A Case of Cap Polyposis with Epidermal Nevus in an Infant

Cap polyposis is extremely rare in children. We report a case of an 11-month-old male infant who visited our hospital because of rectal prolapse and small amount of hematochezia lasting several days. He also had an epidermal nevus in the sacral area. Colonoscopy showed erythematous, multilobulated, circumferential, polypoid lesions with mucoid discharge from the rectum. He was diagnosed with cap polyposis by endoscopy and histologic examination. He was treated with surgical resection, and was closely followed up. In the relevant literature, there is no report of cap polyposis in an infant. We report the first case of cap polyposis in the youngest infant.

Esophageal squamous papillomas with focal dermal hypoplasia and eosinophilic esophagitis

Focal dermal hypoplasia (FDH) is a rare disorder of the mesodermal and ectodermal tissues. Here we present an eight-year-old female known to have FDH who presents with poor weight gain and dysphagia. She was diagnosed with multiple esophageal papillomas and eosinophilic esophagitis. She was successfully treated with argon plasma coagulation and ingested fluticasone propionate, which has not been described previously in a child.

Incidental gallbladder cancer at cholecystectomy

BACKGROUND

Gallbladder tumours rank fifth in the world among gastrointestinal system tumours. Coincidental gallbladder tumours are diagnosed during cholecystectomies, or by examining the cholecystectomy material.

AIMS

In this study, we aimed to evaluate the incidence of gallbladder cancer among patients undergoing cholecystectomies due to gallbladder disease.

STUDY DESIGN

Retrospective study METHODS: The files of 341 patients who had undergone routine cholecystectomy operations between January 2013 and March 2016 were reviewed, and their pathology results were recorded. Those patients with gallbladder carcinomas were evaluated in terms of age, gender, preoperative findings, existing symptoms, radiological findings, surgical findings and follow-up. The cancer invasion depth was classified according to the American Joint Commission on Cancer (AJCC) atlas, and this study was approved by the ethical committee of our university.

RESULTS

Among the 341 patients who participated in this study, 253 (74.41%) were female, 88 (25.80%) were male, and their average age was 49.61 years old (17-86). Seven of the patients (2.05%) had gallbladder tumours; six of which were female, one was male and their average age was 67.71 years old (62-76). One tumour was diagnosed as a frozen specimen during the operation, while the others were diagnosed during the postoperation phase. Three of the patients had T1b and four had T2 tumours.

CONCLUSION

Gallbladder tumours detected incidentally could extend survival rates with proper surgical intervention and chemotherapy. The possibility of a tumour should not be dismissed in those patients with advanced age, females or patients with gallbladder stones. Frozen specimens should be created during a cholecystectomy, and if there is any doubt about the diagnosis, a postoperative histopathological examination of the gallbladder should be conducted.

KEY WORDS

Cholecystectomy, Gall bladder stone, Incidental gallbladder carcinoma.

Pathophysiological and clinical aspects of gastric hyperplastic polyps

Gastric polyps become a major clinical problem because of high prevalence and tendency to malignant transformation of some of them. The development of gastric hyperplastic polyps results from excessive proliferation of foveolar cells accompanied by their increased exfoliation, and they are macroscopically indistinguishable from other polyps with lower or higher malignant potential. Panendoscopy allows detection and differentiation of gastric polyps, usually after obtaining histopathological biopsy specimens. Unremoved gastric hyperplastic polyps may enlarge and sometimes spontaneously undergo a sequential progression to cancer. For this reason, gastric hyperplastic polyps larger than 5 mm in size should be removed in one piece. After excision of polyps with atypical focal lesion, endoscopic surveillance is suggested depending on histopathological diagnosis and possibility of confirming the completeness of endoscopic resection. Because of the risk of cancer development also in gastric mucosa outside the polyp, neighboring fragments of gastric mucosa should undergo microscopic investigations. This procedure allows for identification of patients who can benefit most from oncological endoscopic surveillance. If Helicobacter pylori (H. pylori) infection of the gastric mucosa is confirmed, treatment strategies should include eradication of bacteria, which may prevent progression of intestinal metaplasia. The efficacy of H. pylori eradication should be checked 3-6 mo later.

Two cases of adenocarcinoma occurring in sporadic fundic gland polyps observed by magnifying endoscopy with narrow band imaging

Gastric fundic gland polyps (FGPs) are common non-adenomatous gastric polyps arising from normal fundic mucosa without Helicobacter pylori (H. pylori) infection. Although systemic FGPs associated with familial adenomatous polyposis (FAP) often have dysplasia, there are few reports of dysplasia occurring in sporadic FGPs, especially when detected by magnifying endoscopy with narrow band imaging (ME-NBI). We experienced two cases of adenocarcinoma occurring in sporadic FGPs, and their ME-NBI findings were very useful for differentiating FGP with cancer from non-dysplastic FGP. A 68-year-old man and a 63-year-old woman were referred to our institution for medical checkup. H. pylori was negative in both patients. Endoscopic examination revealed a small reddish polypoid lesion on the anterior wall of the upper gastric body and several FGPs. ME-NBI showed an irregular microvascular architecture composed of closed loop- or open loop-type vascular components, plus an irregular microsurface structure composed of oval-type surface components which was different from that of FGPs. FAP was denied because of the absence of colon polyps and no familial history of FAP. Pathological diagnosis was adenocarcinoma occurring in sporadic FGP.

