담낭 용종성 병변에 대한 복강경 담낭절제술의 적응증 및 유용성

박무신,정진호,이종인,신혁재 대한내시경복강경외과학회 2011 Journal of Minimally Invasive Surgery Vol.14 No.2

Purpose: Polypoid lesions of the gallbladder have a range of causes. A problem exists in the selection of patients for surgery. This study examined the usefulness of laparoscopic cholecystectomy, suspected risk factors and plan of patients with gallbladder polyps. Methods: This study examined 57 patients who underwent laparoscopy cholecystectomy with gallbladder polyps. All patients had been diagnosed preoperatively by ultrasound and abdominal computed tomography between October 2001 and October 2010. Preoperative radiologic diagnosis, age, gender, symptoms, size of polyps, number, concurrent gallstones and histological diagnosis of the polyps as well as the postoperative complications were reviewed retrospectively. The operation indications were polyps >10 mm, age above 55 years, symptomatic polyps, coincidence of a stone, focal thickening of gallbladder wall and detection during other operations. Results: The number of each type of polyp lesion of the gallbladder was as follows: 26 cases (45.6%) had cholesterol polyps, 2 cases (3.6%) inflammatory polyps, 1 case (1.7%) mucosal lymphoid follicles, 12 cases (21.1%) adenomatous polyps, 1 case (1.7%) adenocarcinoma. Non-neoplastic and neoplastic polyps accounted for 50.9% and 22.8%, respectively. Forty-eight cases had an accepted operative indication and underwent surgery. The nine other cases also underwent surgery. Among those with operative indications, 27.1% had neoplastic polyps. Of the patients who had non-indication operative surgery or polyps <5 mm in size, there were non neoplastic polyps in any cases. Two of the patients developed complications; wound infection (1 case), and common bile duct obstruction (1 case). Conclusion: Observation and careful surgery is necessary for patients with polyps <5 mm in size, and who do not have accepted operative indications. Laparoscopic cholecystectomy can be considered an adequate treatment for patients with accepted operative indications.

High Rate of Advanced Colorectal Polyps in a 10-Year-Long Retrospective Study in Qazvin, Iran

Hajmanoochehri, Fatemeh,Mohammadi, Navid,Rasoli, Bashir,Ebtehaj, Mehdi Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.22

Background: Polyps are common lesions in the gastrointestinal (GI) tract. Colon cancer is mostly a result of progression from polyps. The present study aimed to evaluate demographic, clinical, and histological characteristics of colorectal polyps in Iran, particularly neoplastic and advanced types. Materials and Methods: Over a period of 10 years, specimens of all colorectal polyps obtained from colonoscopy were studied. The variables subjected to statistical analysis were age, sex, and the chief clinical complaint of the patients who underwent colonoscopy, their motivation, and the site, size, and histological types of detected polyps. The level of significance was set at p value <0.05. Results: Data were obtained from a total of 352 patients. No difference was seen between male and female patients regarding histological types. Only in nine patients was screening the reason for colonoscopy. Almost two-thirds (66.2%) of the polyps were neoplastic. Familial polyposis syndrome and inflammatory bowel disease were seen in 4.3% and 3.0% of the patients with neoplastic polyps, respectively. Sites of polyps were the sigmoid, rectum, and descending colon in 40.1%, 34.5%, and 17% of the cases, respectively. The advanced type made up 58.8% of neoplastic polyps. Only 3.6% of the patients undergoing colonoscopy in the study period had biopsied polyps. Discussion: No difference was observed between male and female patients in terms of overall incidence of polyps, histological and anatomical profiles, and mean age distribution. Anatomical and histological profiles agreed with the studies performed in areas with a low risk of colon cancer. The findings show that colonoscopy was not performed when it was necessary. A meaningful increase in the number polyp biopsy cases and a corresponding decrease in polyp size in the last few years of the study can be associated with the presence of more GI specialist clinicians in hospital centers, and this holds out much hope for the further improvement of the situation in the future.

