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Kővári BP, Lauwers GY. Mesenchymal Tumors of the Tubular Gastrointestinal Tract (Non-GIST): The GI Pathologist's Approach. Adv Anat Pathol 2025; 32:110-131. [PMID: 39588681 DOI: 10.1097/pap.0000000000000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2024]
Abstract
Mesenchymal neoplasms of the gastrointestinal tract are rare compared with epithelial lesions. However, over the past few decades, the increasing volume of gastrointestinal endoscopy has expedited the recognition of several novel entities with varying clinical significance. Its spectrum extends from reactive changes and benign neoplasms to highly aggressive sarcomas. At the malignant end of the spectrum, the importance of correctly diagnosing these tumors is underscored by the specific therapeutic implications available for some tumor types (eg, tyrosine kinase inhibitors for gastrointestinal stromal tumors) that allow personalized treatments. Benign lesions frequently surface among routine polypectomy specimens, sometimes offering diagnostic challenges. However, precise classification is the only way to avoid prognostic uncertainty and overtreatment, and to recognize possible syndromic associations. Hereby, we offer a pragmatic review of the topic from the gastrointestinal pathologist's perspective, who, although more accustomed to epithelial neoplasms, can use an algorithmic approach to diagnose mesenchymal entities successfully.
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Affiliation(s)
- Bence P Kővári
- Department of Pathology, Mass General Brigham, Harvard Medical School, Boston, MA
| | - Gregory Y Lauwers
- Department of Pathology, Henry Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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2
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Zhuang XY, Wu C, Wu JW, Yang XF, Liu ZH. Transgastric single-incision laparoscopic resection for a recurrent gastric adenoma at the prepyloric antrum: A case report. Int J Surg Case Rep 2025; 127:110940. [PMID: 39862665 PMCID: PMC11803858 DOI: 10.1016/j.ijscr.2025.110940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 01/22/2025] [Accepted: 01/22/2025] [Indexed: 01/27/2025] Open
Abstract
INTRODUCTION Endoscopic resection is suitable for most benign gastric or early stage cancerous polyps. Laparoscopic local resection is performed only for gastric polyps that are difficult to treat with endoscopic resection, such as recurrent or large polyps. However, when polyps are located in difficult regions, such as the gastric cardia and prepyloric antrum, wedge resection may damage the sphincter around the cardia or pylorus, resulting in postoperative deformity or stenosis. PRESENTATION OF CASE A 66-year-old gentleman found a 2.5 cm recurrent adenoma at pre-pyloric antrum when he repeated a esophagogastoscopy 1 year after a 2 cm polyp removed by endoscopic mucosal resection (EMR) at the same site. Owing to submucosal fibrosis, neither EMR nor endoscopic submucosal dissection is considered suitable for recurrent adenoma because of the increased risk of perforation. Pyloric stenosis or deformity was expected with traditional laparoscopic wedge resection for such a lesion located at the pre-pyloric antrum. Instead, we successfully performed a transgastric single-incision laparoscopic en bloc resection of the adenoma. Precise dissection was performed during surgery. The patient's postoperative recovery was uneventful. A repeated esophagogasroscopy one year later showed no recurrence. DISCUSSION Transgastric single-incision laparoscopic resection for recurrent gastric mucosal lesions after previous endoscopic resection is technically feasible and safe. CONCLUSION This procedure can be an alternative choice for local resection of recurrent benign gastric mucosal lesions, especially for those located in special regions such as the prepyloric antrum or gastric cardia.
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Affiliation(s)
- Xin Yu Zhuang
- Department of Surgery, The University of Hong Kong, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Can Wu
- Department of Surgery, The University of Hong Kong, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Jun Wen Wu
- Department of Surgery, The University of Hong Kong, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Xue Fei Yang
- Department of Surgery, The University of Hong Kong, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Zhong Hui Liu
- Department of Surgery, The University of Hong Kong, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.
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Shu F, Yu J, Liu Y, Wang F, Gou G, Wen M, Luo C, Lu X, Hu Y, Du Q, Xu J, Xie R. Mast cells: key players in digestive system tumors and their interactions with immune cells. Cell Death Discov 2025; 11:8. [PMID: 39814702 PMCID: PMC11735678 DOI: 10.1038/s41420-024-02258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 11/22/2024] [Accepted: 12/02/2024] [Indexed: 01/18/2025] Open
Abstract
Mast cells (MCs) are critical components of both innate and adaptive immune processes. They play a significant role in protecting human health and in the pathophysiology of various illnesses, including allergies, cardiovascular diseases and autoimmune diseases. Recent studies in tumor-related research have demonstrated that mast cells exert a substantial influence on tumor cell behavior and the tumor microenvironment, exhibiting both pro- and anti-tumor effects. Specifically, mast cells not only secrete mediators related to pro-tumor function such as trypsin-like enzymes, chymotrypsin, vascular endothelial cell growth factor and histamine, but also mediators related to anti-tumor progression such as cystatin C and IL-17F. This dual role of mast cells renders them an under-recognized but very promising target for tumor immunotherapy. Digestive system tumors, characterized by high morbidity and associated mortality rates globally, are increasingly recognized as a significant healthcare burden. This paper examines the influence of mast cell-derived mediators on the development of tumors in the digestive system. It also explores the prognostic significance of mast cells in patients with various gastrointestinal cancers at different stages of the disease. Additionally, the article investigates the interactions between mast cells and immune cells, as well as the potential relationships among intratumoral bacteria, immune cells, and mast cell within digestive system microenvironment. The aim is to propose new strategies for the immunotherapy of digestive system tumors by targeting mast cells.
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Affiliation(s)
- Feihong Shu
- Department of Endoscopy and Digestive System, Guizhou Provincial People's Hospital, Guiyang, China
- Zunyi Medical University, Zunyi, Guizhou, China
| | - Jie Yu
- Department of Endoscopy and Digestive System, Guizhou Provincial People's Hospital, Guiyang, China
- Zunyi Medical University, Zunyi, Guizhou, China
| | - Youjia Liu
- Zunyi Medical University, Zunyi, Guizhou, China
| | - Fang Wang
- Zunyi Medical University, Zunyi, Guizhou, China
| | - Guoyou Gou
- Zunyi Medical University, Zunyi, Guizhou, China
| | - Min Wen
- Zunyi Medical University, Zunyi, Guizhou, China
| | - Chen Luo
- Zunyi Medical University, Zunyi, Guizhou, China
| | - Xianmin Lu
- Zunyi Medical University, Zunyi, Guizhou, China
| | - Yanxia Hu
- Zunyi Medical University, Zunyi, Guizhou, China
| | - Qian Du
- Department of Endoscopy and Digestive System, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jingyu Xu
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Rui Xie
- Department of Endoscopy and Digestive System, Guizhou Provincial People's Hospital, Guiyang, China.
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4
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Ramachandran R, Grantham T, Loeffler J, Reddy M, Gaduputi V. Successful Endoscopic Management of Oxyntic Gland Adenoma: A Case Report. J Investig Med High Impact Case Rep 2025; 13:23247096251313729. [PMID: 39884983 PMCID: PMC11783470 DOI: 10.1177/23247096251313729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 11/15/2024] [Accepted: 12/24/2024] [Indexed: 02/01/2025] Open
Abstract
Oxyntic gland adenomas (OGAs) are benign gastric neoplasms composed of gland-forming epithelial cells with predominantly chief cell differentiation resembling oxyntic glands confined to the mucosa. If the tumor has submucosal invasion, it should be classified as gastric adenocarcinoma of fundic gland type. The OGAs can pose a diagnostic challenge, as they can resemble aggressive gastric neoplasms. There are no current guidelines on the management of OGA. Due to the relatively small size and low malignant potential, these lesions are typically managed endoscopically. In this case, we are reporting a 22-year-old woman who was diagnosed with OGA during evaluation of iron deficiency anemia and underwent successful endoscopic resection.