Causes of endometriosis and prevalent infertility in patients undergoing laparoscopy without achieving pregnancy

BACKGROUND

Endometriosis is a disease with an unknown pathogenesis that can lead to infertility. Endometrial polyps, fibroids, and polycystic ovarian syndrome (PCOS) have relatively high frequency and are causes of infertility. We hypothesized a possible relationship between the presence of polyps, fibroids, and PCOS in infertile women with endometriosis who underwent laparoscopy and did not get pregnant, compared to women in the control group.

METHODS

This study was a cross-sectional study of 1243 infertile patients (621 with endometriosis and 622 controls). Endometriosis, Body Mass Index (BMI), infertility duration, age, and smoking habits were analyzed in relation to the presence of endometrial polyps, fibroids, and PCOS.

RESULTS

Polyps, 1.8 (95% CI 1.3-2.5); fibroids, 2.5 (95% CI 1.5-4.1); and PCOS, 1.0 (95% CI 0.6-1.6 were observed in the endometriosis group. A total of 285 patients (45.9%) were classified presenting endometriosis grades I and II, and 336 patients (54.1%) with grades III and IV. Our findings showed a significant association between the presence of fibroids in 129 women with endometriosis (20.8%), and in 69 (53.9%) with endometriosis grades III and IV (P=0:04). Among the 31 PCOS patients, 24 (77.4%) showed grades I and II (P<0.001).

CONCLUSIONS

Endometriosis and infertility are associated with the presence of polyps and fibroids. Furthermore, associations between the presence of fibroids with endometriosis grades III and IV, and presence of PCOS with grades I and II were observed.

Utility of Voice Therapy in the Management of Vocal Fold Polyps and Cysts

OBJECTIVE: To evaluate the efficacy of voice therapy in the management of vocal fold polyps and cysts.

STUDY DESIGN AND SETTING: Retrospective review of vocal fold cysts and polyps undergoing voice therapy in a tertiary care center. Symptom resolution or persistence resulting in surgical intervention was the main outcome measure.

RESULTS: Fifty-seven patients were identified, of which 49.1% achieved symptom resolution with voice therapy alone. Patients with complete glottal closure and muscle tension dysphonia did not have a better response than those with incomplete glottal closure and without muscle tension dysphonia ( P = 0.1, χ 2 , respectively). Patients with translucent polyps more commonly responded to voice therapy than fibrotic, hyaline, or hemorrhagic polyps, 81.8% versus 15.4% and 25.0% response rate, respectively ( P = 0.002, χ 2 ).

CONCLUSIONS: Voice therapy is an effective treatment modality for vocal fold polyps and cysts.

SIGNIFICANCE: A multidisciplinary approach including a trial of voice therapy is warranted.

The effect of vocal hygiene education for patients with vocal polyp

Objective

The authors aimed to assess the effect of vocal hygiene education for patients suffering with vocal polyp and to discover the meaningful factors that can predict better outcomes with performing vocal hygiene.

Study Design and Setting

Voice evaluation and vocal hygiene education were provided to 340 consecutive patients with vocal polyp. Three months later, 175 of the 340 patients completed a follow-up evaluation. According to the change in polyp size, these patients were divided into two groups: the “improvement” and the “no improvement.” The effect of vocal hygiene was assessed. Eight parameters were compared between these two groups.

Results

The “improvement” group was composed of 20% of the 340 patients and 38% of the 175 patients. Multivariate analyses demonstrated that nonsmokers with a small polyp had the greatest possibility of improvement with vocal hygiene and so avoid unnecessary surgery.

Conclusion

Patients who do not smoke and who have a polyp that is small in size have a much better chance to improve their voice by performing vocal hygiene.

Gastric inverted hyperplastic polyp: A rare cause of iron deficiency anemia

Gastric inverted hyperplastic polyp (IHP) is a rare gastric polyp characterized by the downward growth of hyperplastic mucosal components into the submucosal layer. Macroscopically, a gastric IHP resembles a subepithelial tumor (SET); as a result, accurately diagnosing gastric IHP is difficult. This issue has clinical significance because gastric IHP can be misdiagnosed as SET or as malignant neoplasm In addition, adenocarcinoma can accompany benign gastric IHP. Although in most cases, gastric IHPs are asymptomatic and are found incidentally, these polyps may cause anemia secondary to chronic bleeding. Here, we report one case involving gastric IHP accompanied by chronic iron deficiency anemia that was successfully managed using endoscopic submucosal dissection.

[An early gastric cancer concurrent with a hyperplastic polyp in a patient confirmed negative for Helicobacter pylori]

A 58-year-old man was suspected of having a gastric polyp based on an upper gastrointestinal series. Esophagogastroduodenoscopy showed a gastric polyp, approximately 7mm in diameter, located at the greater curvature of the upper gastric body. Helicobacter pylori testing yielded negative results, and there was no atrophy of the gastric mucosa. Biopsy revealed a well differentiated tubular adenocarcinoma (Group 5). Endoscopic submucosal biopsies were performed, and histopathology revealed a well differentiated tubular adenocarcinoma coexisting with a hyperplastic polyp. Complete en bloc resection was performed, in accordance with the current Japanese guidelines.

A case report of pyloric intussusception secondary to helicobacter pylori hyperplastic polyps

We report a middle age man who presented with intermittent vomiting and loss of weight. Oesophagogastroduodenoscopy showed numerous antral hyperplastic polyps with inaccessible duodenum. Contrast enhanced computed topography demonstrated a classical target sign of intussusception. This finding was later confirmed at laparotomy. This rare presentation and management strategy is discussed.