Prevalence and Characteristics of Colorectal Polyps in Symptomatic and Asymptomatic Iranian Patients Undergoing Colonoscopy from 2009-2013

Iravani, Shahrokh,Kashfi, Seyed Mohammad Hossein,Azimzadeh, Pedram,Lashkari, Mohammad Hossein Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.22

Background: Colorectal cancer is the third most common type of cancer in males and the second in females in Iran. Males are more likely to develop CRC than women and age is considered as a main risk factor for colorectal cancer. Prevalence of colorectal cancer has been increasing in Asian countries. Aim: The object of this study was to determine the clinical and pathology characteristics of colorectal polyps in Iranian patients and to investigate the variation between our populations with other populations. Materials and Methods: A total of 167 patients with colorectal polyps were included in our study. All underwent colonoscopy during 2009-2013 and specimens were taken through polypectomy and transferred to pathology. All data in patient files including pathology reports were collected and analyzed by SPSS 16 software. A two-tailed test was used and a P-value of < 0.05 was considered significant. Results: Mean age of participants was $57{\pm}15$. Some 84 were females (50.3%) and 83 males (49.7%). Total of 225 polyps were detected which 119 (52.9%) were in males and 106 (47.1%) were in females. Solitary polyps were observed in 124 patients (74%), 26 (15.6%) had two polyps and 17 (10.1%) with more than two polyps (three to five). Rectosigmoid was the site of most of the polyps (63.1%), followed by 19.6% in the descending colon, 7.6% in the transverse, 5.8% in the ascending, and 3.1% in the cecum, data being missing in two cases. Conclusions: Recto sigmoid was site of most of the polyps. The most prevalent type of lesion was adenomatous polyps detected in 78 (34.7%). Mixed hyperplastic adenomatous type observed in 70 (31.1%). This high prevalence of adenomatous polyps in Iranian patients implies the urgent need for screening plans to prevent further healthcare problems with colorectal cancer in the Iranian population.

하부대장 과형성 용종의 의의

김종극(Jong Guk Kim),이창홍(Chang Hong Lee),박영태(Young Tae Bak),김진호(Jin Ho Kim),김재선(Jae Seon Kim),변관수(Kwan Soo byun),지종대(Jong Dae Ji),송훤택(Hwun Taig Song) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4

N/A Adenomatous polyps are known to be precursors for cancer, and identifying of persons with adenomatous polyps is practically important because these individuals should constitute a disproportionate percentage of persons destined to have colorectal cancer. There is enough reason to believe that regclar endoscopic screening of persons with adenomatous polyps and removal of these polyps can reduce the incidence of colorectal cancer. But hyperplastic colonic polyps are generally regarded as being of little or no clinical consequence. Recentlyl, however, controversy has not been settled down on the significance of distal colonic hyperplastic polyp as a marker for proximal colonic adenomatous polyp (s). To establish the prevalence of proximal neoplasms in subjects with or without hyperplastic polyps in distal colon and to determine whether the presence of hypcrplastic polyps in the distal colon could serve as a market for proximal synchronous adenomatous colonic polyps, we prospectively analyzed 895 consecutive subjects who were examined with colcnoscopy between March 1990 and October l992. 191 of 895 subjects (21.4%) had one or more colonic polyps. The prevalence of adenomatous polyps alone was 10.2% hyperplastic polyps 8.4%, and both 1.9%. The proportion of subjects with both proximal adenomatous polyp and distal hyperplastic polyps (6.0%) was not significantly different from the proportion of those without distal hyperplistic polyps(5.1%), But subjects with distal adenomatous polyps (s) were si!nificantly more likely to have proximal adenomatous polyp (s) than those without distal adenomatous polyp (s). The result of this study suggests that hyperplastir. polyps of distal colon do not serve as a marker for neoplastic polyps of proximai colon.

Upper Gastrointestinal Tract Polyps: What Do We Know About Them?

Buyukasik, Kenan,Sevinc, Mert Mahsuni,Gunduz, Umut Riza,Ari, Aziz,Gurbulak, Bunyamin,Toros, Ahmet Burak,Bektas, Hasan Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.7

