies. In our experience, when a lesion is present on specimens labeled “colon polyp,” it is readily identified on the first level. To test our hypothesis, we re-reviewed 500 cases in which a lesion was identified histologically and determined if the diagnosis could be made on the first level. Furthermore, we examined 50 additional cases of high-grade dysplasia/carcinoma to determine if the higher-grade component was also present on the first level. Materials and Methods. Cases were retrieved for lesions that could account for a colon polyp clinically, and the first level was examined to determine if lesional tissue was present on the first level. Fifty additional cases of higher-grade lesions were included to ensure higher-grade lesions were present on the first level. Results. Overall, 497/500 (99.4%) of the non–high-grade lesions were present on the first level, whereas 3/500 (0.6%) required the additional level for diagnosis. All 50 high-grade lesions were present on the first level examined. Discussion. Many pathology practices routinely order upfront levels on all gastrointestinal biopsies, often generating 2 or 3 slides. Additional slides increase costs, increase the likelihood of laboratory-generated errors, and can waste limited tissue on small biopsies for which ancillary studies may be necessary. Our study showed that a single level is sufficient in the overwhelming majority of cases in which a lesion is identified histologically.

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Does high-grade dysplasia/carcinoma in situ of the biliary duct margin affect the prognosis of extrahepatic cholangiocarcinoma? A meta-analysis

World Journal of Surgical Oncology ◽

10.1186/s12957-019-1749-7 ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 2

Author(s):

Qiao Ke ◽

Bin Wang ◽

Nanping Lin ◽

Lei Wang ◽

Jingfeng Liu

Keyword(s):

Local Recurrence ◽

Carcinoma In Situ ◽

Meta Analysis ◽

Surgical Margin ◽

High Grade Dysplasia ◽

Cochrane Library ◽

Biliary Duct ◽

High Grade ◽

Extrahepatic Cholangiocarcinoma

Abstract Background High-grade dysplasia/carcinoma in situ (HGD/CIS) of the biliary duct margin was found to not affect the prognosis of patients with extrahepatic cholangiocarcinoma by recent studies, but it has not yet reached a conclusion. Methods Eligible studies were searched by PubMed, PMC, MedLine, Embase, the Cochrane Library, and Web of Science, from Jan. 1, 2000 to Jun. 30, 2019, investigating the influences of surgical margin status of biliary duct on the prognosis of patients with resectable extrahepatic cholangiocarcinoma. Overall survival (OS) and local recurrence were evaluated by odds ratio (OR) with 95% confidence interval (CI). Results A total of 11 studies were enrolled in this meta-analysis, including 1734 patients in the R0 group, 194 patients in the HGD/CIS group, and 229 patients in the invasive carcinoma (INV) group. The pooled OR for the 1-, 2-, and 3-year OS rate between HGD/CIS group and R0 group was 0.98 (95% CI 0.65~1.50), 1.01 (95% CI 0.73~1.41), and 0.98 (95% CI 0.72~1.34), respectively. The pooled OR for the 1-, 2-, and 3-year OS rate between HGD/CIS group and INV group was 1.83 (95% CI 1.09~3.06), 4.52 (95% CI 2.20~9.26), and 3.74 (95% CI 2.34~5.96), respectively. Subgroup analysis of extrahepatic cholangiocarcinoma at early stage showed that the pooled OR for the 1-, 2-, and 3-year OS rate between HGD/CIS group and R0 group was 0.54 (95% CI 0.21~1.36), 0.75 (95% CI 0.35~1.58), and 0.74 (95% CI 0.40~1.37), respectively, and the pooled OR for the 1-, 2-, and 3-year OS rate between HGD/CIS group and INV group was 3.47 (95% CI 1.09~11.02), 9.12 (95% CI 2.98~27.93), and 9.17 (95% CI 2.95~28.55), respectively. However, the pooled OR for the incidence of local recurrence between HGD/CIS group and R0 group was 3.54 (95% CI 1.66~7.53), and the pooled OR for the incidence of local recurrence between HGD/CIS group and INV group was 0.93 (95% CI 0.50~1.74). Conclusion With the current data, we concluded that HGD/CIS would increase the risk of local recurrence compared with R0, although it did not affect the prognosis of patients with extrahepatic cholangiocarcinoma regardless of TNM stage. However, the conclusion needs to be furtherly confirmed.

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Persistent confirmed low-grade dysplasia in Barrett's esophagus is a risk factor for progression to high-grade dysplasia and adenocarcinoma in a US Veterans cohort

Diseases of the Esophagus ◽

10.1093/dote/doz061 ◽

2019 ◽

Cited By ~ 2

Author(s):

K Y Song ◽

A J Henn ◽

A A Gravely ◽

H Mesa ◽

S Sultan ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Independent Risk Factor ◽