[The Correlation between the Size of Vocal Polyps, Vocal Nodules and Vocal Dysfunction, before and after Laryngeal Microsurgery]

When we operate on a vocal polyp or a vocal nodule with laryngeal microscopy, we always carefully measure their length and width then multiply the length by the width to get the area. We examined whether there is a correlation between the area of these lesions and the acoustic analysis of voice. Before the surgery and one month post-operation, we checked five acoustic parameters, maximum phonation time (MPT), range of voice, mean air flow rate (MFR) and acoustic analyses (jitter% and shimmer%). By doing this, we could arrive at the improvement rate of each of the five acoustic parameters. We examined whether there was a correlation between the lesion area and acoustic parameters before surgery and the improvement rates of these acoustic parameters. Examinations of polyps showed a correlation between the size and range of voice and Jitter% pre-operation, and showed a correlation between the size and improvement rate of range of voice, MFR, Jitter% and Shimmer% post-operation. On the other hand, examination of nodules showed a correlation only between the size and range of voice pre-operation. Next we examined the correlation between the size and these acoustic parameters in the Elite vocal performer (EVP) group and extra EVP group. In the examinations of polyps, the EVP group showed a lower correlation between the size and acoustic parameters than in the extra EVP group. On the other hand, in the examinations of nodules, correlation between the size and acoustic parameters was low in both the EVP and extra EVP group.

The role of hysteroscopy in unexplained infertility

PURPOSE OF INVESTIGATION

To evaluate pregnancy rate after diagnostic and operative hysteroscopy in nulliparous patients with inter- tility of unknown cause.

MATERIALS AND METHODS

The authors conducted this study on 92 nulliparous patients with unexplained infer- tility that underwent diagnostic hysteroscopy which showed an uterine lesion (submucous fibroids, uterine septa, polyps, synechias) and underwent operative hysteroscopy to remove the lesion between 2007 and 2011. Patients' data were retrospectively extrapolated from patient's charts, then the patients were called to ask if they had pregnancies after hysteroscopic surgery.

RESULTS

The present study showed a significant increase in pregnancy rate after hysteroscopic surgery (85% during the two years after the surgery). The most common endocavitary lesions were endometrial polyps (21%), uterine septa (25%), and submucous myomas (18%).

CONCLUSIONS

Ac- cording to the present data, hysteroscopic evaluation of nulliparous women with unexplained infertility could be useful to detect lesions not diagnosed with other tests, and the treatment of these endocavitary lesions plays an important role in the diagnostic and therapeutic iter. The results show-a pregnancy rate of 85% in the patients treated for endocavitary lesions, but 15% of the patients, despite a normal uterine cavity, continue to have unexplained infertility and are classified as idiopathic infertility.

Multiple Tracheobronchial Polyposis Caused by Tracheobronchopathia Osteochondroplastica

Tracheobronchopathia osteochondroplastica (TO) is a rare benign airway disease that is characterized by the presence of multiple rock-garden-like nodules on bronchoscopy. TO is a slowly progressive disease of the trachea and major bronchi, which is typically characterized by such symptoms as a persistent nonproductive cough, dyspnea and wheezing. The clinical features of TO are variable, and asymptomatic patients may incidentally be diagnosed during the work-up for other diseases. We herein report a rare case of TO accompanying multiple tracheobronchial polyposis in which bronchoscopic resection of the airway polyp using a high-frequency snare was successfully performed.

Is there an association between serum vitamin D levels and endometrial polyps?

BACKGROUND/AIM

Anti-proliferative effects of vitamin D (VD) had been proposed previously. Herein, the authors aimed to evaluate serum 25(OH)VitD3 levels in women with endometrial polyps (EPs) and to determine whether VD deficiency is a risk factor for EP formation.

MATERIALS AND METHODS

This study was designed as a controlled cross-sectional study. Forty three women with polyps constituted the study group whereas 47 of them constituted the control group. The selection criteria for the study group were hysteroscopic detection and histological confirmation of EPs. The main parameters recorded for each woman were; age, body mass index (BMI), par- ity, smoking status, co-morbidities, dressing style, dairy intake of VD-rich foods, duration of sunlight exposure, skin photo-type, serum levels of 25(OH)VitD3, calcium, phosphor, and albumin.

RESULTS

The mean serum 25(OH)VitD3 level was 8.3±7.7 ng/ml in the study group and 9.3 ± 10.2 ng/ml in the control group (p = 0.583). Mean BMI was statistically significantly higher in the study group (p = 0.003). Logistic regression model showed that only significant risk factor for EPs was increased BMI (OR=1.241; 95% CI = 1.070-2.440; p = 0.004).

CONCLUSION

VD deficiency is common among the reproductive age women and obesity is the most important risk factor for polyp formation. The authors believe that there is no relation between VD and EPs.

[CHANGES OF HISTOSTRUCTURE OF CHRONIC ANAL FISSURE, DEPENDING ON DURATION OF THE DISEASE]

The results of histological investigation of the chronic anal fissure (AF) edges in 95 patients with the disease duration from 6 mo to 4.5 yrs were analyzed. Basing on estimation of severity of an acute inflammation signs and the granulation and cicatricial tissue presence there was established, that duration of an acute inflammation in the AF may constitute up to 6 - 7 mo; subacute--from 8 to 11 mo, chronic cicatricial process was observed in terms from 12 mo and more.

The effect of endometrial polyps on pregnancy rates in intracytoplasmic spenn injection cycles

OBJECTIVE

The purpose of this study was to determine reproductive results of intracytoplasmic sperm injection (ICSI) for different endometrial polyps subgroup divided according to polyp size and number.

MATERIALS AND METHODS

Eighty-three primer infertile patients were retrospectively analyzed. Group A consisted of 36 patients having an endometrial polyp with a diameter ≤ one cm; whereas 47 patients were included in Group B who had a polyp with a diameter > one cm or more than one polyps. All patients underwent a hysteroscopic polypectomy and ICSI treatments were started in the following cycle.