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Bourke MJ, Lo SK, Buerlein RCD, Das KK. AGA Clinical Practice Update on Nonampullary Duodenal Lesions: Expert Review. Gastroenterology 2025; 168:169-175. [PMID: 39545885 DOI: 10.1053/j.gastro.2024.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 10/02/2024] [Accepted: 10/07/2024] [Indexed: 11/17/2024]
Abstract
DESCRIPTION Nonampullary duodenal polyps are found in up to 5% of all upper endoscopies; the vast majority are identified incidentally in asymptomatic patients. Although most are benign, adenomas are estimated to account for 10%-20% of these lesions. Most international guidelines recommend that all duodenal adenomas should be considered for endoscopic resection; this may be associated with a near 15% adverse event rate (predominantly bleeding and perforation) in prospective studies, with substantial local recurrence on surveillance. The aim of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review was to describe how individuals should be evaluated and risk-stratified for duodenal polyps, the best approaches to endoscopic resection and surveillance, and management of complications, highlighting opportunities for future research to fill gaps in the existing literature. METHODS This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology. These Best Practice Advice statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BEST PRACTICE ADVICE 1: Non-neoplastic duodenal lesions (eg, metaplastic foveolar epithelium and gastric heterotopia) may mimic neoplastic adenomatous pathology. Careful optical evaluation and pathologic correlation may be necessary to exclude dysplasia. Nondysplastic lesions do not require endoscopic resection unless they are symptomatic or bleeding. BEST PRACTICE ADVICE 2: Ideal duodenal endoscopic inspection includes identification of the major and minor papilla with photodocumentation to ensure no involvement by the lesion. Adding a clear distal attachment device to a forward-viewing gastroscope improves visualization of the papilla and the medial wall. A side-viewing duodenoscope should be used when the major and minor papilla are not visible with the gastroscope and for most lesions on the medial wall of the duodenum within 5 cm of the ampulla. BEST PRACTICE ADVICE 3: All duodenal polyps should be described according to their size, Paris morphology, suspected histologic layer of origin (mucosal lesion or subepithelial lesion), duodenal location (D1-4) and orientation (anterior, posterior, medial, or lateral wall), and proximity/relationship to the major papilla to facilitate therapeutic planning and subsequent surveillance. BEST PRACTICE ADVICE 4: Given the high frequency of concomitant colonic adenomas in patients with duodenal adenomas, on identification of a duodenal adenoma, a colonoscopy should be performed if a high-quality examination has not been performed in the last 3 years. BEST PRACTICE ADVICE 5: Routine small bowel investigation (ie, capsule endoscopy) is not advised in patients with sporadic and nonsporadic duodenal adenomas. Periodic small bowel inspection with capsule endoscopy may be of benefit in patients with Peutz-Jeghers syndrome. BEST PRACTICE ADVICE 6: Definitive treatment of duodenal adenomas by endoscopic resection is less morbid, resource-intensive, and expensive than surgery and is therefore the preferred treatment option. BEST PRACTICE ADVICE 7: Due to the risk of malignant transformation, all sporadic duodenal adenomas should be considered for endoscopic resection. However, in comparison with colonic adenomas, the time course to malignant transformation may be more prolonged, and the risk of resection-related morbidity much greater. Therefore, the comorbidities and anticipated longevity of the patient must be carefully factored into the decision-making process. BEST PRACTICE ADVICE 8: The approach to endoscopic duodenal resection (ie, hot vs cold and conventional vs underwater endoscopic mucosal resection) should be individualized to reduce bleeding risk, based on lesion size, morphology, patient comorbidities, and endoscopist comfort level with specific techniques. Piecemeal cold snare resection for flat duodenal adenomas mitigates postprocedural bleeding risk and, for lesions <20 mm, is effective and carries a minimal risk of recurrence. In patients with comorbidities with flat nonbulky lesions measuring < 20 mm, cold snare resection can be considered. BEST PRACTICE ADVICE 9: Currently, duodenal adenomas >20 mm or with large Paris subtype Is components should be removed by conventional hot snare endoscopic mucosal resection. Thermal ablation of the post-endoscopic mucosal resection margin to mitigate the risk of recurrence to <2%-5% is safe and effective and should be considered. BEST PRACTICE ADVICE 10: Endoscopists performing duodenal polyp resection should be aware of the increased risk of postprocedural bleeding (compared with elsewhere in the gastrointestinal tract), which usually occurs in the first 48 hours after the procedure, with the risk proportional to the lesion size. For lesions >3 cm, bleeding risk is >25% and may be life-threatening and associated with hemodynamic compromise; however, after resuscitation, endoscopic hemostasis is generally effective. BEST PRACTICE ADVICE 11: Evaluation of the postpolypectomy/endoscopic mucosal resection defect is critical to identify concerns for postprocedural duodenal perforation, which, if unrecognized and left untreated, may be life-threatening and often mandates surgery. BEST PRACTICE ADVICE 12: Initial endoscopic surveillance for a completely resected duodenal adenoma should be undertaken at an interval of 6 months. Although usually diminutive, recurrence is often scarred and not amenable to conventional snare resection and may require avulsion techniques to achieve cure. BEST PRACTICE ADVICE 13: Nonampullary duodenal adenomas associated with familial adenomatous polyposis should be considered for endoscopic resection based on size (≥1 cm), morphologic characteristics, advanced histology (ie, high-grade dysplasia), and/or based on Spiegelman criteria.
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Affiliation(s)
- Michael J Bourke
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia.
| | - Simon K Lo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ross C D Buerlein
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia
| | - Koushik K Das
- Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri
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Zhang DX, Niu ZY, Wang Y, Zu M, Wu YH, Shi YY, Zhang HJ, Zhang J, Ding SG. Endoscopic and pathological features of neoplastic transformation of gastric hyperplastic polyps: Retrospective study of 4010 cases. World J Gastrointest Oncol 2024; 16:4424-4435. [PMID: 39554740 PMCID: PMC11551629 DOI: 10.4251/wjgo.v16.i11.4424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/17/2024] [Accepted: 09/29/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Hyperplastic polyps, which represent 30%-93% of all gastric epithelial polyps, are the second most common type of gastric polyps after fundic gland polyps. They were previously considered to have no risk of neoplastic transformation. Recently, an increasing number of cases of gastric hyperplastic polyps (GHPs) combined with neoplastic changes have been reported; however, the specific mechanism underlying their transformation has not been thoroughly explored. AIM To investigate the clinical, endoscopic, and pathological characteristics of the neoplastic transformation of GHPs and explore the risk factors. METHODS A retrospective analysis was performed on 4010 cases of GHPs diagnosed by gastroscopy and pathological examination at the hospital from 2005 to 2021. In total, 3874, 119, and 17 cases were in the group without intraepithelial neoplasia (IN), with low-grade IN, and with high-grade IN, respectively. The data analysis examined the association of endoscopic and pathological features with risk factors for neoplastic transformation. Factors with significant differences were entered into univariate logistic regression, followed by multivariate logistic regression analysis. RESULTS Univariate analysis revealed diameter, multiple polyp presence, redness, rough surface, lobulation, erosion, Yamada classification, location, and gastric mucosa were risk factors for neoplastic transformation. Multivariate analysis showed that age > 65 years [odds ratio (OR) = 1.789; 95% confidence interval (CI): 1.227-2.609; P = 0.003], male sex (OR = 1.680; 95%CI: 1.158-2.438; P = 0.006), multiple polyps (OR = 1.851; 95%CI: 1.230-2.784; P = 0.003), pedunculated or semi-pedunculated shape (OR = 2.722; 95%CI: 1.689-4.388; P < 0.001), and polyp diameter were significantly associated with GHPs that demonstrated neoplastic transformation. Compared with chronic superficial gastritis, autoimmune gastritis, atrophic gastritis, and gastritis with IN were independent risk factors for neoplastic transformation [(OR = 2.672; 95%CI: 1.559-4.579; P < 0.001), (OR = 1.876; 95%CI: 1.134-3.103; P = 0.014), and (OR = 5.299; 95%CI: 3.173-8.849; P < 0.001), respectively]. CONCLUSION Male sex, age > 65 years, multiple polyps, pedunculated or semi-pedunculated shape, polyp size > 1 cm, and specific background gastric mucosa are key indicators for predicting neoplastic transformation of GHPs.
