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Gorji L, Albrecht P. Hamartomatous polyps: Diagnosis, surveillance, and management. World J Gastroenterol 2023; 29:1304-1314. [PMID: 36925460 PMCID: PMC10011967 DOI: 10.3748/wjg.v29.i8.1304] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/08/2022] [Accepted: 02/16/2023] [Indexed: 02/28/2023] Open
Abstract
Hereditary polyposis syndrome can be divided into three categories: Ade-nomatous, serrated, and hamartomatous polyps. Hamartomatous polyps, malformations of normal tissue presenting in a disorganized manner, are characterized by an autosomal dominant inheritance pattern. These syndromes exhibit hamartomatous gastrointestinal polyps in conjunction to extra-intestinal manifestations, which require conscientious and diligent monitoring. Peutz-Jeghers syndrome, Cowden syndrome, and juvenile polyposis syndrome are the most common displays of hamartomatous polyposis syndrome (HPS). Diagnosis can be pursued with molecular testing and endoscopic sampling. Early identification of these autosomal dominant pathologies allows to optimize malignancy sur-veillance, which helps reduce morbidity and mortality in both the affected patient population as well as at-risk family members. Endoscopic surveillance is an important pillar of prognosis and monitoring, with many patients eventually requiring surgical intervention. In this review, we discuss the diagnosis, surveillance, and management of HPS.
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Affiliation(s)
- Leva Gorji
- Department of Surgery, Kettering Health Dayton, Dayton, OH 45405, United States
| | - Peter Albrecht
- Department of Surgery, Kettering Health Dayton, Dayton, OH 45405, United States
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Possick Z, Alster TS. CO 2 Laser Treatment of Multiple Oral Hamartomas in Cowden's Syndrome: A Review and Case Study. Clin Cosmet Investig Dermatol 2022; 15:823-827. [PMID: 35547602 PMCID: PMC9084904 DOI: 10.2147/ccid.s357282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/01/2022] [Indexed: 12/03/2022]
Abstract
Background Cowden’s syndrome is a genetic disorder characterized by multiple oral hamartomas and an increased risk of internal malignancy. These mucocutaneous lesions can be physically disfiguring and psychologically distressing. As a result, patients frequently seek treatment for their destruction. Removal of oral hamartomas is often a challenge due to their sensitive location and high risk of recurrence. Objective To review the clinical use, effectiveness, and safety of a fractional ablative laser to treat multiple oral hamartomas in a patient with Cowden’s syndrome. Materials and Methods A thorough literature review pertaining to treatment of oral hamartomas and a discussion of an illustrative case showcasing successful lesional destruction with a fractional ablative carbon dioxide (CO2) laser in a 33-year-old man with Cowden’s syndrome. Results Multiple oral hamartomas were effectively removed with fractional CO2 laser vaporization. No infection, scarring, dermatitis, nor lesional recurrence were observed 6 months post-treatment. Conclusion Fractional CO2 laser vaporization can be used effectively to treat multiple oral hamartomas associated with Cowden’s syndrome.
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Affiliation(s)
- Zoe Possick
- Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA
| | - Tina S Alster
- Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA
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Rahvar M, Kerstetter J. Cutaneous manifestation of gastrointestinal disease. J Gastrointest Oncol 2016; 7:S44-54. [PMID: 27034812 PMCID: PMC4783618 DOI: 10.3978/j.issn.2078-6891.2015.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/10/2015] [Indexed: 12/29/2022] Open
Abstract
The gastrointestinal (GI) and cutaneous systems are closely linked in origin. Skin manifestations are frequently seen as a part of different GI syndromes. Gastroenterologists play an important role in recognizing the symptoms, patient workup and arriving at appropriate diagnoses, often in consultation with dermatologists. This review discusses the diseases with both cutaneous and intestinal involvement. Hereditary polyposis GI cancers, hereditary nonpolyposis colorectal cancers (CRCs), hamartomatous disorders, and inflammatory bowel disease (IBD) are reviewed with emphasis on the genetic basis, diagnostic, histologic findings, screening modalities, and therapeutic options.
