气囊辅助内镜治疗小肠息肉的临床价值研究

目的：探讨应用气囊辅助内镜（ BAE）治疗小肠息肉的可行性、安全性及临床价值。方法回顾性总结2006年8月至2014年7月对199例小肠息肉患者行BAE检查及内镜下息肉切除治疗情况,评价其可行性、安全性及小肠息肉内镜治疗的临床价值。结果199例小肠息肉患者共接受558例次BAE诊治术,摘除小肠息肉共3391枚,其中直径5～10 mm 801枚（23．62％）,11～30 mm 1887枚（55．65％）,31～50 mm 563枚（16．60％）,＞50 mm 140枚（4．13％）,最大者约为7 cm ×10 cm。发生21例次（3．76％）手术相关并发症,包括15例息肉残根出血和6例肠穿孔。结论 BAE是一种安全有效的小肠息肉治疗方法,对大多数小肠息肉患者,可替代外科手术而作为首选治疗方法,具有较好的临床应用价值及发展前景。     

Higher prevalence of proximal colon polyps and villous histology in African-Americans undergoing colonoscopy at a single equal access center

Background

In the United States, African Americans (AA) have the highest incidence and mortality from colorectal cancer (CRC) of any racial group. Few studies have evaluated if AA who undergo colonoscopy are more likely to have aggressive neoplasia (polyp) tumor biology compared to Caucasians (C). The primary aim of the study was to compare polyp characteristics between AA and C undergoing outpatient colonoscopy.

Methods

A single center retrospective cohort study was performed at a single Veteran Administration (VA) health care system. The charts of 4,038 veterans undergoing colonoscopy from 2005 to 2008 were reviewed. After applying exclusion criteria, data was analyzed for 1,388 persons. Categorical variables were compared using the chi-square test and data were expressed as percentages. Continuous variables were compared using student’s t-test and the data were expressed as mean with standard deviation.

Results

A total of 37% of AA had proximal polyps compared to 21% of C (P<0.0001). Twenty-four percent of AA had polyps with villous histology compared to 16% of C (P=0.01). Twelve percent of AA had hyperplastic polyps compared to 20% of C (P=0.02). There was no difference in the overall prevalence of tubular adenomas, adenomatous polyps with high-grade dysplasia, number, size or polyp morphology between groups.

Conclusions

In an equal access healthcare system and under varying indications, AA have more proximal polyps and polyps with more aggressive histology compared to C. This could partially explain the higher incidence of CRC in AA, and the increased likelihood for AA to develop advanced proximal neoplasia.     

Mixed adenoneuroendocrine carcinoma of the gallbladder,amphicrine type: Case report and review of literature

Amphicrine type mixed adenoneuroendocrine carcinoma (MANEC), also known as amphicrine carcinoma, is an exceedingly rare neoplasm comprising of tumor cells simultaneously demonstrating both neuroendocrine and exocrine differentiation. Majority of reported cases were found in tubular gastrointestinal tracts such as colon. Herein, we report the first case of amphicrine carcinoma in gallbladder in a 57-year-old female who presented with abdominal pain, vomiting, and gallbladder mass on imaging followed by radical cholecystectomy. Macroscopically, the tumor was a polypoid solid mass with a firm and tan-white cut surface located at the gallbladder fundus. Histologically, the tumor cells were composed of monotonous-appearing signet-ring cells with fine chromatin, variably conspicuous nucleoli, brisk mitotic figures, and spotty necrosis. They were loosely clustered, forming nests and cords but no glandular formation. Immunohistochemically, the entire tumor showed strong and diffuse immunoreactivity for CDX2, p53, and synaptophysin, with patchy positivity for CD56, chromogranin, and INSM1. Kreyberg stain highlighted both intracytoplasmic and extracellular mucin. Ki-67 proliferation index was approximately 70%. Next-generation sequencing performed on a 724 cancer-related gene panel identified TP53 mutation at c.844C>T (p.R282W). To our knowledge, this is the first case of amphicrine carcinoma in gallbladder. It highlights the complex dynamism and controversial pathogenesis of this unique entity, the exact mechanism and clinicopathologic behavior of which are not yet understood.     

宫腔镜子宫内膜息肉切除术后应用黄体酮栓预防复发的效果

目的 探讨子宫内膜息肉行宫腔镜治疗术后应用黄体酮栓预防复发的临床效果。方法 选取2015年1月~2017年12月在本院行宫腔镜引导下子宫内膜息肉切除手术治疗，且术后病理诊断符合子宫内膜息肉的患者220例为研究对象，根据术后治疗方法的不同分为研究组（106例）与对照组（114例），研究组术后应用黄体酮栓治疗，对照组未用药物治疗，比较两组术后3、6、12个月子宫内膜厚度，月经改变情况及复发情况。结果 研究组术后6、12个月子宫内膜厚度及复发率均优于对照组，差异有统计学差异（P＜0.05）；研究组术后3、6、12个月的月经量改善优于对照组，差异有统计学意义（P＜0.05），术后6个月经期情况比较，差异有统计学意义（P＜0.05）；术后3、12个月经期比较，差异无统计学意义（P＞0.05），9例（8.74%）出现乳房胀痛、头晕，偶有患者点滴出血等不适，均可以耐受。结论 宫腔镜术后应用黄体酮栓治疗子宫内膜息肉有助于降低复发率，改善月经情况，疗效可靠。     

Spindle cell proliferations of the sigmoid colon,rectum and anus: a review with emphasis on perineurioma

A wide range of spindle cell proliferations are found uncommonly in the sigmoid colon, rectum and anus. They usually present as polyps, and include reactive lesions and benign and malignant neoplasms which may be primary or metastatic. They are less frequently described in the literature compared to those in the upper gastrointestinal tract, and may be underdiagnosed. The widespread use of sigmoidoscopy in symptomatic patients and bowel cancer screening programmes means that histopathologists must be aware of, and adopt a logical approach to, diagnosing spindle cell proliferations in biopsy and polypectomy specimens. This is particularly relevant given the strong association of some mesenchymal polyps with hereditary cancer syndromes. This review article will focus on perineurioma and the recent debate in relation to its overlap with fibroblastic polyp. The clinical, endoscopic, histological and immunohistochemical features of spindle cell proliferations which should be considered in the differential diagnosis of perineurioma will be discussed. There is also a brief reference to malignant spindle cell tumours of diagnostic importance.     

慢性鼻-鼻窦炎伴鼻息肉鼻内镜手术中中鼻甲的处理研究进展

慢性鼻-鼻窦炎伴鼻息肉患者是耳鼻咽喉科常见疾病，手术治疗是目前主要治疗手段，但术中是否切除中鼻甲还没有统一的观点。本文探讨中鼻甲的生理、主张切除中鼻甲的研究、主张保留中鼻甲的研究、切除中鼻甲与否对嗅觉影响的研究及特殊情况下中鼻甲的处理等，为临床治疗慢性鼻-鼻窦炎伴鼻息肉患者提供依据。