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Affiliation(s)
- Dong-Xue Zhang
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Zhan-Yue Niu
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Ye Wang
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Ming Zu
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Ya-Han Wu
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Yan-Yan Shi
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - He-Jun Zhang
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Jing Zhang
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Shi-Gang Ding
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
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Kurimoto M, Honjo H, Yoshida S, Okai N, Otsuka Y, Masuta Y, Masaki S, Kamata K, Minaga K, Maenishi O, Kudo M, Watanabe T. Enlargement of Gastric Hyperplastic Polyps Arising from Helicobacter heilmannii sensu strico-infected Mucosa after the Successful Eradication of Helicobacter pylori and the Long-Term Use of a Proton Pump Inhibitor. Intern Med 2024:4230-24. [PMID: 39523000 DOI: 10.2169/internalmedicine.4230-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Abstract
Helicobacter pylori eradication is effective for the regression of gastric hyperplastic polyps (GHPs). We report a case which demonstrated an enlargement of GHPs after H. pylori eradication. The patient, who received long-term proton-pump inhibitor (PPI) therapy, lived with a dog, a natural host of Helicobacter heilmanii sensu stricto. Gastric colonization with Helicobacter heilmannii s.s. was observed after H. pylori eradication, thus suggesting the involvement of non-H. pylori Helicobacter species (NHPHs) infection for the enlargement of GHPs, in addition to the proliferative effects of PPI use on the gastric epithelium. Screening for NHPHs may be necessary in dog lovers to avoid paradoxical responses to H. pylori eradication.
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Affiliation(s)
- Masayuki Kurimoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Hajime Honjo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Saki Yoshida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Natsuki Okai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Yasuo Otsuka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Yasuhiro Masuta
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Sho Masaki
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Osamu Maenishi
- Department of Pathology, Kindai University Faculty of Medicine, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
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Reyes-Placencia D, Cantú-Germano E, Latorre G, Espino A, Fernández-Esparrach G, Moreira L. Gastric Epithelial Polyps: Current Diagnosis, Management, and Endoscopic Frontiers. Cancers (Basel) 2024; 16:3771. [PMID: 39594726 PMCID: PMC11591925 DOI: 10.3390/cancers16223771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 11/02/2024] [Accepted: 11/07/2024] [Indexed: 11/28/2024] Open
Abstract
Polyps are defined as luminal lesions that project into the mucosal surface of the gastrointestinal tract and are characterized according to their morphological and histological features [...].
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Affiliation(s)
- Diego Reyes-Placencia
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8320165, Chile
| | - Elisa Cantú-Germano
- Department of Gastroenterology, Fundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), CIBEREHD, 08036 Barcelona, Spain
- Facultat de Medicina, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Gonzalo Latorre
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8320165, Chile
| | - Alberto Espino
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8320165, Chile
| | - Glòria Fernández-Esparrach
- Department of Gastroenterology, Fundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), CIBEREHD, 08036 Barcelona, Spain
- Facultat de Medicina, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Fundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), CIBEREHD, 08036 Barcelona, Spain
- Facultat de Medicina, Universitat de Barcelona, 08036 Barcelona, Spain
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9
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Hagen R, Tidwell J, Weng E, Goldenberg SA, Shaikh A. Duodenal Polyposis: An Incidental Finding of Duodenal-Type Follicular Lymphoma. Cureus 2024; 16:e73237. [PMID: 39650864 PMCID: PMC11624914 DOI: 10.7759/cureus.73237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2024] [Indexed: 12/11/2024] Open
Abstract
Duodenal-type follicular lymphoma is a newly recognized and rare variant of follicular lymphoma with a good prognosis. Patients may present with non-specific gastrointestinal symptoms, but they are often asymptomatic. Diagnosis usually occurs incidentally during EGD when duodenal polyps are biopsied. We describe the unique case of incidentally found biopsy-proven duodenal-type B cell follicular lymphoma. Secondary involvement by systemic type B-cell lymphoma was excluded. The patient underwent localized radiotherapy, obtaining complete remission six months later, confirmed by pathology. Physicians should be aware of this rare pathology, considering the potential for extra-duodenal systemic B-cell lymphoma.
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Affiliation(s)
- Rachael Hagen
- Internal Medicine, University of Connecticut, Farmington, USA
| | - Jasmine Tidwell
- Internal Medicine, University of Connecticut Health, Farmington, USA
| | - Emily Weng
- Gastroenterology and Hepatology, University of Connecticut Health, Farmington, USA
| | - Steven A Goldenberg
- Gastroenterology and Hepatology, University of Connecticut Health, Farmington, USA
| | - Anjiya Shaikh
- Gastroenterology and Hepatology, Yale New Haven Hospital, New Haven, USA
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10
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Yan Z, Zheng H, Feng J, Li Y, Hu Z, Wu Y, Liao G, Miao T, Qiu Z, Mo Q, Li J, Lai A, Lu Y, Chen B. Causal links between circulatory inflammatory cytokines and risk of digestive polyps: a Mendelian randomization analysis. Front Pharmacol 2024; 15:1405503. [PMID: 39439893 PMCID: PMC11493649 DOI: 10.3389/fphar.2024.1405503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 09/24/2024] [Indexed: 10/25/2024] Open
Abstract
Background There is a high morbidity of polyps in the digestive tract, and certain subtypes of polyps are thought to induce cancer progression and often recur, which may be associated with chronic inflammation. Mendelian randomization (MR) can help identify potential causative relationships and inform early treatment action. Methods We performed a bidirectional two-sample MR analysis implementing the results from genome-wide association studies for 41 serum cytokines from 8,293 Finnish individuals, and three types of polyps from European ancestry, respectively, including gastric polyp (6,155 cases vs. 341,871 controls), colonic polyp (22,049 cases vs. 332,368 controls) and gallbladder polyp (458 cases vs. 340,083 controls). Inverse-variance weighted (IVW), weight median (WM), and MR-Egger methods were used for calculating causal estimates. Furthermore, Bayesian model averaging MR (MR-BMA) method was employed to detect the dominant causal circulatory cytokines with adjustment for pleiotropy effects. Results Our univariable MR using inverse-variance weight method identified causal associations of IL-2ra (OR: 0.892, 95%CI: 0.828-0.961, p = 0.003), MIG (OR: 1.124, 95%CI: 1.046-1.207, p = 0.001) and IL-18 (OR: 0.912, 95%CI: 0.852-0.977, p = 0.008) with gastric polyp, MIP1b (OR: 0.956, 95%CI: 0.927-0.987, p = 0.005) and IL-6 (OR: 0.931, 95%CI: 0.870-0.995, p = 0.035) with colonic polyp and IL-9 (OR: 0.523, 95%CI: 0.345-0.794, p = 0.0007) with gallbladder polyp. Finally, our MR-BMA analysis prioritized MIG (MIP = 0.332, MACE = 0.022; PP: 0.264, MSCE = 0.059), IL-18 (MIP = 0.302, MACE = -0.020; PP: 0.243, MSCE = -0.059) and IL-2ra (MIP: 0.129; MACE: -0.005; PP: 0.112, MSCE: -0.031) for gastric polyp, and MIP1b (MIP = 0.752, MACE = -0.033; PP: 0.665, MSCE = -0.044) and IL-6 (MIP: 0.196; MACE: -0.012; PP: 0.140, MSCE: -0.064) for colonic polyp, and IL-9 (MIP = 0.936, MACE = -0.446; PP: 0.781, MSCE = -0.478) for gallbladder polyp as the top-ranked protective factors. Conclusion Our research advances the current understanding of the function of certain inflammatory biomarker pathways in the genesis and malignant mutation of polyps in the digestive tract. Deeper substantiation is necessary to assess the potential of these cytokines as pharmacological or lifestyle targets for digestive polyps prevention.