High Grade Dysplasia ◽

Low Grade ◽

High Grade ◽

Increased Risk ◽

Low Grade Dysplasia

SUMMARY Patients with Barrett's esophagus (BE) and low-grade dysplasia (LGD) are at increased risk of esophageal adenocarcinoma (EAC), although many regress to nondysplastic BE. This has significant clinical importance for patients being considered for endoscopic eradication therapy. Our aim is to determine the risk for progression in patients with confirmed persistent LGD. We performed a single-center retrospective cohort study of patients with BE and confirmed LGD between 2006 and 2016. Confirmed LGD was defined as LGD diagnosed by consensus conference with an expert GI pathologist or review by an expert GI pathologist and persistence as LGD present on subsequent endoscopic biopsy. The primary outcome was the incidence rate of HGD (high-grade dysplasia)/EAC. Secondary outcomes included risk factors for dysplastic progression. Risk factors for progression were assessed using univariate and multivariate analysis with logistic regression. Of 69 patients (mean age 65.2 years) with confirmed LGD were included. In total, 16 of 69 patients (23.2%) with LGD developed HGD/EAC during a median follow-up of 3.74 years (IQR, 1.24–5.45). For persistent confirmed LGD, the rate was 6.44 (95% confidence interval (CI), 2.61–13.40) compared to 2.61 cases per 100 patient-years (95% CI, 0.83–6.30) for nonpersistent LGD. Persistent LGD was found in only 29% of patients. Persistent LGD was an independent risk factor for the development of HGD/EAC (OR 4.18; [95% CI, 1.03–17.1]). Persistent confirmed LGD, present in only 1/3 of patients, was an independent risk factor for the development of HGD/EAC. Persistence LGD may be useful in decision making regarding the management of BE.

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251 Post-coital bleeding and younger age are risk factors for high-grade dysplasia in women with biopsy proven low-grade squamous intraepithelial lesions

10.1136/ijgc-2019-igcs.251 ◽

2019 ◽

Author(s):

A Borovich ◽

D Nassie ◽

G Sabah ◽

G Cohen ◽

E Yehusa ◽

...

Keyword(s):

Risk Factors ◽

High Grade Dysplasia ◽

Low Grade ◽

High Grade ◽

Squamous Intraepithelial Lesions ◽

Younger Age ◽

Intraepithelial Lesions

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MISMATCH REPAIR PROTEINS AND SURVIVIN IN ADENOMATOUS COLON POLYPS WITH LOW GRADE AND HIGH GRADE DYSPLASIA: AN IMMUNOHISTOCHEMICAL STUDY. Las proteínas para la reparación de desajustes y survivin en pólipos adenomatosos de colon con displasias de bajo y a

Revista Argentina de Anatomía Clínica ◽

10.31051/1852.8023.v10.n3.20923 ◽

2018 ◽

Vol 10 (3) ◽

pp. 98-111

Author(s):

Marian Adamkov ◽

Desanka Výbohová ◽

Slávka Drahošová ◽

Štefan Galbavý

Keyword(s):

Mismatch Repair ◽

Survivin Expression ◽

High Grade Dysplasia ◽

Low Grade ◽

Colon Polyps ◽

High Grade ◽

Immunohistochemical Expression ◽

Significant Relation ◽

Colon Adenomas ◽

Mismatch Repair Proteins

Objective: The aim of our study was to observe the immunohistochemical expression pattern of mismatch repair proteins (MMRP) MLH1, MSH2, MSH6 and PMS2, as well as survivin, in colon polyps. Methods: We assessed above mentioned proteins in a unified group of 124 tubular adenomatous colon polyps with regard to the presence of dysplastic abnormalities in order to explore their relationship. Furthermore, we studied their relation to such clinicomorphological parameters as the age of patients, size of adenoma, degree of dysplastic changes and localization of the lesion. Results: Survivin was expressed in 97 cases (78.2%), MLH1 was found in 111 cases (89.5%), MSH2 in 115 cases (92.7%), MSH6 in 118 cases (95.2%) and PMS2 in 105 cases (84.7%). The majority of absent MMRP cases was detected where the adenoma size was less than 10 mm with LGD (low-grade dysplasia). Survivin expression significantly correlated with the adenoma size and dysplasia grade. Subcellular survivin compartmentalization was statistically associated with the adenoma size, dysplasia grade and adenoma localization. Furthermore, we confirmed a significant relation between survivin expression and MMRP. In general, the intensity of immunoreaction was stronger in the MMRP than in survivin. Conclusions: Our recent results suggest that MMRP may suppress the antiapoptotic activity of survivin in LGD and HGD (high grade dysplasia) colon adenomas. Antecedentes: Las proteínas de reparación de desajustes (MMRP) y survivin representan señales diametralmente opuestas que pueden controlar las vías apoptóticas. Además, se sabe que tanto MMRP como survivin son poderosos parámetros pronósticos. Material y métodos: El objetivo de nuestro estudio fue observar el patrón de expresión inmunohistoquímica de MMRP MLH1, MSH2, MSH6 y PMS2, y survivin en un grupo unificado de 124 adenomatosos pólipos tubulares de colon con respecto a la presencia de anomalías displásicas para explorar sus relaciones. Además, estudiamos su relación con los parámetros clinicomorfológicos, como la edad de los pacientes, el tamaño del adenoma, el grado de cambios displásicos y la localización de la lesión. Resultados: Survivin se expresó en 97 casos (78.2%), MLH1 se encontró en 111 casos (89.5%), MSH2 en 115 casos (92.7%), MSH6 en 118 casos (95.2%) y PMS2 en 105 casos (84.7%). La mayoría de los casos ausentes de MMRP se detectaron en un tamaño de adenoma inferior a 10 mm, estos casos se asociaron principalmente con displasia de bajo grado y fueron más frecuentes en el colon distal. La expresión de survivin se correlacionó significativamente con el tamaño del adenoma y el grado de displasia. La compartimentalización de survivin subcelular se asoció estadísticamente con el tamaño del adenoma, el grado de displasia y localización del adenoma. Además, confirmamos una relación significativa entre la expresión de survivin y el MMRP. En general, la intensidad de la inmunorreacción fue más fuerte en MMRP en comparación con la intensidad del survivin. Conclusiones: Con base en nuestros resultados recientes, sugerimos que el MMRP puede suprimir la actividad antiapoptótica del survivin en los adenomas de colon con displasias de bajo y alto grado.

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