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Affiliation(s)
- Maral Rahvar
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Justin Kerstetter
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
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Shah KR, Boland CR, Patel M, Thrash B, Menter A. Cutaneous manifestations of gastrointestinal disease. J Am Acad Dermatol 2013; 68:189.e1-21; quiz 210. [DOI: 10.1016/j.jaad.2012.10.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 10/11/2012] [Accepted: 10/13/2012] [Indexed: 01/13/2023]
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Campolmi P, Bonan P, Cannarozzo G, Bassi A, Bruscino N, Arunachalam M, Troiano M, Lotti T, Moretti S. Highlights of thirty-year experience of CO2 laser use at the Florence (Italy) department of dermatology. ScientificWorldJournal 2012; 2012:546528. [PMID: 22593693 PMCID: PMC3347966 DOI: 10.1100/2012/546528] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 01/04/2012] [Indexed: 12/01/2022] Open
Abstract
The CO2 laser has been used extensively in dermatological surgery over the past 30 years and is now recognised as the gold standard for soft tissue vaporization. Considering that the continuous wave CO2 laser delivery system and the newer “superpulsed” and scanned CO2 systems have progressively changed our practice and patient satisfaction, a long range documentation can be useful. Our experience has demonstrated that the use of CO2 laser involves a reduced healing time, an infrequent need for anaesthesia, reduced thermal damage, less bleeding, less inflammation, the possibility of intra-operative histologic and/or cytologic examination, and easy access to anatomically difficult areas. Immediate side effects have been pain, erythema, edema, typically see with older methods, using higher power. The percentage of after-treatment keloids and hypertrophic scars observed was very low (~1%) especially upon the usage of lower parameters. The recurrence of viral lesions (condylomas and warts) have been not more frequent than those due to other techniques. Tumor recurrence is minor compared with radiotherapy or surgery. This method is a valid alternative to surgery and/or diathermocoagulation for microsurgery of soft tissues. Our results are at times not consistent with those published in the literature, stressing the concept that multicentric studies that harmonization methodology and the patient selection are vital.
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Affiliation(s)
- Piero Campolmi
- Section of Clinical, Preventive and Oncologic Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, Villa S.Chiara, Piazza Indipendenza 11, 50129 Florence, Italy
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Farooq A, Walker LJ, Bowling J, Audisio RA. Cowden syndrome. Cancer Treat Rev 2010; 36:577-83. [PMID: 20580873 DOI: 10.1016/j.ctrv.2010.04.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 04/06/2010] [Accepted: 04/11/2010] [Indexed: 12/15/2022]
Abstract
Cowden syndrome (CS) is a rare inherited condition characterised by multiple hamartomas in a variety of tissues from all three embryonic layers. It is a cancer predisposition syndrome with an increased risk of developing malignancy in many tissues but especially breast, thyroid and endometrium. It is inherited in an autosomal dominant manner with ∼80% of patients having a germ-line mutation of the PTEN tumour suppressor gene. Presenting signs and symptoms are highly non-specific. Nevertheless clinicians should be able to recognise this syndrome so that patients may be screened for cancerous growths and afforded the opportunity to have genetic testing to assist them and their family members in making medical management decisions. We present a review of this unusual but important condition with particular emphasis on the diagnostic criteria, clinical features, genetics, management and surveillance.
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Affiliation(s)
- A Farooq
- Department of General Surgery, St. Helens and Knowsley Teaching Hospitals, Warrington Road, Prescott L35 5DR, UK.
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Al-Thihli K, Palma L, Marcus V, Cesari M, Kushner YB, Barkun A, Foulkes WD. A case of Cowden's syndrome presenting with gastric carcinomas and gastrointestinal polyposis. Nat Rev Gastroenterol Hepatol 2009; 6:184-9. [PMID: 19190598 DOI: 10.1038/ncpgasthep1359] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 12/18/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND A 73-year-old white man was referred to a cancer genetics clinic for evaluation of a approximately 20-year history of mixed upper and lower gastrointestinal polyposis, including hyperplastic, inflammatory and adenomatous polyps, colonic ganglioneuromas, and associated diffuse, esophageal glycogenic acanthosis. Two synchronous gastric carcinomas had been identified before referral and the patient had undergone a total gastrectomy, omentectomy and cholecystectomy. Multiple hyperplastic polyps and small, sessile polyps were also observed in the gastrectomy specimen. INVESTIGATIONS History and physical examination, upper and lower gastrointestinal endoscopy and biopsy, genetic testing, molecular pathology investigations (immunohistochemistry), thyroid ultrasonography, fine-needle aspiration of a thyroid nodule. DIAGNOSIS Cowden's syndrome. MANAGEMENT Genetic counseling, thyroidectomy, vitamin B(12) supplementation, continued endoscopic surveillance and genetic testing of at-risk family members.