RESULTS

Pregnancy was achieved in 16 patients (44.4%) in Group A and 23 patients (48.9%) in Group B. The pregnancy ratios did not reveal a statistically significant difference between the two groups.

CONCLUSION

The authors concluded that in patients who have undergone hysteroscopic polypectomy before the Intracytoplasmic sperm injection (ICSI) cycle, the pregnancy rates do not depend on the diameter of the endometrial polyps.

FIBROVASCULAR POLYP: AN UNUSUAL MASS IN THE ESOPHAGUS CAUSING DYSPHAGIA

We present a case of a 56-year-old Caucasian women with long-standing gastroesophageal reflux disease complicated with non-dysplastic Barrett's esophagus and stricture presented with difficulty in swallowing.

Vabrasio is a reliable test to rule out endometrial cancer

INTRODUCTION

Endometrial cancer is the most common gynaecological cancer in Denmark, and its incidence peaks in the postmenopausal years. The aim of the present study was to evaluate the effectiveness of vacuum aspirator (vabrasio) for the detection of endometrial cancer in terms of sensitivity, specificity and predictive value.

METHODS

A cohort counting 503 women who had vabrasio was evaluated retrospectively. The women included were consecutive patients who had received vabrasio at the Department of Gynaecology and Obstetrics at Herning Hospital, Denmark, during a two-year period. They were identified by searching the hospital database for the International Classification of Diseases, tenth version (ICD-10) code for vabrasio.

RESULTS

The indications for vabrasio were postmenopausal bleeding (45%), meno/metrorrhagia (43%) and thickened endometrium/polyp (6%). The first evaluation by vabrasio was normal in 381 women (76%), insufficient in 83 women (17%), 22 (4%) had endometrial cancer and 17 (3%) had another non-malignant diagnosis. The first evaluation for cancer with vabrasio had a sensitivity of 81%, a specificity of 100% and predictive values of 100% (positive) and 99% (negative).

CONCLUSION

Vabrasio has a good diagnostic reliability with respect to endometrial cancer, but has some shortcomings due to insufficient sampling for diagnosis.

FUNDING

none.

TRIAL REGISTRATION

not relevant. Danish Data Protection Agency: case no.: 1-16-02-601-14.

[Hysteroscopic polypectomy, treatment of abnormal uterine bleeding]

OBJECTIVES

To evaluate the effectiveness of the hysteroscopic polypectomy in terms of the decrease of the abnormal uterine bleeding.

METHODS

A cross-sectional and analytical study was done with patients to whom a hysteroscopic polypectomy was done for treating the abnormal uterine bleeding, between January 2009 and December 2013. The response to the treatment was evaluated via a survey given to the patients about the behavior of the abnormal uterine bleeding after the procedure and about overall satisfaction.

RESULTS

The results were obtained after a hysteroscopic polypectomy done to 128 patients and were as follows. The average time from the polypectomy applied until the survey was 30.5 months, with a standard deviation of 18 months. 67.2% of the patients reported decreased abnormal uterine bleeding and the 32.8% reported a persistence of symptoms. On average 82.8% of the. patients were satisfied with the treatment. Bivariate and multivariate analysis showed no association between the variables studied and no improvement of abnormal uterine bleeding after surgery (polypectomy). There were no complications.

CONCLUSION

Hysteroscopic polypectomy is a safe surgical treatment, which decreases on two of three patients the abnormal uterine bleeding in the presence of endometrial polyps, with an acceptable level of satisfaction.

True left-sided gallbladder with variations of bile duct and cholecystic vein

A left-sided gallbladder without a right-sided round ligament, which is called a true left-sided gallbladder, is extremely rare. A 71-year-old woman was referred to our hospital due to a gallbladder polyp. Computed tomography (CT) revealed not only a gallbladder polyp but also the gallbladder located to the left of the round ligament connected to the left umbilical portion. CT portography revealed that the main portal vein diverged into the right posterior portal vein and the common trunk of the left portal vein and right anterior portal vein. CT cholangiography revealed that the infraportal bile duct of segment 2 joined the common bile duct. Laparoscopic cholecystectomy was performed for a gallbladder polyp, and the intraoperative finding showed that the cholecystic veins joined the round ligament. A true left-sided gallbladder is closely associated with several anomalies; therefore, surgeons encountering a true left-sided gallbladder should be aware of the potential for these anomalies.

Outpatient versus inpatient uterine polyp treatment for abnormal uterine bleeding: randomised controlled non-inferiority study

OBJECTIVE

To compare the effectiveness and acceptability of outpatient polypectomy with inpatient polypectomy.

DESIGN

Pragmatic multicentre randomised controlled non-inferiority study.

SETTING

Outpatient hysteroscopy clinics in 31 UK National Health Service hospitals.

PARTICIPANTS

507 women who attended as outpatients for diagnostic hysteroscopy because of abnormal uterine bleeding and were found to have uterine polyps.

INTERVENTIONS

Participants were randomly assigned to either outpatient uterine polypectomy under local anaesthetic or inpatient uterine polypectomy under general anaesthesia. Data were collected on women's self reported bleeding symptoms at baseline and at 6, 12, and 24 months. Data were also collected on pain and acceptability of the procedure at the time of polypectomy.

MAIN OUTCOME MEASURES

The primary outcome was successful treatment, determined by the women's assessment of bleeding at six months, with a prespecified non-inferiority margin of 25%. Secondary outcomes included generic (EQ-5D) and disease specific (menorrhagia multi-attribute scale) quality of life, and feasibility and acceptability of the procedure.

