结直肠锯齿状腺瘤内镜表现和病理学特征分析

目的探讨锯齿状腺瘤（SA）内镜下表现和病理学特征。方法回顾分析滨州医学院附属医院2000年1月～2008年5月检出的大肠息肉病例,了解SA的检出率、内镜形态和病理学特征。结果8726例肠镜检查共检出大肠息肉1062例（1457枚）,检出率为12．17％,其中SA32例（60枚）,检出率为0．37％,占息肉构成比为3．01％。SA直径〉1cm者占21．63％,明显大于增生性息肉（8．57％）;SA表现为有蒂息肉所占的比例（8．33％）略高于增生性息肉（5．71％）,但都低于腺瘤性息肉（40．84％）。SA癌变率介于管状腺瘤和绒毛状腺瘤之间,接近于管状绒毛状腺瘤。结论SA内镜形态、病理学特点提示SA是兼有增生性息肉形态学特征和腺瘤性息肉组织学特点的息肉,具有恶变潜能.     

结肠息肉的临床特征分析

目的 研究结肠息肉内镜下的形态和病理组织学等临床特征.方法 回顾分析我院消化内镜中心2005年～2007年期间检出的结肠息肉病例,分析息肉的检出率、内镜下息肉形态、病理组织学类型、息肉癌变率、息肉术后复发、新生等情况.结果 633例电子肠镜检查共检出息肉病例138例,检出率为21.80%,以乙状结肠部位息肉数量最多,为52例,检出率8.21%,占息肉构成比37.68%(P<0.01).息肉直径在1～4 cm之间者90例,占息肉构成比65.22%(P<0.01);内镜下表现为有蒂息肉所占的比例(69.18%)明显高于无蒂息肉(P<0.05).从息肉病理组织学上分析,腺瘤性息肉为96例,占息肉构成比69.57%,明显高于增生性息肉(P<0.01);96例腺瘤性息肉中绒毛状腺瘤占62.50%,明显多于管状腺瘤(P<0.05);绒毛状腺瘤的癌变率为40%,明显高于管状腺瘤的16.67%(P<0.05).所有腺瘤性息肉经摘除术后(包括内镜下摘除和外科手术摘除)1年复查肠镜,发现绒毛状腺瘤和管状腺瘤的术后复发率分别为28.33%和8.82%(P<0.05),而新生率接近,分别为65%和88.24%(P>0.05).结论 结肠息肉的好发部位以乙状结肠居多;内镜下息肉大小多数在1～4 cm,以有蒂息肉居多;绒毛状腺瘤的癌变率、摘除术后1年的复发率均高于管状腺瘤,更具有恶变潜能.     

大肠锯齿状腺瘤的内镜表现和癌胚抗原表达

目的探讨大肠锯齿状腺瘤（SA）的内镜特征和癌胚抗原的表达情况。方法选择2005年6月-2008年7月在消化内镜室检出的SA患者27例（SA组）,另选择同期检出的进展期结直肠腺癌（ACC）患者共26例（ACC组）。结肠镜检查发现大肠息肉后用0．4％靛胭脂溶液进行喷洒染色并判断息肉的腺管开口,采用活检钳钳咬、高频电切除术、EMR等方法摘除息肉,对大肠癌等病灶则采用活检钳钳咬组织。上述标本进行病理组织学常规检查和腺体组织癌胚抗原（CEA）免疫组化染色。结果SA组锯齿状腺瘤47枚,其它类型息肉27枚。SA形态以隆起亚蒂型多见,2枚最大径≥10mm,45枚最大径在3～8mm。SA腺管开口较常见到Ⅱ型pit与ⅢL型pit的混合表现,Ⅱ型pit也占一定比例,好发部位均在左半结肠。SA的腺瘤性腺体CEA阳性表达明显强于其增生性腺体CEA阳性表达（P〈0．01）。结论SA是一种独特的大肠腺瘤类型,其瘤细胞已有较强合成CEA能力,具备一定的恶变潜能,临床医师应予以高度重视。     