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Affiliation(s)
- Ziqi Yan
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hongming Zheng
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jieni Feng
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yiting Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhifan Hu
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuan Wu
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guibin Liao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Taosheng Miao
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zexin Qiu
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiaolan Mo
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jia Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ailin Lai
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yue Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Bin Chen
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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11
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Kim GH, Lee JS, Lee JH, Park YS. Oxyntic Gland Neoplasms - From Adenoma to Advanced Gastric Cancer: A Review of 29 Cases. J Gastric Cancer 2024; 24:378-390. [PMID: 39375054 PMCID: PMC11471317 DOI: 10.5230/jgc.2024.24.e30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/03/2024] [Accepted: 07/13/2024] [Indexed: 10/09/2024] Open
Abstract
PURPOSE Oxyntic gland neoplasm (OGN) is a rare condition that can be classified as oxyntic gland adenoma (OGA) or gastric adenocarcinoma of fundic-gland type (GA-FG). GA-FG primarily presents as early gastric cancer, with only a few reported cases of advanced gastric cancer (AGC). We aimed to investigate the clinicopathological features of OGN and describe an aggressive variant. MATERIALS AND METHODS We investigated a total of 29 cases, including a patient with double primary cases, diagnosed with OGN or differentiated-type adenocarcinoma with GA-FG morphology, between November 2016 and April 2022. We analyzed 54 pathological specimens and reviewed their clinicopathological, endoscopic, and histological features. The lesions were reclassified as OGA or GA-FG, and immunohistochemical (IHC) staining for MUC-5AC and MUC-6 was performed on available resected GA-FG cases. RESULTS The median patient age was 65 years and males accounted for 58.6% of patients. Most cases occurred in the body horizontally (69.0%) and on the greater curvature side cross-sectionally (48.3%). Endoscopically, type 0-IIa (41.4%) and a subepithelial tumor-like appearance (24.1%) were the most common findings. Histologically, there were 8 cases of OGA (27.6%) and 21 cases of GA-FG (72.4%). In GA-FG, MUC-6 was positive in 13 cases (81.3%), whereas MUC-5AC was positive in 8 cases (50.0%). Three cases presented as AGCs. CONCLUSIONS Although OGNs are generally considered low-grade, they can present as AGCs and may exhibit features of lymphovascular or perineural invasion. Recognizing the clinicopathological features and accurately diagnosing OGN are important for providing adequate treatment.
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Affiliation(s)
- Gi Hwan Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Pathology, Central Draft Physical Examination Office, Military Manpower Administration, Daegu, Korea
| | - Jun Su Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Division of Gastroenterology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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12
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Kővári B, Carneiro F, Lauwers GY. Epithelial tumours of the stomach. MORSON AND DAWSON'S GASTROINTESTINAL PATHOLOGY 2024:227-286. [DOI: 10.1002/9781119423195.ch13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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13
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Kelly P, Lauwers GY. Polyps and tumour‐like lesions of the stomach. MORSON AND DAWSON'S GASTROINTESTINAL PATHOLOGY 2024:195-226. [DOI: 10.1002/9781119423195.ch12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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14
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El Ouardi W, Bouchabou B, Regragui A, Benazzouz M. Gastric foveolar adenoma in the duodenal bulb: case report. Pan Afr Med J 2024; 48:178. [PMID: 39650829 PMCID: PMC11624469 DOI: 10.11604/pamj.2024.48.178.43852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 08/01/2024] [Indexed: 12/11/2024] Open
Abstract
Foveolar-type adenomas are very rare lesions, representing approximately 2.7% of duodenal adenomas with gastric phenotype, histologically characterized by tall columnar cells resembling gastric foveolar epithelium and a tubulovillous structure with various degrees of dysplasia. Their risk of progression to adenocarcinoma is related to the size of the polyp and the presence of high-grade dysplasia. The recommended therapeutic approach is the endoscopic resection. our clinical case reports a rare case of a patient in whom gastric foveolar adenoma was incidentally discovered as an 8 mm sessile polyp in the duodenal bulb resected entirely by en-bloc mucosectomy technique. Through this case, we draw attention to the existence of bulbar adenomas, which carry a risk of dysplasia and progression to adenocarcinoma.
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Affiliation(s)
- Walid El Ouardi
- Department of Gastroenterology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Bochra Bouchabou
- Department of Hepatogastroenterology, Mongi Slim Hospital, Tunis, Tunisia
| | - Asmaa Regragui
- Department of Anatomopathology, Pathological Anatomy Center of Agdal, Rabat, Morocco
| | - Mustapha Benazzouz
- Department of Gastroenterology, International University of Rabat, Riad Annakhil International Polyclinic, Rabat, Morocco
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15
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Sejben A, Ej MJ, Almakrami M, Kiss TB. [Oxyntic gland neoplasia - case report and diagnostic dilemma]. Orv Hetil 2024; 165:1053-1057. [PMID: 39002113 DOI: 10.1556/650.2024.33090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 07/15/2024]
Abstract
Az oxynticus mirigy neoplasia terminológia a gyomor olyan atípusos fő- és
fedősejtek által alkotott mirigyei esetében használatos, amikor nem látszik
invázió, tehát a fundus mirigy adenocarcinoma diagnózisa nem állítható fel,
ugyanakkor a laesio nem került kompletten eltávolításra, tehát teljes vastagsága
nem vizsgálható. Az oxynticus mirigy neoplasiák etiológiája jelenleg
tisztázatlan, egyes források protonpumpagátlókkal, valamint
antihisztamin-használattal hozták őket összefüggésbe. Endoszkópos vizsgálat
során a morfológiájuk nem specifikus, lapos és polypoid laesiók egyaránt
lehetnek, és döntően a gyomor felső egyharmadára lokalizáltak. Amennyiben
komplett endoszkópos nyálkahártya-reszekció kivitelezhető, további kezelés nem
szükséges, tehát összességében jó prognózisú elváltozásoknak tarthatók.
Közleményünkben egy 84 éves nő esetét mutatjuk be, akinél haspuffadás miatt
indult kivizsgálás, és gasztroszkópia történt. A corpus területén 1 cm-es, lapos
polypus volt látható, melyből többszörös biopszia történt, a képlet közel teljes
eltávolításával. A szövettani vizsgálat során a nyálkahártya mélyén jól körülírt
és jól differenciált, expanzív szélű elváltozás volt megfigyelhető, melyet
atípusos fősejtek, elvétve pedig fedősejtek alkottak. Ezek a sejtek
oxynticusmirigy-szerű struktúrákat képeztek. A pepszinogénreakció a fősejtekben
szemcsés jellegű, citoplazmatikus pozitivitást mutatott.
H+/K+ ATPáz reakcióval a fedősejtekben szintén
szemcsés jellegű, citoplazmatikus pozitivitás látszott. MUC6-tal a laesionalis
sejtekben diffúz, citoplazmatikus pozitivitás volt megfigyelhető. Invázió jeleit
nem láttuk. A morfológiai, valamint az immunfenotípus alapján is az elváltozást
oxynticus mirigy neoplasiának véleményeztük, ’low-grade’ dysplasiával. Az
oxynticus mirigy neoplasiák mind klinikai, mint patológiai szempontból fokozott
figyelmet igényelnek, ugyanis ritka entitásokról van szó, melyeknek egyelőre sem
az etiológiájuk, sem a prognózisuk nem tisztázott teljes mértékben.
Differenciáldiagnosztikai szempontból fundus mirigy polypus, pylorus mirigy
adenoma, valamint neuroendokrin tumor jön szóba. A definitív diagnózis
felállítását pepszinogén, H+/K+ ATPáz, valamint MUC6
immunhisztokémiai reakciók segíthetik. Orv Hetil. 2024; 165(27): 1053–1057.