RESULTS

73% (166/228) of women in the outpatient group and 80% (168/211) in the inpatient group reported successful treatment at six months (intention to treat relative risk 0.91, 95% confidence interval 0.82 to 1.02; per protocol relative risk 0.92, 0.82 to 1.02). Failure to remove polyps was higher (19% v 7%; relative risk 2.5, 1.5 to 4.1) and acceptability of the procedure was lower (83% v 92%; 0.90, 0.84 to 0.97) in the outpatient group Quality of life did not differ significantly between the groups. Four uterine perforations, one of which necessitated bowel resection, all occurred in the inpatient group.

CONCLUSIONS

Outpatient polypectomy was non-inferior to inpatient polypectomy. Failure to remove a uterine polyp was, however, more likely with outpatient polypectomy and acceptability of the procedure was slightly lower.

TRIAL REGISTRATION

International Clinical Trials Registry 65868569.

Surgical intervention versus expectant management for endometrial polyps in subfertile women

BACKGROUND

Endometrial polyps, which are benign growths of the endometrium, may be a factor in female subfertility. Possible mechanisms include physical interference with gamete transport, alteration of the endometrial milieu and unresponsiveness to the cyclical global endometrial changes. As such polyps remain mostly asymptomatic, their diagnosis is often incidental during routine investigations prior to embarking on assisted reproductive treatment. Transvaginal sonography, hysterosalpingography and saline infusion sonography are the diagnostic tools most commonly employed. However, hysteroscopy remains the gold standard for diagnosis, as well as for treatment. Due to the possible effect of endometrial polyps on fertility, their removal prior to any subfertility treatment is widely practiced.

OBJECTIVES

To determine the effectiveness and safety of removal of endometrial polyps in subfertile women.

SEARCH METHODS

Electronic databases were searched, including the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL and trial registers. The reference lists of identified articles were checked. The last search was performed on 30 July 2014.

SELECTION CRITERIA

Only randomised controlled trials, reporting pregnancy or live birth rates and complication rates as primary or secondary outcomes, in which polyps were removed surgically prior to treatment of subfertility were eligible for inclusion. The diagnosis of endometrial polyps was required to be made by transvaginal ultrasound, hysterosalpingography, saline infusion, sono-hysterography or hysteroscopy. Any surgical technique of polyp removal was acceptable, with no intervention in the control groups.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened the titles, abstracts and full articles to assess their suitability for inclusion in this review. Quality assessment was attempted independently by two authors with discrepancies being settled by consensus or consultation with a third review author.No data extraction was performed due to the absence of useable data in the one eligible study. If there had been data to include, two review authors would have independently extracted the data from the studies using a data extraction form designed and pilot tested by the authors. Any disagreements would have been resolved by discussion or by a third review author.

MAIN RESULTS

Only one randomised controlled trial of endometrial polypectomy was identified for inclusion. However, a single set of data could not be extracted from this study due to internal inconsistencies of the results reported. Attempts to contact the authors to resolve the issue were unsuccessful, by phone, post and e-mail.

AUTHORS' CONCLUSIONS

Removal of endometrial polyps in subfertile women is commonly being performed in many countries with an aim to improve the reproductive outcome. We did not identify any analysable randomised trials which would allow us to reach any sound scientific conclusions on the efficacy of endometrial polypectomy in subfertile women. Well designed, methodologically sound, randomised controlled trials are urgently needed.

[Expression and significance of p63, aromatase P450 and steroidogenic factor-1 in endometrial polyp]

OBJECTIVE

To investigate the expression and signification of p63, aromatase P450 (P450 arom) and steroidogenic factor-1 (SF-1) in endometrial polyp, and to explore its role in the pathogenesis of endometrial polyp.

METHODS

Specimen were collected from hysteroscopic resection, pathologically confirmed endometrial polyp specimens of 30 cases of endometrial polyp and the adjoining endometrium around endometrial polyp in 20 cases, endometrial tissue of normal control group of 25 patients. Immunohistochemistry SP method and real- time PCR technology were used to detect the three groups in the expression of p63, P450 arom and SF- 1 protein and gene.

RESULTS

P450arom gene (0.274 ± 0.082) and protein (1.2 ± 1.1) expression in endometrial polyp was significantly higher than the adjoining endometrium and normal endometrium (P < 0.05); the expression of SF- 1 protein (1.1 ± 0.8) and p63 protein (0.8 ± 0.5) were also higher in the endometrial polyp than the other two control groups (P < 0.05); while the expression of SF-1 mRNA (0.105 ± 0.049 versus 0.053 ± 0.043) and p63 mRNA (0.261 ± 0.052 versus 0.180 ± 0.018) in endometrial polyp had no significant difference between endometrial polyp and the adjoining endometrial (P > 0.05).

CONCLUSION

p63, P450 arom and SF-1 may play a role in the formation of endometrial polyp.

Antenatal mild hydronephrosis with subsequent polyp of the upper ureter in a child presenting with recurrent Dietl's crisis

We report a 7-year-old boy who had antenatally diagnosed and postnatally confirmed asymptomatic right congenital hydronephrosis secondary to ureteropelvic junction obstruction with the anteroposterior diameter ranging from 7 to 15 mm on serial ultrasound scans till the age of 6 years. He then presented with recurrent attacks of Dietl's crisis almost every month in the seventh year of his life and eluded diagnosis for over a year at various national hospitals, and ended up with an international referral to us. Investigations of the acute attacks clinched the diagnosis of ureteral polyp causing intermittent crisis and he underwent segmental resection and reconstruction in the form of dismembered Anderson-Hyne pyeloplasty with good recovery. Our case revealed that prenatally detected hydronephrosis may worsen after spontaneous postnatal improvement and a polyp acting as a flip valve may produce intermittent hydronephrosis and symptoms later in life. The child should undergo urgent investigations during acute symptoms.