普通窄带成像内镜对结直肠增生性息肉和腺瘤的鉴别诊断价值

目的 分析普通窄带成像(NBI)内镜下结直肠增生性息肉与腺瘤腺管及微血管特征的差异,评价NBI的鉴别诊断价值.方法 将普通内镜下诊断结直肠息肉、病理检查证实为增生性息肉或腺瘤者纳入研究并进行NBI内镜检查.将腺管形态参照改良的工藤分型法分为A型和B型.将微血管形态分为3型,无微血管判为Ⅰ型,微血管沿腺管开口排列、粗细均匀判为Ⅱ型,微血管粗细不均、排列紊乱判为Ⅲ型.比较增生性息肉和腺瘤NBI图像中腺管形态和微血管形态特征的差异,同时对无放大NBI图像观察者间的一致性进行评价.结果 共87例患者的107个息肉(腺瘤73个、增生性息肉34个)进行普通NBI内镜检查.腺瘤组息肉最大径和表面分叶者比例明显高于增生性息肉组(P值分别=0.0023和0.0047).腺瘤组中B型腺管形态[86.3％(63/73)]及Ⅱ或Ⅲ型微血管形态[82.2％(60/73)]者较多.以B型腺管形态、Ⅱ型或Ⅲ型微血管中任一特征诊断腺瘤的敏感度、特异度、准确率分别为97.3％、82.4％、92.5％.以B型腺管形态联合Ⅱ型或Ⅲ型微血管诊断腺瘤的敏感度、特异度、准确率分别为71.2％、91.2％、77.6％.观察者间一致性评价平均Kappa值为0.761.结论 普通NBI内镜下结直肠腺瘤和增生性息肉的微血管特征和腺管特征存在差异,依据以上两方面可在NBI内镜下实时初步鉴别腺瘤和增生性息肉.     

结肠息肉临床病理特点分析313例

目的:探讨结肠息肉临床及病理组织学特征为临床诊疗工作提供参考.方法:回顾性分析南京市第一医院2011-09/2014-09共313例结肠息肉病例,所有患者于门诊就诊行电子肠镜检查,考虑为息肉者经患者知情同意后住院行结肠息肉内镜下治疗,镜下及病理组织学均证实为结肠息肉.结果:结肠息肉患者中腺瘤发生率为72.8%腺瘤与非腺瘤病例临床表现无统计学差异,结肠息肉中腺瘤的发生与性别、山田分型、生长部位及息肉数目无关,各年龄层、息肉直径之间腺瘤的发生率有统计学差异(P0.05);腺瘤上皮内瘤变程度与性别、年龄、生长部位、息肉数目无关,而山田分型、各息肉直径之间腺瘤上皮内瘤变程度有统计学差异(P0.05).结论:结肠息肉的临床表现无特异性,以左半结肠多见,腺瘤发生率男女之间无统计学差异,以40岁以上中老年人多见,直径1 cm息肉腺瘤发生率更高,山田分型、生长部位及息肉数目不影响腺瘤发生率;腺瘤性息肉上皮内瘤变程度与山田分型及息肉直径相关,山田Ⅲ、Ⅳ型息肉、直径1 cm息肉高级别上皮内瘤变发生增高.     

放大结肠镜对大肠息肉的诊断价值

目的探讨大肠息肉黏膜腺管开口形态分型与病理组织学的相关性，提高大肠早期癌的检出率。方法放大结肠镜检查结合0．2％亚甲蓝染色观察151颗大肠息肉黏膜腺管开口形态，采用日本学者Kudo分型，将其分型与病理学相比较。结果151颗大肠息肉中癌变5颗，放大内镜下1颗表现为Ⅳ型，4颗为V型。放大结肠镜对大肠息肉是否瘤性的镜下诊断的灵敏度为94．8％，特异度为89．2％，阳性预测值为96．5％，阴性预测值为84．6％，Kappa值为0．822，具有极好的一致性。结论放大结肠镜有利于鉴别瘤性和非瘤性息肉，镜下判断大肠息肉性质准确率高。     

大肠锯齿状腺瘤7例报告

大肠的锯齿状腺瘤指大肠的一类特殊病理形态的腺瘤,其成瘤上皮成分有明显增生,使腺管或绒毛呈现锯齿状外观,类似于增生性息肉样改变,或腺瘤成分与增生性息肉成分同时存在。1990年Longacre TA报告了110例这种形态的腺瘤,并将其命名为混合型增生性腺瘤样息肉／Serrated腺瘤,后被简称为Serrated腺瘤即锯齿状腺瘤。     

