SP1.1.11Is polyp detection rate a suitable surrogate measure for adenoma detection rate in colonoscopy?

Aims The Joint Advisory Group on GI Endoscopy (JAG) has set key quality indicators for colonoscopy, which includes an adenoma detection rate of a minimum of 15%. Given the difficulty in reporting adenoma detection rate, JAG have stated that polyp detection rate is accepted as a surrogate measure. Our aim was to assess whether polyp detection rate can be used as a substitute marker for adenoma detection, by examining the histology of samples taken as polyps to determine what proportion are truly adenomas. Methods The pathology department provided a registry of all histological samples taken from the colon or rectum during a one-year period April 2017 to April 2018. These samples were cross-referenced with the endoscopy report to assess which were identified as “polyps” by the performing endoscopist. The pathology report was then reviewed to determine what the histological conclusion was for each “polyp”. Results A total of 1601 colorectal histology samples were reviewed, taken by 32 different endoscopists. 451 of these were identified as polyps by the performing endoscopist. On histological review 153 (33.9%) were not adenomas of the colon or rectum. Common alternative histological diagnoses were hyperplastic polyp, inflammatory polyp and normal tissue. Rarer alternative histological diagnoses were melanosis coli, submucosal leiomyoma and endometriosis of the rectum. Conclusions Polyp detection rate which is used as a surrogate marker for adenoma detection rate is an inaccurate measure of colonoscopy quality.

Inflammatory cap polyp of the sigmoid colon: a case report

Background Inflammatory cap polyp is a very rare benign entity of the distal left colon, characterized by inflammatory polyp with a “cap” of fibrinopurulent exudates. They are usually multiple and commonly present with bleeding per rectum or mucoid discharge. Solitary polyp presenting with intermittent intussusceptions is rare. Case presentation We report the case of a 45-year-old Nepalese male with a solitary inflammatory sigmoid colon polyp. The patient presented with a 1-month history of rectal bleeding, mucoid discharge, and severe colicky abdominal pain due to intussusceptions. On colonoscopy, there was an exophytic mass with surface exudates. Colonic resection and anastomosis were performed, due to recurring partial intestinal obstruction. At a 6-month follow-up, the patient was asymptomatic. Conclusion Inflammatory cap polyp is a benign entity, and it should be kept in mind as an important differential diagnosis of exophytic colonic mass with surface exudates.

Langerhans Cell Histiocytosis of the Temporal Bone in Children: Two Cases Report

Langerhans cell histiocytosis is a rare hematologic disease due to multiplication and accumulation of Langerhans cells, which are immature dendritic cells. The clinical presentation is highly variable and can range from isolated, self-healing skin or bone lesions to life-threatening multisystem disease. We report 2 cases confirmed by Histological and immunohistochemical evaluation of temporal bone biopsies. The first case is a 2-year-old child with chronic bilateral otorrhea and polyuria-polydipsia syndrome. Physical examination showed bilateral retroauricular redness and induration with filling all of the right and left external ear canal. Computed tomography showed osseous lysis of the temporal bone bilaterally. Magnetic resonance imaging of the brain showed the presence of pituitary infiltration. The second case is 2-year-old girl with chronic left otorrhea. Clinical examination objectified the presence of redness and induration in the left mastoid with the presence of an inflammatory polyp filling the entire left external auditory canal. Computed tomography revealed a left temporal bone lysis. Both patients were treated with chemotherapy.

Clinicopathologic profile of sinonasal diseases in a tertiary hospital in Port Harcourt

Background: In a typical ear nose and throat clinic, disease conditions involving the nose and paranasal sinuses are not uncommon. The aim of this study is to determine the clinicopathologic profile of these diseases as it occurs in university of Port Harcourt teaching hospital. Methodology: A retrospective descriptive analysis of all patients with diagnosis of sinonasal disease that presented in the ear nose and throat surgery department of university of Port Harcourt teaching hospital within the period of 5years (from 2016 – 2020). Data retrieved were biodata, clinical features, diagnosis and treatment, these were all collated and analysed. Patients without complete records were excluded. The patients recruited had clinical diagnosis which was aided by radiological investigations and confirmed by histology. Result: A total of 68 patients were studied within the 5year period. There were 35males and 33 females. The mean age was 33.96+/_17.9 years. The age groups 11-20 and 41-50 were more affected. Rhinosinusitis was the commonest condition seen while inflammatory polyp was the commonest histologic diagnosis. Polypectomy with bilateral antrostomy was the commonly done surgery in 26.4% age. Conclusion: Disease of the nose and paranasal sinuses are commonly seen in ENT practice and rhinosinusitis is the commonest entity encountered with inflammatory polyp as the commonest histopathologic finding. Squamous cell carcinoma was the commonest malignant lesion seen occurring more in males. Age distribution of the diseases was statistically significant.