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Affiliation(s)
- Anita Sejben
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Pathologiai Intézet Szeged, Állomás u. 1., 6725 Magyarország
| | - Mohammad Jamal Ej
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Pathologiai Intézet Szeged, Állomás u. 1., 6725 Magyarország
| | - Mohammed Almakrami
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Pathologiai Intézet Szeged, Állomás u. 1., 6725 Magyarország
| | - Tamás Balázs Kiss
- 2 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged Magyarország
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16
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Judge SJ, Gearty SV, Catchings A, Ranganathan M, Roehrl MH, Vardhana SA, Tang L, Stadler ZK, Strong VE. Consideration of a Novel Surgical Approach in the Management of Gastric Adenocarcinoma and Proximal Polyposis Syndrome. JCO Precis Oncol 2024; 8:e2400175. [PMID: 38976808 PMCID: PMC11232921 DOI: 10.1200/po.24.00175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/03/2024] [Accepted: 05/17/2024] [Indexed: 07/10/2024] Open
Abstract
Investigators at MSKCC highlight a novel surgical approach to manage GAPPS.
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Affiliation(s)
- Sean J. Judge
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Sofia V. Gearty
- Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Amanda Catchings
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Megha Ranganathan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Michael H. Roehrl
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Santosha A. Vardhana
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Laura Tang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Zsofia K. Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Vivian E. Strong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY USA
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17
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Cabrera Charleston M, Oscura Paredes DG, Alfaro Mendez G, Cabrera Tello JM. Development of Gastric Polyps: 15 Years of Proton Pump Inhibitor Therapy. Cureus 2024; 16:e60814. [PMID: 38779437 PMCID: PMC11109474 DOI: 10.7759/cureus.60814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
Gastroesophageal reflux disease (GERD) is a common disease affecting millions of people worldwide. Proton pump inhibitors (PPI) are the most common drugs used to treat this acid-related disorder due to their high efficacy and fewer side effects. However, long-term use of these drugs can cause histopathological changes, including cystic dilation of gastric fundic glands. The present report describes a 53-year-old man with chronic GERD and daily use of PPIs 20 mg once a day for over 15 years. This case demonstrates the association between PPI and the development of fundic gland polyps.
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18
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Chen JW, Liu G, Lin YF, You T, Yao LJ, Wang BS, Wang QH, Li DZ, Wang W. Feasibility and efficacy of endoscopy with blue laser imaging for the detection and diagnosis of cardia polyps: A single-center randomized controlled study. J Dig Dis 2024; 25:191-199. [PMID: 38697920 DOI: 10.1111/1751-2980.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE To compare the detection rate and diagnostic accuracy of cardia polyps using endoscopy with blue laser imaging (BLI) and white-light imaging (WLI). METHODS Patients were randomly divided into the BLI group and WLI group according to the endoscopic procedures. BLI followed by WLI was conducted in the BLI group, whereas WLI followed by BLI examination was conducted in the WLI group. The number, size, microstructure, and microvascular patterns of cardia polyps detected were recorded. Biopsy of the polyps was then performed. RESULTS The detection rate of cardia polyps in the BLI group was higher than that in the WLI group (7.87% vs 4.22%, P = 0.018). The rate of overlooked lesions in the BLI group was lower than in the WLI group (0.64% vs 3.38%, P = 0.003). The diagnostic coincidence rate between magnifying BLI and histopathology was 88.16%. The sensitivity, specificity, positive predictive value and negative predictive value for the diagnosis of neoplastic lesions by magnifying endoscopy with BLI were 90.91%, 87.69%, 55.56%, and 98.28%, respectively. The most remarkable patterns for predicting inflammatory polyps were the prolonged and fine network patterns (sensitivity 71.43%, specificity 93.75%). Small round combined with honeycomb patterns were the most common among fundic gland polyps (sensitivity 80.00%, specificity 98.48%). Neoplastic lesions presented as villous or ridge-like combined with core vascular or unclear pattern for both microvascular and microstructure patterns. CONCLUSION BLI is more effective than WLI in the detection and diagnosis of cardia polyps, and magnifying endoscopy with BLI may help diagnose such lesions.
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Affiliation(s)
- Jia Wei Chen
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force of the People's Liberation Army, Fuzhou, Fujian Province, China
| | - Gang Liu
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force of the People's Liberation Army, Fuzhou, Fujian Province, China
| | - Yan Fang Lin
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force of the People's Liberation Army, Fuzhou, Fujian Province, China
| | - Ting You
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force of the People's Liberation Army, Fuzhou, Fujian Province, China
| | - Li Jia Yao
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force of the People's Liberation Army, Fuzhou, Fujian Province, China
| | - Bao Shan Wang
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force of the People's Liberation Army, Fuzhou, Fujian Province, China
| | - Qing Hua Wang
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Da Zhou Li
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force of the People's Liberation Army, Fuzhou, Fujian Province, China
| | - Wen Wang
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force of the People's Liberation Army, Fuzhou, Fujian Province, China
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19
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Chen X, Zhang D, Chen M. High frequency electrocoagulation resection effect analysis and prognosis observation in the treatment of patients with gastric polyps under painless gastroscopy. Medicine (Baltimore) 2024; 103:e37027. [PMID: 38335390 PMCID: PMC10860979 DOI: 10.1097/md.0000000000037027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/12/2023] [Accepted: 01/02/2024] [Indexed: 02/12/2024] Open
Abstract
To explore high frequency electrocoagulation resection effect in treatment of patients with gastric polyps under painless gastroscopy. Sixty-four patients with gastric polyps were randomly divided into experimental group (32 cases) and control group (32 cases). Experimental group received basic treatment drugs for 8 weeks, and then treated with painless gastroscope high-frequency electrocoagulation resection. Control group was also given basic treatment drugs for 8 weeks, and then received high-frequency electrocoagulation resection under ordinary gastroscope. The patients in both groups were given rabeprazole sodium enteric coated capsules for 4 weeks. The improvement of symptom score, postoperative gastric mucosal healing and comprehensive curative effect of the 2 groups were observed after treatment. The patients with polyps cured under gastroscopy were subjected to a 6-month follow-up period during which gastroscopy was performed to assess the recurrence of polyps. Symptom scores comparison after treatment showed that experimental group had obvious advantages in improving epigastric fullness, fatigue and loose stool in patients with gastric polyps (P < .01 or P < .05). Gastric mucosa healing in experimental group was better at 2 weeks after operation (P < .05), showing no difference 4 weeks after operation (P > .05). Comprehensive curative effect comparison showed that the experimental group was better (P < .01), showing no difference in long-term efficacy (P > .05). In treating patients with gastric polyps, painless endoscopic high-frequency electrocoagulation resection effect is better, which not only promotes postoperative rehabilitation in patients but also reduces complications incidence, demonstrating a high level of safety. Therefore, it is highly recommended for widespread adoption and application.