排便习惯改变人群结直肠息肉患病率临床分析

背景:结直肠癌的发生与结直肠息肉,尤其是腺瘤性息肉密切相关。结直肠息肉患者常有排便习惯改变的表现。目的:分析排便习惯改变人群的结直肠息肉患病率及其临床病理特点,以期指导此类个体的干预和治疗。方法:收集2009~2012年因排便习惯改变至上海瑞金医院卢湾分院行结肠镜检查的患者,对其息肉检出率、病理类型和分布情况进行回顾性分析。结果:共6 204例患者入选,结直肠息肉检出率为32.2%(1 997例),男性检出率显著高于女性(38.8%对26.2%,P0.01)。有病理记录的息肉共3 041枚,其中腺瘤性息肉1 798枚(59.1%),增生性息肉592枚(19.5%),炎性息肉554枚(18.2%),腺癌83枚(2.7%),227枚(12.6%)腺瘤性息肉伴有低级别或高级别上皮内瘤变。息肉、腺瘤、腺癌分布于肝曲远端者均在80%以上。结论:排便习惯改变人群的结直肠息肉患病率较高且以腺瘤性息肉为主,病变多位于肝曲远端。对此类患者应尽早行全结肠镜检查/治疗,从而有效预防结直肠癌的发生。     

大肠腺瘤性息肉癌变因素的探讨——附245例分析

本文回顾性的总结分析了我院245例大肠腺瘤性息肉的内镜诊断和病理特点，旨在探讨大肠腺瘤癌变过程的相关因素，以提高大肠癌的早期诊断率。临床资料我院1978年～1996年间进行肠镜检查6807例，检出息肉629例，检出率9．24％。其中腺瘤性息肉245例，检出率3．60％。245例腺癌性息肉中，男167例，女78例。男女之比2．14：1。年龄8～81岁，平均44S岁。临床表现以便血或粘液血便为主，占53．88％（132例）。息肉分布：直肠102例（4。63％），乙状结肠79例（3．24％），降结肠19例（．76％），横结肠20例（．16％），升结肠及盲肠17例（．94％）…     

内镜智能分光比色放大内镜对胃息肉的诊断价值

[目的]探讨内镜智能分光比色技术(FICE)染色放大内镜对胃息肉的诊断价值。[方法]回顾性分析FICE染色放大内镜下178枚胃息肉的腺管开口分型,将FICE染色放大内镜诊断与病理结果进行对比。[结果]178枚息肉中,胃底40枚,胃体75枚,胃窦63枚。腺管开口Ⅰ型53枚,Ⅱ型74枚、ⅢL型34枚、Ⅲs型6枚,Ⅳ型10枚、Ⅴi型1枚。病理结果提示炎性息肉多为Ⅰ型,少数为Ⅱ型和ⅢL型,增生性息肉主要为Ⅱ型,胃底腺息肉主要为Ⅲl型,腺瘤性息肉主要为Ⅳ型。[结论]FICE染色放大内镜诊断胃息肉与病理诊断符合率高,可有效拟诊胃息肉性质,为胃息肉的治疗提供参考依据。     

Endoscopic Characteristics of Gastric Polyps and Their Background Mucosa on the Gastric Body

Abstract: We investigated the endoscopic and histopathological characteristics of 112 gastric polyps on the gastric body. According to the histopathological findings of the glands in the biopsy specimens, we classified the polyps into 6 categories; dense fundic gland type (group A), sparse fundic gland type (B), mixed fundic and pyloric gland type (C), pyloric gland type (D), complete atrophic gland type (E) and others (F). The grade of atrophic gastritis was defined by the fundic-pyloric border type of the stomach, and was found to change from mild to severe respectively in groups A to E. The gastric area type of background fundic gland mucosa also changed from F₀ to F₃ in parallel with the order of the groups A to E. Thirty-five of the 36 polyps in group A, all 19 in group B, 2 out of 3 in group C, 1 of 4 in group D, and the 1 in group E were located on the dye-endoscopically defined fundic gland mucosal area. The gland type of biopsy specimens which were obtained from the mucosa adjacent to the polyps changed from fundic to fundic-pyloric and to pyloric type in groups A to E respectively. In conclusion, the histopathological findings of polyps on the gastric body reflect the background mucosa, and in particular the extent of the atrophic change of the stomach. The majority of polyps, either fundic gland polyps (groups A and B) or hyperplastic polyps (groups C, D and E), on the gastric body were found to be the same gland type as their respective background mucosa. They thus seem to fall into the same category as hyperplastic polyps of background mucosal origin but are not the same as a hamartomatous polyp.     