Background: This study aimed to evaluate upper gastrointestinal polyps detected during esophago-gastroduodenoscopy tests. Materials and Methods: We conducted a retrospective analysis on data regarding 55,987 upper gastrointestinal endoscopy tests performed at the endoscopy unit of Istanbul Education and Research Hospital between January 2006 and June 2012. Results: A total of 66 upper gastrointestinal polyps from 59 patients were analyzed. The most common clinical symptom was dyspepsia, observed in 41 cases (69.5%). The localizations of the polyps were as follows: 29 in the antrum (43.9%), 15 in the corpus (22.7%), 11 in the cardia (16.7%), 3 in the fundus (4.54%), 3 in the second portion of the duodenum (4.54%), 2 in the bulbus (3.03%) and 3 in the lower end of the esophagus (4.54%). Histopathological types of polyps included hyperplastic polyps (44) (66.7%), faveolar hyperplasia (8) (12.1%), fundic gland polyps (4) (6.06%), squamous cell polyps (4) (6.06%), hamartomatous polyps (3) (4.54%), and pyloric gland adenoma (3) (4.54%). Histopathological analysis of the gastric mucosa showed chronic atrophic gastritis in 30 cases (50.84%), HP infection in 33 cases (55.9%) and intestinal metaplasia in 19 cases (32.20%). In 3 cases with multiple polyps, adenocarcinoma was detected in hyperplastic polyps. Conclusions: Among polypoid lesions of the upper gastrointestinal tract, the most common histological type is hyperplastic polyps. Generally, HP infection is associated with chronic atrophic gastritis and intestinal metaplasia. The incidence of adenocarcinoma tends to be higher in patients with multiple hyperplastic polyps.

담낭 용종의 진단과 관리에 대한 최신지견

이엄석 ( Eaum Seok Lee ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.2

A polypoid lesions of the gallbladder (PLGs) is defined as any elevated lesion of the mucosal surface of the gallbladder wall. Even though most of the gallbladder polyps are benign in nature, malignant polyps are found in some cases. Because advanced gallbladder cancer displays poor prognosis, early detection and appropriate early measures are important for curative treatment and improvement in long-term survival. Patients who have GB polyps are usually almost always asymptomatic and often diagnosed incidentally by abdomen CT scan or transabdominal ultrasonography (TAUS) imaging. However TAUS and CT scan can not differentiate precancerous and cancerous lesions from cholesterol polyps. To increase the diagnostic accuracy, New imanging modality is being performed. Of the available tests, the accuracy of EUS (or CEH-EUS) for the differentiation of neoplastic from nonneoplastic polyps was higher than that of transabdominal US or CT scan. The cholecystectomy should be undertaken only in cases where there are clinical signs of gallbladder polyps, polyps with diameters greater than 10 mm, fast-growing polyps, sessile polyps or wide-based polyps, patient aged over 50, concurrent gallstones, polyps of the gallbladder in fundibulum or abnormal gallbladder wall US. Gallbladder polyps that are not resected should be followed-up with serial ultrasound examinations. guidelines on the screening interval are not yet available, but follow-up with the same modality is generally recommended after 3-6 months. If there are no changes in size, contour, or vascualrity, the follow-up should be individualized; most often a follow up after another 12-24 months could be recommended up to 5 years at least.

대장내시경에서 원위부 용종이 발견되었을 때 근위부 용종의 유병률과 임상적 특징

주세경 ( Sae Kyung Joo ),김지원 ( Ji Won Kim ),이국래 ( Kook Lae Lee ),김병관 ( Byeong Gwan Kim ),정지봉 ( Ji Bong Jeong ),이재경 ( Jae Kyung Lee ),고성준 ( Seong Joon Koh ),김영훈 ( Young Hoon Kim ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.1