Russell Body Typhlitis: A Case Report and Literature Review

Russell bodies are accumulation of immunoglobulin in plasma cells forming intracytoplasmic inclusions. Russell body colitis is rare with only 3 cases described in the English literature up to date. We report a 78-year-old male with cirrhosis showing prominent cecal infiltration of Russell body containing plasma cells. Plasma cells showed no nuclear atypia or mitoses, and no evidence of light chain restriction. In this article, we report a fourth case of Russell body colitis, that is unique in being localized to the cecum in contrast to the other 3, 1 of which was in an inflammatory polyp in the sigmoid colon, 1 in a rectal tubulovillous adenoma and 1 as part of diffuse gastrointestinal disease. This is therefore the first report of localized Russell body typhlitis, occurring in a cirrhotic patient in whom an adjacent erosion was likely nonsteroidal anti-inflammatory drug-associated, a combination that may have facilitated the formation of Russell bodies.

Histopathological study of nasal masses, a one year retrospective study in a tertiary care centre of Assam

Background: Prolapsed lining of the nasal sinuses are defined as nasal polyp. Diseases of the nasal cavity include viral, bacterial and fungal infections, nasal cavity tumors (benign and malignant) as well as inflammations of the nasal mucosa. This study was undertaken to note the various histopathological patterns of nasal masses, their classification and relative distribution of various lesions with regard to age and sex in our setting.Methods: The study is done for a period of 1 year (July 2018 to June 2019). In this study, 30 patients are selected who presented in our hospital with nasal masses and having multiple types of clinical presentations.Results: Total 30 cases presented as nasal mass. Overall male to female ratio was 2.3:1. Nonneoplastic nasal masses formed the largest group of lesions; 24 cases (80%), followed by 6 cases (20%) of neoplastic nasal masses. Inflammatory polyp was the commonest non neoplastic lesion constituting 22 cases followed by rhinosporidiosis with 2 cases. Out of the 6 neoplastic nasal masses, 5 were benign and 1 was malignant. Out of the benign neoplastic masses, inverted papilloma constituted 3 cases and nasopharyngeal angiofibroma constituted 2 cases. Malignant neoplastic mass was embryonal rhabdomyosarcoma.Conclusions: Nasal obstruction and rhinorrhea are the most common symptoms of presentation. Simple inflammatory nasal polyps are the most common histological pattern seen in our environment, and surgery is the best modality of treatment.

Acute upper airway obstruction as a life-threatening complication of ventral bulla osteotomy: report of two consecutive cases

Case summary This paper presents two cases of acute postoperative upper airway obstruction following ventral bulla osteotomy (VBO) in cats. The first cat underwent a unilateral left-sided VBO for a suspected inflammatory polyp. The second cat underwent a single-session bilateral VBO procedure for bilateral otitis media. In the first case, immediate re-intubation and a gradual lightening of the anaesthetic plane resolved the clinical signs; in the second case, the patient deteriorated and went into acute cardiorespiratory arrest and received cardiopulmonary resuscitation. Both patients recovered well and were discharged home 3 days after surgery. Both cases were reported to show no further clinical signs on postoperative follow-up 3 weeks and 4 months after surgery, respectively. Relevance and novel information Upper airway obstruction should be regarded as a potential complication of VBO in cats.

Manifestaciones gastrointestinales en neurofibromatosis tipo 1. Reporte de un caso

Neurofibromatosis type 1, also known as von Recklinghausen disease, is an inherited neurocutaneous disorder with gastrointestinal involvement in 5-25% of the patients, which develops following cutaneous manifestations. Only 5% have symptoms such as abdominal pain, diarrhea, palpable mass, bleeding, obstruction or intestinal perforation. There is an increased risk of developing digestive malignancies, frequently in the small bowel. The following report presents the case of a patient with neurofibromatosis type 1, with the diagnosis of a jejunal gastrointestinal stromal tumor and a fibroid inflammatory polyp in the context of gastrointestinal bleeding.