Clinical significance of colonoscopy in patients with upper gastrointestinal polyps and neoplasms: a meta-analysis

BACKGROUND

Some authors have studied the relationship between the presence of polyps, adenomas and cancers of upper gastrointestinal tract (stomach and duodenum) and risk of colorectal polyps and neoplasms; however, the results are controversial, which may be due to study sample size, populations, design, clinical features, and so on. No meta-analysis, which can be generalized to a larger population and could provide a quantitative pooled risk estimate of the relationship, of this issue existed so far.

METHODS

We performed a meta-analysis to evaluate risk of colorectal polyps or neoplasms in patients with polyps, adenomas or cancers in upper gastrointestinal tract comparing with controls. A search was conducted through PubMed, EMBASE, reference lists of potentially relevant papers, and practice guidelines up to 27 November 2013 without languages restriction. Odd ratios (ORs) were pooled using random-effects models.

RESULTS

The search yielded 3 prospective and 21 retrospective case-control studies (n = 37152 participants). The principal findings included: (1) OR for colorectal polyps was 1.15 (95% CI, 1.04-1.26) in the gastric polyps group comparing with control groups; (2) Patients with gastric polyps and neoplasms have higher risk (OR, 1.31 [95% CI, 1.06-1.62], and 1.72 [95% CI, 1.42-2.09], respectively) of colorectal neoplasms comparing with their controls; and (3) Positive association was found between the presence of colorectal neoplasms and sporadic duodenal neoplasms (OR, 2.59; 95% CI, 1.64-4.11).

CONCLUSIONS

Findings from present meta-analysis of 24 case-control studies suggest that the prevalence of colorectal polyps was higher in patients with gastric polyps than in those without gastric polyps, and the risk of colorectal neoplasms increases significantly in patients with gastric polyps, neoplasms, and duodenal neoplasms. Therefore, screening colonoscopy should be considered for patients with upper gastrointestinal polyps and neoplasms.

Gallbladder cancer

Gallbladder cancer remains a relatively rare malignancy with a highly variable presentation. Gallbladder cancer is the most common biliary tract malignancy with the worst overall prognosis. With the advent of the laparoscope, in comparison with historical controls, this disease is now more commonly diagnosed incidentally and at an earlier stage. However, when symptoms of jaundice and pain are present, the prognosis remains dismal. From a surgical perspective, gallbladder cancer can be suspected preoperatively, identified intraoperatively, or discovered incidentally on final surgical pathology.

Morules in fundic gland polyposis: a case report

Morular metaplasia has been exceptionally described in the stomach. We report the formation of morules in a case of sporadic fundic gland polyposis with low grade dysplasia in a 47 year old woman that underwent total gastrectomy. The immunophenotype of the morules was CD10, CDX2, Beta-catenin nuclear positive; p63, Ki67, chromogranin, synaptophysin, Ck20 negative. The presence of morules in a neoplasm know to be associated with the disruption of wnt/β-catenin pathway is discussed. The report provides the first description of the immunophenotype of morules in the stomach and hypothesizes the biological similitude of fundic gland polyposis to other tumors characterized by morules formation and wnt/β-catenin pathway dysfunction.

Successful endoscopic submucosal dissection of a giant polyp in a 21-month-old female

Endoscopic submucosal dissection (ESD) is now recognized as the preferred treatment modality for gastrointestinal epithelial lesions. A 21-month-old female was admitted with a giant hyperplastic polyp causing a gastric outlet obstruction. Successful ESD was performed with caution. The post-procedural course was uneventful without a bleeding episode. Although further study of the feasibility of ESD in early children is necessary, ESD could be applied to avoid laparotomy even in young children.

Predictors of malignancy in endometrial polyps: a multi-institutional cohort study

PURPOSE OF INVESTIGATION

The risk of endometrial cancer in women with endometrial polyps (EPs) has been reported to vary between 0.3% and 4.8%. There is a lack of data about the management of asymptomatic women with incidental diagnosis of EPs. In the present study the authors correlated demographic and clinical characteristics with histopathological features of the EPs hysteroscopically removed.

MATERIALS AND METHODS

An observational multi-institutional cohort study was conducted from February 2010 to December 2012 to identify all the premenopausal and postmenopausal women consecutively undergoing hysteroscopic polypectomy. The data of women were reviewed and clinical features were related to histopathologic results.

RESULTS

The patients recruited were 813. The mean age was 52.5 years (range 22-87). The results showed a correlation between older age, high body mass index (BMI) and obesity, postmenopausal state, abnormal uterine bleeding (AUB), hypertension, and risk of malignant EPs. On multivariable analysis, the correlation remained only for age (OR 1.08, 95% CI 1.03 - 1.14) and AUB (OR 3.53, 95% CI 1.87 - 6.65).

CONCLUSION

Older patients in postmenopausal status with AUB, a high BMI, and hypertension are at higher risk for premalignant and malignant polyps. In these patients a surgical approach should be used, consisting in hysteroscopical removing of the polyp.