Three cases of Solitary Peutz-Jeghers-type hamartomatous polyp in the duodenum

A solitary Peutz-Jeghers-type hamartomatous polyp in the duodenum is rare, and few reports have described its characteristic endoscopic features. We describe three cases of solitary Peutz-Jeghers-type hamartomatous polyp and their endoscopic findings in detail. The polyp in all of our three cases showed an irregularly lobular or nodular surface, whereas adenomas often show a regularly nodular or granular surface. The color of the polyp was whitish in all of our cases. In the present cases, close observation by endoscopy revealed that the solitary Peutz-Jeghers-type hamartomatous polyps looked whitish because of the presence of diffusely scattered white spots on the surface of the polyps. Duodenal polyps that exhibit the aforementioned endoscopic characteristics may be diagnosed as Peutz-Jeghers-type hamartomatous polyps and treated by polypectomy because of the malignant potential.     

A large inflammatory polyp of the gallbladder masquerading as gallbladder carcinoma

An inflammatory polyp of the gallbladder is a rare variant of benign gallbladder polyp. Differentiation between an inflammatory polyp and polypoid gallbladder carcinoma is difficult when the polyp is more than 1 cm in diameter. We report a rare case of a large inflammatory polyp of the gallbladder masquerading as gallbladder carcinoma in a 37-year-old Japanese woman who was incidentally diagnosed with a large gallbladder polyp, measuring 1 cm in diameter, by ultrasonography. She was asymptomatic and physical examination was unremarkable. Abdominal ultrasonography and endoscopic ultrasonography revealed three polypoid lesions in the gallbladder. One lesion was an isoechoic polyp, measuring 15 × 8 mm, showing a nodular surface and located in the fundus of the gallbladder. The other two lesions were hyperechoic polyps, measuring 5 × 5 mm, in the body of the gallbladder. Computed tomography and magnetic resonance imaging revealed marked enhancement of the largest polypoid lesion by dynamic study, and no lymph node enlargement was noted. Endoscopic retrograde cholangiography revealed a 12 × 8 mm polyp with an irregular surface in the fundus of the gallbladder. Superselective angiography of the cystic artery revealed neovascularity and a tumor stain in the fundus of the gallbladder. Cholecystectomy with lymph node dissection was performed. Intraoperative frozen section diagnosis of the largest polyp was an inflammatory polyp of the gallbladder. The other two polyps were cholesterol polyps. Inflammatory polyp should be considered as a differential diagnosis of hypervascular gallbladder polyps that measure more than 1 cm in diameter. Received Dec. 26, 1997; accepted Apr. 24, 1998     

A significant number of sessile serrated adenomas might not be accurately diagnosed in daily practice

Background/Aims

The diagnosis of hyperplastic polyps (HPs) may involve a conglomeration of subgroups of serrated polyps. The diagnosis of HPs may therefore be revisited if this is sessile serrated adenoma (SSA). The aim of this study was to determine clinically and endoscopically relevant information associated with reclassification to SSA.

Methods

After reviewing the data from 1,372 patients who underwent colonoscopic polypectomy, 49 HPs larger than 10 mm were analyzed in this study. Two gastrointestinal pathologists reclassified each of the original 49 HPs as conventional HPs, SSAs, and others.

Results

Among the 49 initially diagnosed HPs, 18.4% were reclassified into SSAs or mixed polyps. Overall architectural features were useful for the diagnosis of SSA, but cytological features were less useful. The patient and polyp characteristics did not differ between HPs with and without reclassification of the initial pathological diagnosis.

Conclusions

A significant number of SSAs might not be accurately diagnosed in daily clinical practice without any predilection for size, shape, and location. Therefore, when large HPs are diagnosed in clinical practice, it is necessary for physicians to have greater awareness of the diagnosis of SSA and to individualize subsequent surveillance.     