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Affiliation(s)
- Xiaomei Chen
- Department of Nursing, The Fifth People’s Hospital of Wuhu City, Wuhu, Anhui, People’s Republic of China
| | - Dandan Zhang
- Department of Nursing, The Fifth People’s Hospital of Wuhu City, Wuhu, Anhui, People’s Republic of China
| | - Mei Chen
- Department of Nursing, The Fifth People’s Hospital of Wuhu City, Wuhu, Anhui, People’s Republic of China
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20
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Kim Y, Kang S, Ahn JY, Jung HY, Lee GH, Song HJ, Choi KD, Kim DH, Jung KW, Lee JH, Na HK. Risk factors associated with recurrence of gastric hyperplastic polyps: a single-center, long-term, retrospective cohort study. Surg Endosc 2023; 37:7563-7572. [PMID: 37438481 DOI: 10.1007/s00464-023-10194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/01/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND The likelihood of recurrence of gastric hyperplastic polyps (GHPs) following endoscopic resection and the need for long-term follow-up remain unknown. We, therefore, aimed to investigate the factors associated with the recurrence and cumulative incidence of GHPs over a 10-year period. METHODS Between May 1995 and December 2020, 1,018 GHPs > 1 cm were endoscopically resected from 869 patients. Medical records of these patients were retrospectively reviewed and their clinical features and outcomes were assessed. Groups of GHPs with recurrence and those without recurrence group were compared, and univariate and multivariable analyses were performed to identify the potential risk factors for GHP recurrence. RESULTS A total of 104 (12.0%) patients who underwent endoscopic removal of GHPs experienced recurrence. Compared to patients without recurrent GHPs, those with recurrent GHPs showed considerably larger median polyp size (28 mm vs. 14 mm, P < 0.001), a higher proportion of multiple polyps (41.3% vs. 29.3%, P = 0.020), polyps with lobulation (63.5% vs. 40.3%, P = 0.001), and exudate (63.5% vs. 46.8%, P = 0.001). Compared to the local recurrence (n = 52) group, the metachronous recurrence (n = 52) group had larger median polyp size (20 mm vs. 16 mm, P = 0.006) as well as higher rates of polyp lobulation (86.5% vs. 40.4%, P < 0.001) and exudate (82.7% vs. 44.4%, P = 0.001). After primary GHP excision, the cumulative incidence of recurrence was 7.2%, 12.7%, and 19.6% at 2 years, 5 years, and 10 years, respectively. CONCLUSION The incidence of GHP recurrence following endoscopic excision increased as the follow-up period increased, especially in patients whose GHPs were large-sized, multiple, or characterized by surface exudates/lobulations.
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Affiliation(s)
- Yuri Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Seokin Kang
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
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21
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Krooks J, Thaker H, Qiu S, Reep G, He J. Oxyntic Gland Adenoma in a Patient With Refractory Reflux. Cureus 2023; 15:e38577. [PMID: 37284353 PMCID: PMC10239566 DOI: 10.7759/cureus.38577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/08/2023] Open
Abstract
A 58-year-old African American male was referred for endoscopic evaluation due to a persistent nine-year history of reflux. Previous endoscopy nine years ago revealed a small hiatal hernia and chronic gastritis caused by Helicobacter pylori (H. pylori), which was treated with triple therapy. During the current endoscopic evaluation, findings consistent with reflux esophagitis were identified, along with the discovery of an incidental 6 mm sessile polyp in the gastric fundus. Pathological examination revealed the presence of an oxyntic gland adenoma (OGA). Otherwise, the stomach was found to be unremarkable endoscopically and histologically. OGA is a rare gastric neoplasm that is primarily observed in Japan, with very few reported cases in North America. Studies have suggested a potential association with antacids, while the role of H. pylori in the development of OGA remains controversial. Our patient's OGA was completely resected during the endoscopy, with no recurrence noted on the three-month follow-up.
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Affiliation(s)
- Jolie Krooks
- Pathology, University of Texas Medical Branch, Galveston, USA
| | | | - Suimin Qiu
- Pathology, University of Texas Medical Branch, Galveston, USA
| | - Gabriel Reep
- Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, USA
| | - Jing He
- Pathology, University of Texas Medical Branch, Galveston, USA
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Sathirawich P, Pongpaibul A, Parakonthun T, Kaosombatwattana U. Gastric villous adenoma: a case report and review of the literature. J Med Case Rep 2023; 17:167. [PMID: 37098577 PMCID: PMC10131319 DOI: 10.1186/s13256-023-03893-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/17/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Villous adenoma is the one subtype of adenomatous polyp that is very uncommon in the stomach. Data regarding clinical characteristics, natural history, and prognosis were scarce. CASE PRESENTATION This report presented an 87-year-old Thai woman with a large gastric villous adenoma incidentally revealed in a computed tomography of chest for the evaluation of right pleural effusion. The esophagogastroduodenoscopy demonstrated a huge, glossy, proliferative polypoid mass involving gastric cardia, fundus, and a lesser curve of the upper body. The pathological report confirmed villous adenoma with low grade dysplasia. Although surgical resection was suggested, the patient denied any treatment due to advanced age and multiple comorbidities. She was generally well after 12 months of clinical and radiologic surveillance. CONCLUSION From literature review, only 14 cases of gastric villous adenoma were reported to date. Most of the lesions were large and symptomatic. Malignancy presented in 43% of the cases. Nevertheless, our patient remained asymptomatic without surgical removal following a 12-month period.
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Affiliation(s)
- Phalat Sathirawich
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Siriraj Subdistrict, Bangkok-noi, Bangkok, 10700, Thailand
- Vikit Viranuvatti Siriraj GI Endoscopy Center, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ananya Pongpaibul
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thammawat Parakonthun
- Vikit Viranuvatti Siriraj GI Endoscopy Center, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Minimally Invasive Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Uayporn Kaosombatwattana
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Siriraj Subdistrict, Bangkok-noi, Bangkok, 10700, Thailand.
- Vikit Viranuvatti Siriraj GI Endoscopy Center, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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23
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Cai MY, Zhu L, Xu XY, Xu JX, Zhang DF, Zhang Z, Li QL, Qin WZ, Feng L, Xu JG, Li P, Zhou PH. Endoscopic mucosal resection of gastrointestinal polyps with a novel low-temperature plasma radio frequency generator: a non-inferiority multi-center randomized control study. Surg Endosc 2023; 37:3272-3279. [PMID: 36890416 DOI: 10.1007/s00464-023-09945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 02/12/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND To evaluate the efficacy and safety of novel plasma radio frequency generator and its single-use polypectomy snares for endoscopic mucosal resection (EMR) of gastrointestinal (GI) polyps. METHODS A total of 217 patients with 413 GI polyps were recruited from four centers in China. Patients were assigned to experimental or control groups using a central randomization method. The experimental group used the novel plasma radio frequency generator and its matched single-use polypectomy snares (Neowing, Shanghai), while the control group used the high-frequency electrosurgical unit (Erbe, Germany) and disposable electrosurgical snares (Olympus, Japan). The primary endpoint was the en bloc resection rate, and the non-inferiority margin was set at 10%. Secondary endpoint included operation time, coagulation success rate, intraoperative and postoperative bleeding rate, and perforation rate. RESULTS The en bloc resection rate was 97.20% (104/107) in the experimental group and 95.45% (105/110) in the control group (P = 0.496). The operation time was 29.14 ± 20.21 min in the experimental group and 30.26 ± 18.74 min in the control group (P = 0.671). The average removal time of a single polyp in the experimental group was 7.52 ± 4.45 min, which was slightly shorter than that in the control group 8.90 ± 6.67 min, with no statistical difference (P = 0.076). The intraoperative bleeding rates of the experimental group and control group were 8.41% (9/107) and 10.00% (11/110), respectively (P = 0.686). No intraoperative perforation occurred in either group. The postoperative bleeding rates of the experimental group and the control group were 1.87% (2/107) and 4.55% (5/110), respectively (P = 0.465). No postoperative perforation occurred in the experimental group (0/107), while one case of delayed perforation occurred in the control group (1/110, 0.91%). There was no statistical difference between the two groups. CONCLUSIONS Endoscopic mucosal resection of GI polyps with the novel plasma radio frequency generator is safe and effective, and non-inferior to the conventional high-frequency electrosurgical system.