[Diagnostics of olfactory disorders in the patients with Parkinson's disease and polypous sinusitis with the use of the Sniffin' Sticks test]

The objective of the present study was the characteristic of the sense of smell and comparison of its peculiarities in the patients presenting with Parkinson's disease and polypous sinusitis based on the results of otorhinolaryngological examination with the use of the Sniffin' Sticks test. A total of 31 patients with polypous rhinosinusitis (PRS) (18 men and 17 women at the age of 44-58 years ) and 97 patients with Parkinson's disease (PD) (47 men and 50 women at the age of 50-56 years) were enrolled in the study. It was shown that 85% of the patients with PRS and PD suffered from olfactory disorders. The evaluation of selected parameters determined by the Sniffin' Sticks test demonstrated the impairment of the sense of smell in 48% of the patients with PRS and in 54% of those having PD. The main difference between the two groups was in the odour threshold that was reduced in 97% of the patients with PRS and in 72% of the cases with PD and in the ability to distinguish between odours that was compromised in 37% and 78% of these patients respectively.

Severe gastric impaction secondary to a gastric polyp in a horse

A 13-year-old Percheron gelding was presented for refractory gastric impaction. At necropsy a pedunculated 10 cm × 11 cm × 14 cm mass, histologically identified as an inflammatory polyp, was suspected to have been partly obstructing the pylorus. This is the first report of a polyp resulting in gastric outflow obstruction in a horse.

[Benign gallbladder polyp is a rare cause of haemobilia]

Haemobilia can present with gastrointestinal bleeding, biliary colic and jaundice. Causes include trauma, iatrogenic causes, calculi, inflammation, vascular malformations and neoplasms. Benign gallbladder polyp is a very rare cause. A 63-year-old male with suspected gallbladder cancer due to the results from ultrasound scanning and computed tomography presented with epigastric pain, vomiting, weight loss, dizziness, sweating, fatigue, black stool and low haemoglobin level. Gastroscopy and colonoscopy were normal. Surgery revealed a gallbladder with inflammation, fibrosis, haemorrhage, blood clot and a 2 cm pedunculate polyp with no signs of dysplasia or malignant invasion.

Cap polyposis: A rare cause of rectal bleeding in children

AIM: To evaluate the clinicopathological features and treatment outcomes of cap polyposis in the pediatric population.

METHODS: All pediatric patients with histologically proven diagnosis of cap polyposis were identified from our endoscopy and histology database over a 12 year period from 2000-2012 at our tertiary pediatric center, KK Women’s and Children’s Hospital in Singapore. The case records of these patients were retrospectively reviewed. The demographics, clinical course, laboratory results, endoscopic and histopathological features, treatments, and outcomes were analyzed. The study protocol was approved by the hospital institutional review board. The histological slides were reviewed by a pediatric histopathologist to confirm the diagnosis of cap polyposis.

RESULTS: Eleven patients were diagnosed with cap polyposis. The median patient age was 13 years (range 5-17 years); the sample included 7 males and 4 females. All of the patients presented with bloody stools. Seven patients (63%) had constipation, while 4 patients (36%) had diarrhea. All of the patients underwent colonoscopy and polypectomies (excluding 1 patient who refused polypectomy). The macroscopic findings were of polypoid lesions covered by fibrinopurulent exudates with normal intervening mucosa. The rectum was the most common involvement site (n = 9, 82%), followed by the rectosigmoid colon (n = 3, 18%). Five (45%) patients had fewer than 5 polyps, and 6 patients (65%) had multiple polyps. Histological examination of these polyps showed surface ulcerations with a cap of fibrin inflammatory exudate. Four (80%) patients with fewer than 5 polyps had complete resolution of symptoms following the polypectomy. One patient who did not consent to the polypectomy had resolution of symptoms after being treated with sulphasalazine. All 6 patients with multiple polyps experienced recurrence of bloody stools on follow-up (mean = 28 mo).

CONCLUSION: Cap polyposis is a rare and under-recognised cause of rectal bleeding in children. Our study has characterized the disease phenotype and treatment outcomes in a pediatric cohort.

Gastric xanthoma with hyperplastic polyp: a case report

Gastric xanthoma is uncommon lesion with a variably reported frequency. Hyperplastic polyps are commonest epithelial polyps in stomach. A rare case of simultaneous presence of xanthoma with hyperplastic polyp is reported. A 70-year-old female presented with dyspepsia and heartburn. Upper gastro-intestinal endoscopy showed multiple sessile small whitish polyps in stomach. Histopathological examination of the polyps-showed features of xanthoma with hyperplastic polyp in the mucosa with areas of intestinal metaplasia and occasional H pylori. There was no evidence of malignancy in the present case.

Portal hypertensive polyps: distinct entity

INTRODUCTION

Gastric mucosal changes in portal hypertension (PH) are well known, but gastroduodenal polyps in PH are rarely described.

AIM

This study aims to estimate prevalence of upper gastrointestinal (GI) polyps in patients with PH of any etiology and to evaluate the role of angiogenesis in portal hypertensive polyps.

MATERIAL AND METHODS

This is a retrospective analysis of all patients undergoing upper GI endoscopy to compare the etiology of the polyps in the portal hypertensive group vs. those without PH. The diagnosis of polyps was done using standard histological criteria. Another part of the study consisted of prospective analysis of vascular proliferative marker CD 34 and morphometry in 47 patients.

RESULTS

A total of 3,811 upper GI endoscopies were done of which 121 patients (3.2 %) had polyps in upper GI tract. In patients with PH (=631), polyps were noted in 16, portal hypertensive polyps in 9, hyperplastic in 6, and fundic gland polyp in 1. In the patients without PH (n = 3,180), polyps of various etiologies were noted in 105 patients. The prevalence of polyps of all causes was similar in both groups (2.5 % vs. 3.3 %, p = 0.3957). Prevalence of hyperplastic polyps was similar in PH (0.95 %) and non-PH group (1.3 %). On immunohistochemistry, PH polyps and PH gastric mucosa had significantly higher vessel diameter of >50 μm, increased vascular density as compared to non-portal hypertensive polyps (PHP) and normal gastric mucosa.