The Differential Diagnosis of Colorectal Polyps Using Colon Capsule Endoscopy

Objective Although colorectal polyps (CPs) can be observed with colon capsule endoscopy (CCE), it is difficult to determine the type of polyp using CCE. The objective of this study was to differentiate adenomatous polyps (APs) from hyperplastic polyps (HPs) with CCE. Methods In this single-center retrospective study, an analysis was conducted on the same CPs with both CCE and colonoscopy (CS) and histopathologically diagnosed as AP or HP. The color difference (ΔE) between the polyp surface and the surrounding mucosa was calculated using the CIE1976 L*a*b* color space method on white light (WL), flexible spectral imaging color enhancement (FICE), and blue mode (BM) CP images. We investigated the ability of the ratio of the color differences (ΔE'') to differentiate between APs and HPs. Results The size of all 51 polyps (34 APs, 17 HPs) was 7.5±4.6 mm with CCE and 7.3±4.2 mm with CS, and this difference was not significant (p=0.28). The FICEΔE'' of APs was 3.3±1.8, which was significantly higher than the FICEΔE'' of HPs (1.3±0.6; p<0.001). A receiver operating characteristic analysis showed that FICEΔE'' was useful for differentiating between APs and HPs, with an area under the curve of 0.928 (95% confidence interval, 0.843-1). The sensitivity was 91.2%, and the specificity was 88.2% with a cut-off value of 1.758. Conclusion Using FICE on CCE images of CPs and applying the CIELAB color space method, we were able to differentiate between APs and HPs with high accuracy. This method has the potential to reduce unnecessary CS procedures.     

Giant cholesterol polyp mimicking gallbladder carcinoma: A case report

Cholesterol polyps are the most common polypoid lesion of the gallbladder and are usually less than 10 mm in diameter. In this report, we present a case of giant cholesterol polyp 32 mm in diameter treated by cholecystectomy, in which it was difficult to differentiate preoperatively between a cholesterol and a neoplastic polyp. The tumor was histologically diagnosed as a cholesterol polyp with fibrosis. We also discuss the diagnosis and treatment of large polyps of the gallbladder.     

Recurrent giant fibrovascular polyp of the esophagus

Giant fibrovascular polyps of the esophagus and hypopharynx are rare benign esophageal tumors. They arise most commonly in the upper esophagus and may, rarely, originate in the hypopharynx. They can vary significantly in size. Even though they are benign, they may be lethal due to either bleeding or, rarely, asphyxiation if a large polyp is regurgitated. Patients commonly present with dysphagia or hematemesis. The polyps may not be well visualized on endoscopy and imaging plays a vital role in aiding diagnosis as well as providing important information for preoperative planning, such as the location of the pedicle, the vascularity of the polyp and the tissue elements of the mass. They can also be recurrent in rare cases, especially if the resection margins of the base are involved. We review the recent literature and report a case of a 61-year-old man with a recurrent giant esophageal fibrovascular polyp with illustrative contrast barium swallow, CT and intra-operative images, who required several surgeries via a combination of endoscopic, trans-oral, trans-cervical, trans-thoracic and trans-abdominal approaches.     

Endoscopic treatment of a large colonic polyp as a cause of colocolonic intussusception in a child

Colocolonic intussusception is an uncommon cause of intestinal obstruction in children. The most common type is idiopathic ileocolic intussusception. However, pathologic lead points occur approximately in 5% of cases. In pediatric patients, Meckel's diverticulum is the most common lead point, followed by polyps and duplication. We present a case of recurrent colocolonic intussusception which caused colonic obstruction in a 10-year-old boy. A barium enema revealed a large polypoid mass at the transverse colon. Colonoscopy showed a colonic polyp, 3.5 centimeters in diameter, which was successfully removed by endoscopic polypectomy.     

134例贲门息肉患者内镜及病理特征研究

目的研究胃贲门息肉的内镜下表现、病理特征,提高对其认识。方法回顾分析解放军总医院内镜中心2012年-2013年134例贲门息肉患者内镜及病理资料。结果贲门息肉的检出率为0.495%。134例贲门息肉中,增生性息肉123例,贲门腺癌2例,胃底腺息肉9例。增生性息肉的组织来源主要为胃柱状上皮。贲门增生性息肉常合并反流性食管炎和慢性胃炎。结论贲门息肉是一组异质性疾病,最多见的是增生性息肉,极少数为贲门腺癌。