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Affiliation(s)
- Ming-Yan Cai
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Liang Zhu
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Xiao-Yue Xu
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jia-Xin Xu
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Dan-Feng Zhang
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Zhen Zhang
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Quan-Lin Li
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Wen-Zheng Qin
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Li Feng
- Department of Gastroenterology, Central Hospital of Minhang District, Shanghai, China
| | - Jian-Guang Xu
- Department of Gastroenterology, Quzhou People's Hospital, Zhejiang, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ping-Hong Zhou
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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24
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Kiparissi F, Dastamani A, Palm L, Azabdaftari A, Campos L, Gaynor E, Grünewald S, Uhlig HH, Kleta R, Böckenhauer D, Jones KDJ. Phosphomannomutase 2 (PMM2) variants leading to hyperinsulinism-polycystic kidney disease are associated with early-onset inflammatory bowel disease and gastric antral foveolar hyperplasia. Hum Genet 2023; 142:697-704. [PMID: 36773065 PMCID: PMC10181953 DOI: 10.1007/s00439-023-02523-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023]
Abstract
Phosphomannomutase 2 (PMM2) deficiency causes Congenital Disorder of Glycosylation (PMM2-CDG), but does not have a recognised association with Inflammatory Bowel Disease (IBD). A distinct clinical syndrome of hyperinsulinism and autosomal recessive polycystic kidney disease (HIPKD) arises in the context of a specific variant in the PMM2 promotor, either in homozygosity, or compound heterozygous with a deleterious PMM2 variant. Here, we describe the development of IBD in three patients with PMM2-HIPKD, with onset of IBD at 0, 6, and 10 years of age. In each case, intestinal inflammation coincided with the unusual finding of gastric antral foveolar hyperplasia. IBD disease was of variable severity at onset but well controlled with conventional and first-line biologic treatment approaches. The organ-level pattern of disease manifestations in PMM2-HIPKD-IBD may reflect a loss of cis-acting regulatory control by hepatocyte nuclear factor 4 alpha (HNF4A). Analysis of published transcriptomic data suggests that IBD most likely arises due to an impact on epithelial cellular function. We identify a specific pattern of variation in PMM2 as a novel association of early-onset IBD with distinctive gastric pathology.
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Affiliation(s)
- Fevronia Kiparissi
- Department of Paediatric Gastroenterology & Nutrition, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Antonia Dastamani
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Liina Palm
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Aline Azabdaftari
- Translational Gastroenterology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Luis Campos
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Edward Gaynor
- Department of Paediatric Gastroenterology & Nutrition, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stephanie Grünewald
- Department of Metabolic Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Holm H Uhlig
- Translational Gastroenterology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Department of Paediatrics and Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Robert Kleta
- Department of Renal Medicine, University College London, London, UK.,Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Detlef Böckenhauer
- Department of Renal Medicine, University College London, London, UK.,Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kelsey D J Jones
- Department of Paediatric Gastroenterology & Nutrition, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,The Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
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25
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Al Ghamdi SS, Ngamruengphong S. Endoscopic Submucosal Dissection in the Stomach and Duodenum: Techniques, Indications, and Outcomes. Gastrointest Endosc Clin N Am 2023; 33:67-81. [PMID: 36375887 DOI: 10.1016/j.giec.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Gastric endoscopic submucosal dissection (ESD) is established for management of early gastric cancer (EGC). Diagnosis of EGC relies on adequate endoscopic assessment involving lesion size, histopathology, presence of ulceration, and depth of invasion. Absolute indications for endoscopic resection of EGC are if patients are presumed to have a less than 1% risk of lymph node metasta endoscopic submucosal dissectionsis, and long-term outcomes are similar to those with surgical gastrectomy. Duodenal ESD is more technically difficult and requires expertise in ESD in other locations.
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Affiliation(s)
- Sarah S Al Ghamdi
- Division of Gastroenterology and Hepatology, Department of Medicine, King Abdulaziz University, Jeddah, PO Box 80215, Saudi Arabia
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, Department of Medicine, King Abdulaziz University, Building 10, 2nd Floor, PO Box 80215, Jeddah 21589, Saudi Arabia.
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26
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Cheng Y, Han J, Li Q, Shi Y, Zhong F, Wu Y, Wang Z, Yuan Z, Fan X, Zhao J. Metabolic obesity phenotypes: a friend or foe of digestive polyps?-An observational study based on National Inpatient Database. Metabolism 2022; 132:155201. [PMID: 35427603 DOI: 10.1016/j.metabol.2022.155201] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Obesity is associated with an increased risk of digestive polyps, whereas all obesity are not created equally. The role of metabolic states in occurrence risks of polyps among individuals with varying degrees of obesity remains unknown. Our study aimed to evaluate the association between metabolic obesity phenotypes and the occurrence of digestive polyps. RESEARCH DESIGN AND METHODS Data from 9,278,949 patients between 2016 and 2018 from the National Inpatient Sample (NIS) database, a nationally representative database of all discharges from US health-care hospitals, were analyzed. According to obesity phenotype, the study population was classified into four groups: metabolically healthy nonobese (MHNO), metabolically unhealthy nonobese (MUNO), metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO). We calculated the incidence rates of various digestive polyps (stomach/duodenum, colon and rectum polyps) among these participants by searching the hospital records for ICD-10 diagnosis codes indicating each gastric, duodenum, colon or rectal polyps. The multiple stepwise regression analysis and further in-depth subgroup analysis were used to determine the associations between metabolic obesity phenotypes and the occurrence of digestive polyps. RESULTS In the total or female population, those with the MUNO and MUO phenotypes had significantly higher prevalence of digestive polyps compared with individuals with the MHNO or MHO phenotypes (all p < 0.05) and a significant difference was not found between MUNO and MUO phenotypes (p > 0.05). Obese subjects seem to be more likely to develop stomach and duodenum polyps or colon polyps than non-obese subjects in metabolically healthy people of males (MHO vs. MHNO, p < 0.05), whereas obesity status seems to have little effect on the occurrence of digestive polyps in metabolically healthy people of females (MHO vs. MHNO, p>0.05). After adjusting for the potential confounders, the MHO, MUNO and MUO phenotypes were all risk factors for stomach and duodenum polyps (OR = 1.46, 95% CI: 1.36-1.58, p< 0.01; OR = 1.19, 95% CI: 1.14-1.25, p< 0.01; OR = 1.44, 95% CI: 1.35-1.55, p< 0.01, respectively) or colon polyps (OR = 1.28, 95% CI: 1.21-1.35, p< 0.01; OR = 1.18, 95% CI: 1.14-1.22, p< 0.01; OR = 1.46, 95% CI: 1.38-1.54, p< 0.01, respectively) compared with the MHNO phenotype,especially in menopausal female. Interestingly, we also observed in further in-depth subgroup analysis that metabolic abnormalities may have a greater impact on the occurrence of digestive polyps than obesity (all p < 0.05). CONCLUSIONS Both metabolic abnormities and obesity were associated with a higher risk of digestive polyps. The effect of metabolism on digestive polyp occurrence may be stronger than that of obesity, highlighting the importance of abnormal metabolic status modification regardless of obesity status. Clinical intervention should not only focus on obesity, but also on metabolic abnormalities to decrease digestive polyp risk.
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Affiliation(s)
- Yiping Cheng
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Junming Han
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Qihang Li
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Yingzhou Shi
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Fang Zhong
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Yafei Wu
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Zhixiang Wang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Zhongshang Yuan
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Xiude Fan
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China.
| | - Jiajun Zhao
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China.