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Abstract
Cowden disease is a genetically inherited disorder presenting with multiple hamartomatous and neoplastic lesions in various organs and tissues. We present a review of the diagnostic criteria, clinical presentation, genetics, and management of this condition.
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Affiliation(s)
- S Uppal
- Molecular Medicine Unit, University of Leeds, St. James's University Hospital, Leeds, UK.
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Tanzi EL, Lupton JR, Alster TS. Lasers in dermatology: four decades of progress. J Am Acad Dermatol 2003; 49:1-31; quiz 31-4. [PMID: 12833005 DOI: 10.1067/mjd.2003.582] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Advances in laser technology have progressed so rapidly during the past decade that successful treatment of many cutaneous concerns and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair-can be achieved. The demand for laser surgery has increased substantially by patients and dermatologists alike as a result of the relative ease with which many of these lesions can be removed, combined with a low incidence of adverse postoperative sequelae. Refinements in laser technology and technique have provided patients and practitioners with more therapeutic choices and improved clinical results. In this review, the currently available laser systems with cutaneous applications are outlined, with primary focus placed on recent advancements and modifications in laser technology that have greatly expanded the cutaneous laser surgeon's armamentarium and improved overall treatment efficacy and safety.
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Affiliation(s)
- Elizabeth L Tanzi
- Washington Institute of Dermatologic Laser Surgery, Washington, DC 20037, USA
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Ratner D, Tse Y, Marchell N, Goldman MP, Fitzpatrick RE, Fader DJ. Cutaneous laser resurfacing. J Am Acad Dermatol 1999; 41:365-89; quiz 390-2. [PMID: 10459111 DOI: 10.1016/s0190-9622(99)70110-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Cutaneous resurfacing with the new generation of carbon dioxide and erbium lasers has recently come into favor for the treatment of facial rhytides, photodamage, and scarring. The precise control of these resurfacing lasers over the extent of tissue vaporization minimizes thermal damage to the skin while maximizing therapeutic efficacy. Proper use of resurfacing lasers is contingent upon a complete understanding of their clinical, histologic, and ultrastructural effects, as well as an appreciation of the principles of laser safety. An organized approach to the preoperative, intraoperative, and postoperative management of the patient undergoing laser resurfacing will be provided, including a discussion of prevention and treatment of postoperative side effects and complications. (J Am Acad Dermatol 1999;41:365-89.) LEARNING OBJECTIVE At the conclusion of this learning activity, participants should be familiar with the clinical, histologic, and ultrastructural effects of resurfacing lasers and be able to discuss the preoperative, intraoperative, and postoperative management of patients undergoing laser resurfacing.
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Affiliation(s)
- D Ratner
- Department of Dermatology, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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Weinstein C, Roberts TL. Aesthetic Skin Resurfacing with the High-Energy Ultrapulsed CO2 Laser. Clin Plast Surg 1997. [DOI: 10.1016/s0094-1298(20)31071-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Affiliation(s)
- T S Alster
- Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA
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Affiliation(s)
- R E Fitzpatrick
- Dermatology Associates of San Diego County, Inc., La Jolla, California, USA
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Abstract
The accessibility of the skin to examination and study has permitted dermatologists to play an extremely important role in defining the clinical usefulness and limitations of many laser systems as well as developing innovative concepts, techniques and devices that further improved the effectiveness of laser treatment. As new laser technology evolved over the years, dermatologists have also helped define the specificity of laser-tissue interaction and employed the newly developed laser technologies in innovative ways which further expanded the usefulness of these devices. One of the most important concepts to be developed by dermatologists--selective photothermolysis--has led to the creation of a series of laser systems which have provided numerous unique advantages in the management of many common vascular and pigmented conditions of the skin and mucous membranes, even in infants and children. The net result of these technologic advances has been the creation of new and effective treatment techniques which have been so profoundly superior to existing technology that they have been rapidly incorporated into the daily practice of most dermatologists.