목적: 대장암은 서구뿐 아니라 국내에서도 증가하고 있으며 이로 인한 사망률도 높아 조기에 발견을 하는 것이 중요하다. 대장암의 선별 검사로 분변 잠혈 반응 검사와 구불창자내시경이 가장 보편적으로 시행되고 있다. 그러나 분변 잠혈 반응 검사의 경우 민감도와 특이도가 낮다는 문제가 있으며 구불창자내시경의 경우 대장암의 전구 병변인 대장 용종의 진단이 위치에 따라 불가능하다는 문제가 있다. 이번 연구는 근위부 대장까지 검사가 가능한 대장내시경을 이용하여 위치에 따른 용종의 유병률과 임상적 특성을 알아보고자 하였다. 대상 및 방법: 2009년 1월 1일부터 2010년 12월 31일까지 보라매병원 소화기센터에 내원하여 대장내시경을 시행받은 6,417명의 환자를 대상으로 후향적 의무 기록을 분석하였다. 결과: 총 1,972명의 환자에서 1개 이상의 대장 용종이 발견되었다. 염증성 장질환이 있거나 대장암으로 치료받은 병력이 있는 경우, 가족성 선종 용종증을 갖고 있는 경우에는 제외하였다. 633명(32.1%)의 환자는 근위부에서만 용종이 발견되었다. 원위부와 근위부 모두에 용종이 있는 환자는 530명 (26.9%)이었으며 남자와 노인인 경우 통계적으로 유의하였다. 근위부에만 용종이 있는 경우 임상적 특징은 원위부에만 용종이 있는 경우와 비교하여 통계적 차이가 없었고 원위부용종의 크기나 숫자와도 관련이 없었다. 또한 진행성 선종의 경우 원위부에 용종이 없이 근위부에만 용종이 존재한 경우가 29.4%로 나타났고 원위부 용종의 크기가 증가할수록, 조직형이 진행할수록 근위부 진행성 선종의 유병률이 증가하였다. 결론: 용종의 크기와 숫자와 관계 없이 모든 환자에서, 특히 남자 노인인 경우에 전 대장내시경을 추천한다. Background/Aims: Colorectal cancer is the third most common type of cancer and second leading cause of cancer death overall. Recently, there has been an emphasis on primary screening for colorectal cancer with colonoscopy. In this study, we aimed to address clinical characteristics and incidence of colonic polyps according to location. Methods: From January 2009 to December 2010, 6,417 total colonoscopic examinations were performed at Boramae Hospital in Seoul, Korea. We reviewed these patients retrospectively. The distal colon was defined as the rectosigmoid junction. Results: Overall, 1,972 patients (31.3%) had one of more colorectal polyps. Total of 4,445 patients were excluded from this study because of combined advanced colorectal cancer, inflammatory bowel disease, or familial adenomatous polyposis. Patients who had only proximal polyps were 633 (32.1%), 530 patients (26.9%) had both proximal and distal polyps, and 809 patients (41.0%) had polyps only in the rectosigmoid region. The prevalence of the proximal polyps in patients with rectosigmoid polyps was found to be significantly related to the male gender and elderly patients. However, the prevalence of the proximal colonic polyps was not related to the size and number of rectosigmoid polyps. In 530 patients with both rectosigmoid and proximal colonic polyps, the characteristics of proximal colonic polyps as size and number were similar to those of rectosigmoid polyps. Advanced proximal adenomas without distal polyps were found in 25 (29.4%) patients whom were associated with size and pathology. Conclusions: We recommend total colonoscopic examination in all patients regardless of the size and number, especially in elderly males. (Korean J Gastroenterol 2013; 62:42-48)

Endometrial polyps: Is the prediction of spontaneous regression possible?

( Semra Yuksel ),( Guray Tuna ),( Hale Goksever Celik ),( Suleyman Salman ) 대한산부인과학회 2021 Obstetrics & Gynecology Science Vol.64 No.1

Objective Endometrial polyps have been considered as a hyperplastic growth of endometrial stromal and glandular tissues. Even asymptomatic polyps in premenopausal women are usually removed as soon as they are diagnosed, although it is still unknown how often endometrial polyps disappear spontaneously. The aim of this study was to investigate the regression rate of endometrial polyps and the possible factors related to their spontaneous regression. Methods A total of 197 women with endometrial polyps were treated with operative hysteroscopy between January 2017 and April 2019 at our tertiary center. Of these, 123 patients who preferred conservative follow-up were enrolled in the study. Clinical and pathological data were obtained from electronic medical records. Results Patients with endometrial polyps were followed up for a median period of 62 days (range 30-360 days). Most women with endometrial polyps (84%) were reported to have gynecologic symptoms. Spontaneous polyp regression was observed in 28 (23%) patients who underwent surgery reevaluation. Patient age (<45 years), premenopausal period, and polyp size (<2 cm) were found to be associated with spontaneous endometrial polyp regression (P<0.05). We also observed more polyp regression in women with abnormal uterine bleeding (P=0.05). Second-look hysteroscopy showed that all postmenopausal women had persistent endometrial polyps. Conclusion Patient age (<45 years), premenopausal period, polyp size (<2 cm), and abnormal uterine bleeding may be associated with spontaneous endometrial polyp regression.

