Prevalence of neoplasia in solitary and multiple esophago-gastrointestinal polyps: 5 years retrospective histopathological study

The increasing use of endoscopy has led to more discernable abnormalities in the stomach, including polyps. Gastric polyps encompass a spectrum of pathologic conditions that can vary in histology, neoplastic potential, and management. Despite their high prevalence, there is a paucity of literature to support management and treatment decisions for endoscopists. The goal of this review is to summarize clinical, endoscopic, and histopathologic features of various polyps, review syndromes associated with such polyps and provide management recommendations. The present study was carried out for analyzing and comparing the prevalence of neoplasia in polyps (Solitary and multiple) removed endoscopically from the esophagus, stomach, and bowel undergoing screening. Five years retrospective study was done on patients who underwent endoscopy procedures including Oesophagogastroduodenoscopy (OGD) and colonoscopy between June 2015 and March 2019 in Faruk Medical City Hospital, Sulaimani City. Age and sex of patients, site of occurrence, number of polyps (solitary or multiple), and polyps' histologic type of 369 cases were analyzed in this study. Regarding solitary polyps, out of 279 polyps, 155 were neoplastic (55%) and 124 were non-neoplastic polyps, while multiple polyps, out of a total of 90 cases, 68 were neoplastic (75%) and 22 were non-neoplastic. More than 78% of patients were above the age of 40 years. Tubular adenoma was the most commonly diagnosed polyp. Large bowel was the most commonly involved site and left-sided polyps outnumbered right-sided ones with the sigmoid colon being the most commonly involved site. Screening programs including endoscopy, especially the colon for detecting polyps and particularly the colorectal region can be helpful to reduce morbidity and mortality of patients.

SP10.1.6 Benefit of Two week colorectal cancer referrals of patients who had colonic imaging within the last 5 years: do they improve the colorectal cancer outcome?

Purpose There has been a significant rise in the number of colorectal rapid access referrals. These referral results in additional demand for hospital services as well as delays assessment and management of other patients. We analyzed the outcome of colorectal fast tract clinic re- referrals on bowel cancer outcome in patients with recent colonic imaging. Methods We retrospectively analyzed 1000 consecutive colorectal rapid access pathway referrals in 2019.Patients with complete colonic imaging within the preceding 5 years were included. We assessed their clinical outcome and colonic imaging when performed. Results In total, 82 (8.2%) patients out of 1000 met the selection criteria. Among these 12 patients (14%) did not need any further colonic investigations. A further 12 patients (14%) were already on the colorectal surveillance program, including a patient with recently diagnosed rectal cancer. Hence 24 patients (29.2%) referral was not indicated. 58 patients had further colonic imaging in the form of colonoscopy or virtual colonoscopy following clinic consultation. 32 (55.17%) of them had normal colonic imaging. 14 patients (24.1%) were identified with colorectal polyps with only one identified as tubular adenoma. The remaining 12 patients had non neoplastic pathology. Conclusion No new significant colorectal pathology was identified in this group of patients. We suggest that symptomatic patients who had complete colonic imaging within 5 years be referred to routine colorectal clinic in order to make the colorectal rapid access referral pathway more effective especially during these unprecedented times.

Cell Proliferation PET Imaging with 4DST PET/CT in Colorectal Adenocarcinoma and Adenoma

An age of 70-year-old man was incidentally found two focal high 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) uptake in the descending colon and in the sigmoid colon. We observed the feature of these two areas in the preplanned 4′-[methyl-11C]-thiothymidine (4DST) positron emission tomography (PET)/computed Tomography (CT)providing cell proliferation imaging. A mass forming high 4DST uptake in the descending colon and focal moderate 4DST uptake in the sigmoid colon was confirmed, and that were proven pathologically as adenocarcinoma and moderate to severe type tubular adenoma, respectively. This is the first report to present that colorectal adenoma can be visualized by proliferation PET imaging and the degree of uptake may enable discrimination of colorectal adenoma from adenocarcinoma, based on pathological considerations.