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Affiliation(s)
- R G Wheeland
- Department of Dermatology, University of New Mexico, Albuquerque 87131, USA
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Fitzpatrick RE, Goldman MP, Ruiz-Esparza J. Clinical advantage of the CO2 laser superpulsed mode. Treatment of verruca vulgaris, seborrheic keratoses, lentigines, and actinic cheilitis. THE JOURNAL OF DERMATOLOGIC SURGERY AND ONCOLOGY 1994; 20:449-56. [PMID: 8034839 DOI: 10.1111/j.1524-4725.1994.tb03215.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Unintended thermal damage occurring during surgery with the CO2 laser limits its usefulness because of slow healing and increased scarring. The superpulsed mode was developed to address this problem, but little clinical data exist to evaluate its effectiveness. OBJECTIVE Patients having warts of the hands and feet, seborrheic keratoses, lentigines, and actinic cheilitis were treated by three experienced laser surgeons using both the conventional continuous mode CO2 laser and a superpulsed CO2 laser. Effectiveness of therapy, healing time, and rates of scarring were compared for the two groups of patients. METHODS Charts of patients treated in 1988 and 1989 were reviewed and data recorded regarding surgical parameters, healing time, scarring, and effectiveness of therapy. Patients were placed in a diagnosis category with each laser only if there was a corresponding patient treated by the same physician using the other laser. CONCLUSION The superpulsed mode was found to convey only a slight advantage. The use of a 50-millisecond pulse was even more advantageous. The superpulse parameters are analyzed and ideal parameters to prevent unwanted thermal damage are suggested.
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Affiliation(s)
- R E Fitzpatrick
- Dermatology Associates of San Diego County, Inc., Encinitas, California
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Abstract
This article reviews the cutaneous manifestations of gastrointestinal tract diseases. In part I, the gastrointestinal tract polyposis syndromes and gastrointestinal tract malignancies will be discussed. The cutaneous manifestations of inflammatory bowel disorders, vascular disorders of the gastrointestinal tract, celiac disease and bowel-associated dermatosis-arthritis syndrome will be discussed in part II. For each entity, a brief summary of the gastrointestinal tract (and other extracutaneous) manifestations is given. This is followed by a detailed discussion of the cutaneous signs. Current guidelines for the investigation and management of these diseases are presented.
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Affiliation(s)
- B Gregory
- Division of Dermatology, University of British Columbia, Vancouver, Canada
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Abstract
Experienced gained with the Carbon Dioxide Laser over a two year period is documented. This laser modality has been used successfully for many indications. We believe it is the treatment of choice for conditions such as resistant verrucae, extensive actinic cheilitis or labial leukoplakia, and for the cosmetic removal of widespread facial tumours, some keloid scars and rhinophyma.
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Affiliation(s)
- R J Sinclair
- Dermatology Department, Repatriation General Hospital, Greenslopes, Queensland
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Frank F, Eichenlaub M, Hessel S, Wondrazek F. Application systems for intracorporeal laser-induced shockwave lithotripsy using the Nd:YAG Q-switched laser. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 1990; 8:51-5. [PMID: 10150126 DOI: 10.1089/clm.1990.8.51a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
For laser-induced shockwave lithotripsy, the electromagnetic energy of a laser light pulse is converted intracorporeally into the acoustic energy of a shockwave. The lithotriptor is based on a specially developed, Q-switched Nd:YAG laser whose high power light pulses (70 mJ, 25 nsec) are coupled into a flexible quartz fiber with a core diameter of 600 mum. Using focusing elements, energy densities higher than 6 x 10 5 J m -2 can be achieved, resulting in an optical breakdown in water followed by a shockwave. As a result of different absorption mechanisms, the breakdown threshold can be decreased by placing a metallic target into the laser beam. The different shockwave formations of such optomechanical transducers have been measured. First clinical applications have been performed.
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Affiliation(s)
- F Frank
- MBB-Medizintechnik GmbH, Munich, West Germany
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