CONCLUSION

PHP are definite identifiable lesion in patients of cirrhosis with PH. PHP are probably related to increased angiogenesis in gastric mucosa.

Optıc neuropathy secondary to inflammation of sphenoidal sinuses and Onodi cell polyps: a case report

An inflammation or injury to optic nerve anywhere its pathway by extrinsic lesions causes the optic neuropathy. These lesions are more effective in confined spaces like optic canal, orbital apex. We present a 61 year old woman with optic neuropathy due to lesion in an Onodi cell. In this case patient presented with progressive loss of vision in her right eye within a few days. Computed tomography (CT) revealed mucosal thickening and inflammatory signs in right sphenoid sinus and presence of Onodi cell in that side. Magnetic Resonance Imaging confirmed compression to the optic nevre. Systemic antibioterapy and endoscopic sinus surgery was performed. Postoperatively, the visual acuity and control CT views were better than initial findings. Histopathologic evaluation revealed polyps in Onodi cell. Ophthalmologists should be aware of the Onodi cell pathologies that caused compressive optic neuropathy.

Comorbidity of recurrent aphthous stomatitis and polyps ventriculi

As it is known, many diseases of gastric system cause changes in the oral cavity, with either pathological findings or subjective impressions. When these changes are of pathological nature, the most common finding is recurrent aphthous stomatitis on the tongue, which emerges as a consequence of gastric diseases. Recurrent aphthous stomatitis is a disorder characterised by recurrent ulcerations limited to the oral mucosa, without any other signs of diseases. According to their clinical form, they may be big, small and hyperform. Etiology of recurrent aphthae is genetic predisposition, systemic diseases (virus, certain vitamin deficiency, gastric disorders), and autoimmune disorder and psychogenesis. The symptoms include a prodromal burning sensation and ulceration emerging within 24-48 hours as round symmetrical lesions inflicting the entire oral cavity except for palate and gingiva. Polyps ventriculi are tumours on the gastric mucosa. They can lie on a broad background or hang on the stem, and may be both individual and clustered at the same time. They are more common with elderly male population. They may have a malignant alteration. According to WHO, they have been classified as hyperplastic and neoplastic polyps. Etiology of polyps is atrophic gastritis or H. pylori.

Value of 3-dimensional and power Doppler sonography for diagnosis of endometrial polyps

OBJECTIVES

To investigate whether the endometrial thickness, endometrial volume, and endometrial and subendometrial vascularization index, flow index, and vascularization-flow index were useful for diagnosing endometrial polyps in infertility.

METHODS

Transvaginal and 3-dimesional power Doppler sonography was performed to calculate the endometrial echogenicity, endometrial thickness, endometrial volume, and endometrial and subendometrial vascularization index, flow index, and vascularization-flow index, followed by hysteroscopy in the follicular phase of the menstrual cycle (postmenstrual days 3-7). A total of 555 patients were selected, and 4 groups were defined according to the comparison of sonographic and hysteroscopic diagnoses: group A (sonographically positive but hysteroscopically negative), group B (sonographically and hysteroscopically negative), group C (sonographically negative but hysteroscopically positive), and group D (sonographically and hysteroscopically positive).

RESULTS

A total of 426 patients were enrolled in the final analysis. Significantly higher endometrial thickness and volume were found in groups C and D compared with groups A and B (P < .05). There were no significant differences among the 4 groups in terms of the endometrial and subendometrial vascularization index, flow index, and vascularization-flow index (P > .05). The sensitivity, specificity, and positive and negative predictive values of endometrial thickness and volume in predicting endometrial polyps were 62.7%, 69.8%, 26.9%, and 91.9% and 39.3%, 88.2%, 35.8%, and 89.7%, respectively. Combined sonographic evaluation (sonographic echogenicity, endometrial thickness, and endometrial volume) showed higher sensitivity, specificity, and positive and negative predictive values (65.6%, 89.0%, 50.0%, and 93.9%) compared with a single indicator.

CONCLUSIONS

A combination of endometrial echogenicity, thickness, and volume on sonography may be better than a single indicator for predicting endometrial polyps in infertility. However, the endometrial or subendometrial vascularization index, flow index, and vascularization-flow index are not useful for prediction.

Ureteral fibroepithelial polyp causing urinary obstruction

Ureteral polyps are rare causes of ureteropelvic junction (UPJ) obstruction, particularly in children. We report a nine year-old boy with UPJ obstruction initially suggestive of an obstructive urinary stone. CT showed intraureteral calcification at the UPJ and hydronephrosis. A retrograde pyelogram showed narrowing at the UPJ and partial obstruction that was found to be a ureteral polyp. This case illustrates a rare cause of UPJ obstruction that should be considered when the imaging findings and presentation are atypical for more common etiologies of ureteral obstruction.

Cap-polyposis-like gastropathy with hypoproteinemia treated with H. pylori eradication

We herein report the case of a 43-year-old man with distinct gastropathy and hypoproteinemia treated with H. pylori eradication therapy. Most reported cases of protein-losing gastropathy are divided into Ménétrier's disease (MD) and diffuse varioliform gastritis (DVG). Our patient presented with leg edema due to marked hypoalbuminemia, which we ascribed to distinct gastropathy with novel endoscopic findings resembling cap polyposis in the colon, apparently different from both MD and DVG. H. pylori eradication therapy promptly induced the normalization of laboratory data and mucosal healing. Our case together with two previously published similar cases may contribute to establishing an association between cap-polyposis-like-gastropathy with hypoproteinemia and H. pylori.