1382 Retrospective Audit to Assess Compliance to National Guidance for The Follow-Up of Acute Uncomplicated Diverticulitis and Adenoma Detection Rate at University Hospital Bristol

Aim Diverticulitis is a common cause for acute surgical admissions. UK guidance recommends uncomplicated diverticulitis is managed with antibiotics, and follow-up outpatient lower gastrointestinal (LGI) endoscopy (flexible sigmoidoscopy or colonoscopy) arranged 6-8 weeks after discharge. This audit aimed to assess compliance to national guidance and assess adenoma detection rate. Method Retrospective analysis of discharge summaries coded ‘diverticulitis’ from January 2017 – April 2020 at University Hospital Bristol(UHB). Results 426 patients presented with uncomplicated diverticulitis, mean age 60.5 years (22-92 years). 42% (179/426) of patients underwent LGI endoscopy as an inpatient or on discharge. Median time to outpatient endoscopy was 70 days (6-287 days). 23% (99/426) had LGI endoscopy within the 8-week target. Histology showed: 21% (37/179) polyp; 5% (9/179) tubular adenoma; and one patient had high grade dysplasia. The histology for the remaining 28 patients with polyps showed: hyperplasia; granulation tissue; inflammation; or samples were not sent for histology. No cases of malignancy were detected. Conclusions 58% of patients admitted with acute uncomplicated diverticulitis did not have a follow-up LGI endoscopy and only 23% had LGI endoscopy within the 8-week target. 21% had a polyp with a 5% rate of tubular adenoma and no cases of malignancy. UHB needs to improve compliance with national guidance for the arrangement of follow-up LGI endoscopy, however the absence of detection of malignancy raises the question of whether we need to re-consider its necessity for patients with uncomplicated diverticulitis.

Pure somatic pathogenic variation profiles for patients with serrated polyposis syndrome

Background The serrated pathway is a distinct genetic/epigenetic mechanism of the adenoma-carcinoma sequence in colorectal carcinogenesis. Although many groups have reported the genetic-phenotypic correlation of serrated lesions (SLs), previous studies regarding the serrated pathway were conducted on patients with SLs that have heterogeneous germline genetic backgrounds. We aimed to compare pure somatic genetic profiles among SLs within identical patients with SPS as a homogenous germline background. Methods We analysed SLs from one patient with SPS (Case #1) and compared DNA variant profiles using targeted DNA multigene panels via NGS among the patient’s hyperplastic polyp (HP), three sessile serrated lesions (SSLs), and one traditional serrated adenoma (TSA), in addition to leucocytes as a germline variant, and separately analysed three SSLs and one tubular adenoma (TA) within another patient with SPS (Case #2). Results In two patients, no germline pathogenic variant was observed, and a known pathogenic variant of BRAF (c.1799T > A, p.Val600Glu) was observed in one TSA and one SSL in Case #1, while three SSLs exhibited the BRAF variant in Case #2. Further, the genetic profile of TA is consistent with the adenoma-carcinoma sequence pathway profile and distinct from that of the other SLs within the same patient with SPS. Conclusions These findings of pure somatic genetic variant profiles among SLs with identical germline genetic background support the previous results analysed among SLs with heterogeneous germline genetic backgrounds.

Histopathological Evaluation of Lesions of Appendix - A Cross Sectional Study

BACKGROUND Appendix is considered as a vestigial organ in medical history. But recent studies reveal its importance in immunological function. Appendicectomy is one of the most common surgeries performed and acute appendicitis being the most frequent pathology noted. Various less common pathologies like parasitic infestation, granuloma, diverticulum, neoplasms are also described. In our institute, we have seen an increased rate of acute appendicitis and a relative increase in neoplastic conditions. The purpose of this study was histopathological evaluation of lesions of appendix over a period of five years and its association with demographic data. METHODS This cross-sectional study included all specimens received in the department of pathology with primary pathology in appendix. Appendix removed as a part of other surgical procedures were excluded. Relevant clinical data, gross findings and histopathological diagnoses were retrieved from pathology records and computer databases and statistical analysis was done using Statistical Package for Social Sciences (SPSS 16.0). RESULTS Out of the 576 cases, 485 (84 %) patients showed findings consistent with acute appendicitis on histopathological examination. Perforation rate was 4.86 % and was higher in male patients. Other pathologies include chronic appendicitis in 58 cases (10.06 %), eosinophilic appendicitis in one case (0.17 %), appendix with lymphoid hyperplasia in 14 cases (2.43 %), periappendicitis in 4 cases (0.69 %), fibrous obliteration of appendix in 2 cases (0.34 %), granulomatous appendicitis in 4 cases (0.69 %), appendix with lymphoid hyperplasia in 14 cases (2.43 %), diverticulitis in one case (0.17 %), tubular adenoma with low grade dysplasia in one case (0.17 %), neuroendocrine tumour in one case (0.17 %) and mucinous neoplasms in 5 cases (0.86 %). CONCLUSIONS The study supports routine histological examination of all the appendicectomy specimens to avoid missing of any clinically important condition which has significant impact on treatment and prognosis. Also noted an increased number of mucinous neoplasms suggesting the importance of future studies in this field. KEYWORDS Appendix, Acute Appendicitis, Chronic Appendicitis, Mucinous Neoplasms of Appendix, Diverticulitis