The Role of NF-κB in Chronic Rhinosinusitis With Nasal Polyps

정한진,Yu-Lian Zhang,김동규,이채서,김동영 대한천식알레르기학회 2019 Allergy, Asthma & Immunology Research Vol.11 No.6

Purpose: Whereas the majority of nasal polyps observed in Western populations are eosinophilic, non-eosinophilic nasal polyps are significantly more frequent in Asian countries. Given the importance of nuclear factor-kappa B (NF-κB) in inflammation, this study focused on the role of NF-κB in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNPs) in Asian patients. Methods: A total of 46 patients were enrolled in this study (22 diagnosed with CRSwNPs, 10 with chronic rhinosinusitis without nasal polyps [CRSsNP], and 14 control subjects). Nasal polyps and uncinate tissues (UTs) were collected and the tissues prepared for hematoxylineosin staining and immunohistochemistric (IHC) analysis. Total RNA was isolated for real-time polymerase chain reaction for p65, interleukin (IL)-6, IL-8, intracellular adhesion molecule (ICAM)-1, IL-1β, tumor necrosis factor (TNF)-α, and eotaxin. Results: In the CRSwNPs group, 50% of nasal polyps were non-eosinophilic. IHC revealed a significantly higher fraction of NF-κB p65-positive cells in nasal polyps of the CRSwNPs group than in the UTs of control and CRSsNP groups. No difference in NF-κB p65-positive cell fraction was observed between eosinophilic and non-eosinophilic nasal polyps. The mRNA expression of p65, IL-6, IL-8, and eotaxin was significantly higher in nasal polyps of the CRSwNPs than in the UTs of control and CRSsNP group. However, no difference in expression was observed between eosinophilic and non-eosinophilic nasal polyps, with the exception of IL-1β expression. Conclusions: Elevated expression of NF-κB- and NF-κB-associated inflammatory cytokines suggests NF-κB as the key factor for CRSwNPs pathogenesis in Asian patients. Understanding NF-κB-associated mechanisms will provide a deeper insight into CRSwNPs pathogenesis and ultimately improve therapeutic strategies for CRSwNPs.

Roles of Sonography and Hysteroscopy in the Detection of Premalignant and Malignant Polyps in Women Presenting with Postmenopausal Bleeding and Thickened Endometrium

Cavkaytar, Sabri,Kokanali, Mahmut Kuntay,Ceran, Ufuk,Topcu, Hasan Onur,Sirvan, Levent,Doganay, Melike Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.13

Background: To assess the role of sonographic endometrial thickness and hysteroscopic polyp size in predicting premalignant and malignant polyps in postmenopausal women. Materials and Methods: A total of 328 postmenopausal women with abnormal uterine bleeding and thickened endometrium underwent operative hysteroscopy due to detection of endometrial polyps were included in this retrospective study. Preoperative endometrial thickness measured by transvaginal ultrasonography and polyp size on hysteroscopy were noted. Hysteroscopic resection with histology was performed for endometrial polyps. Endometrial thickness and polyp size were evaluated on the basis of final diagnosis established by histologic examination. Receiver operator characteristic curves were calculated to assess the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of endometrial thickness and polyp size for detecting pemalignant and malignant polyps. Results: Premalignant and malignant polyps were identified in 26 (7.9%) of cases. Sonographic measurement showed a greater endometrial thickness in cases of premalignant and malignant polyps when compared to benign polyps. On surgical hysteroscopy, premalignant and malignant polyps were also larger. Endometrial thickness demonstrated a sensitivity of 53.8%, specificity of 85.8%, PPV of 24.6% and NPV of 95.6% at a cut-off limit of 11.5 mm with diagnostic accuracy of 83.2%. Polyp size has a diagnostic accuracy of 94.8% with a sensitivity of 92.3%, specificity of 95.0%, PPV of 61.5% and NPV of 99.3% at a cut-off point of 19.5mm. Conclusions: Endometrial thickness measured by transvaginal ultrasonography is not sufficient in predicting premalignant and malignant endometrial polyps in postmenopausal women with abnormal uterine bleeding and thickened endometrium. Polyp size on hysteroscopy is a more accurate parameter, because of better sensitivity and specificity. However, while polyp size ${\geq}19.5mm$ seems to have a great accuracy for predicting premalignancy and malignancy, histologic evaluation is still necessary to exclude premalignant and malignant polyps.