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27
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Yoo BS, Houston KV, D'Souza SM, Elmahdi A, Davis I, Vilela A, Parekh PJ, Johnson DA. Advances and horizons for artificial intelligence of endoscopic screening and surveillance of gastric and esophageal disease. Artif Intell Med Imaging 2022; 3:70-86. [DOI: 10.35711/aimi.v3.i3.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Affiliation(s)
- Byung Soo Yoo
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
| | - Kevin V Houston
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23298, United States
| | - Steve M D'Souza
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
| | - Alsiddig Elmahdi
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
| | - Isaac Davis
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
| | - Ana Vilela
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
| | - Parth J Parekh
- Division of Gastroenterology, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
| | - David A Johnson
- Division of Gastroenterology, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
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28
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Fu S, Gong J, Zhou M, Wang Y, Liu D, Tan Y. Risk Factors of Non-en Bloc Resection and Non-R0 Resection During Endoscopic Resection in the Treatment of Superficial Duodenal Epithelial Lesions. Front Oncol 2022; 12:881815. [PMID: 35669421 PMCID: PMC9163665 DOI: 10.3389/fonc.2022.881815] [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: 02/23/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Superficial duodenal epithelial lesions are precancerous lesions of duodenal carcinoma. Upper gastrointestinal endoscopy has been widely used in the screening and treatment of this disease. This article will collect the data of patients who underwent endoscopic resection of superficial duodenal epithelial lesions in our hospital from 2010 to 2021, aiming to describe the efficacy and safety of endoscopic resection, as well as to explore the risk factors of non-en bloc resection and non-R0 resection. METHODS Patients who underwent endoscopic resection for superficial duodenal epithelial lesions in our hospital from January 2010 to September 2021 were selected. The curative effect was expressed by the en bloc resection rate and R0 resection rate. The safety was expressed by intra- or postoperative complications, such as bleeding and perforation. The potential risk factors of curative effect were analyzed by logistic regression. RESULTS A total of 137 patients were included. The en bloc resection rate was 95.62% (131/137), R0 resection rate was 91.97% (126/137), the postoperative bleeding rate was 2.19% (3/137), and no postoperative perforation was found. The histology result of ectopic gastric mucosa was the risk factor of non-en bloc resection (OR: 8.86, 95% CI: 1.38-56.92); the lesion size ≥2 cm was the risk factor of non-R0 resection (OR: 12.55, 95% CI: 2.95-53.38). CONCLUSION Endoscopic resection is a safe and effective method for the treatment of superficial duodenal epithelial lesions. The histology result of ectopic gastric mucosa was the risk factor of non-en bloc resection and the lesion size ≥2 cm was the risk factor of non-R0 resection.
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Affiliation(s)
- Shifeng Fu
- Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
| | - Jian Gong
- Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
| | - Mei Zhou
- Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
| | - Yongjun Wang
- Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
| | - Deliang Liu
- Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
| | - Yuyong Tan
- Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
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29
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Kővári B, El Naili R, Pereira DV, Kumarasinghe P, De Boer WB, Jiang K, Pimiento JM, Fukuda M, Misdraji J, Kushima R, Lauwers GY. Fundic gland polyps related to diverse aetiologies show subtle morphologic differences: A multicentre retrospective study. Histopathology 2022; 80:827-835. [DOI: 10.1111/his.14623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Bence Kővári
- Department of Pathology H. Lee Moffitt Cancer Center & Research Institute
- Department of Pathology University of Szeged, Albert Szent‐Györgyi Medical School
| | | | | | | | - W. Bastiaan De Boer
- Department of Pathology PathWest Laboratory –University of Western Australia
| | - Kun Jiang
- Department of Pathology H. Lee Moffitt Cancer Center & Research Institute
| | - Jose M. Pimiento
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center & Research Institute
| | | | | | - Ryoji Kushima
- Department of Pathology Shiga University of Medical Science
| | - Gregory Y Lauwers
- Department of Pathology H. Lee Moffitt Cancer Center & Research Institute
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30
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Carbone R, Rovedatti L, Lenti MV, Furlan D, Errichiello E, Gana S, Luinetti O, Arpa G, Alvisi C, De Grazia F, Valente EM, Sessa F, Paulli M, Vanoli A, Di Sabatino A. Histologic heterogeneity and syndromic associations of non-ampullary duodenal polyps and superficial mucosal lesions. Dig Liver Dis 2021; 53:1647-1654. [PMID: 33814312 DOI: 10.1016/j.dld.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Duodenal polyps and superficial mucosal lesions (DP/SMLs) are poorly characterised. AIMS To describe a series of endoscopically-diagnosed extra-ampullary DPs/SMLs. METHODS This is a retrospective study conducted in a tertiary referral Endoscopy Unit, including patients who had DPs or SMLs that were biopsied or removed in 2010-2019. Age, gender, history of familial polyposis syndromes, DP/SML characteristics were recorded. Histopathological, immunohistochemical and molecular analyses were performed. RESULTS 399 non-ampullary DP/SMLs from 345 patients (60.6% males; median age 67 years) were identified. Gastric foveolar metaplasia represented the most frequent histotype (193 cases, 48.4%), followed by duodenal adenomas (DAs; 77 cases, 19.3%). Most DAs (median size 6 mm) were sessile (Paris Is; 48%), intestinal-type (96.1%) with low-grade dysplasia (93.5%). Among syndromic DAs (23%), 15 lesions occurred in familial adenomatous polyposis 1, two were in MUTYH-associated polyposis and one was in Peutz-Jeghers syndrome (foveolar-type, p53-positive, low-grade dysplasia). Only one (3.3%) tubular, low-grade DA showed mismatch repair deficiency (combined loss of MLH1 and PMS2, heterogeneous MSH6 expression), and it was associated with a MLH1 gene germline mutation (Lynch syndrome). CONCLUSION DPs/SMLs are heterogeneous lesions, most of which showing foveolar metaplasia, followed by low-grade, intestinal-type, non-syndromic DAs. MMR-d testing may identify cases associated with Lynch syndrome.
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Affiliation(s)
- Riccardo Carbone
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Italy
| | - Laura Rovedatti
- Endoscopy Unit, First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, University of Pavia, IRCCS San Matteo Hospital Foundation, Viale Golgi 19, 27100, Italy.
| | - Daniela Furlan
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Edoardo Errichiello
- General Biology and Medical Genetics Unit, Department of Molecular Medicine, University of Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy
| | | | - Ombretta Luinetti
- Anatomic Pathology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Giovanni Arpa
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, Italy
| | - Costanza Alvisi
- Endoscopic Unit, Department of Surgery, ASST Pavia, Pavia, Italy
| | - Federico De Grazia
- Endoscopy Unit, First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Enza Maria Valente
- General Biology and Medical Genetics Unit, Department of Molecular Medicine, University of Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy
| | - Fausto Sessa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Marco Paulli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, Italy; Anatomic Pathology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Alessandro Vanoli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, Italy; Anatomic Pathology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, University of Pavia, IRCCS San Matteo Hospital Foundation, Viale Golgi 19, 27100, Italy
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31
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Vanoli A, Grillo F, Furlan D, Arpa G, Grami O, Guerini C, Riboni R, Mastracci L, Di Sabatino A. Small Bowel Epithelial Precursor Lesions: A Focus on Molecular Alterations. Int J Mol Sci 2021; 22:4388. [PMID: 33922305 PMCID: PMC8122855 DOI: 10.3390/ijms22094388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 12/15/2022] Open
Abstract
The wider use of gastrointestinal endoscopic procedures has led to an increased detection of small intestinal preneoplastic and neoplastic epithelial lesions, most of which are identified in the duodenum and ampullary region. Like their malignant counterparts, small intestinal glandular precursor lesions, which include adenomas and hamartomas, may arise sporadically or be associated with hereditary tumor syndromes, such as familial adenomatous polyposis, MUTYH-associated polyposis, Lynch syndrome, Peutz-Jeghers syndrome, juvenile polyposis syndrome, and Cowden syndrome. In addition, dysplastic, preinvasive lesions have been observed adjacent to small bowel adenocarcinomas complicating immune-related disorders, such as celiac or Crohn's disease. Adenomatous lesions may exhibit an intestinal-type, gastric-type, or, very rarely, serrated differentiation, related to different molecular pathogenetic mechanisms. Finally, in the background of multiple endocrine neoplasia 1 syndrome, precursor neuroendocrine growths have been described. In this review we offer a comprehensive description on the histo-molecular features of the main histotypes of small bowel epithelial precursors lesions, including: (i) sporadic adenomas (intestinal-type and gastric-type; non-ampullary and ampullary); (ii) syndromic adenomas; (iii) small bowel dysplasia in celiac and Crohn's disease; (iv) serrated lesions; (v) hamartomatous lesions; and (vi) neuroendocrine precursor lesions.
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Affiliation(s)
- Alessandro Vanoli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Lombardy, Italy; (G.A.); (O.G.); (C.G.); (R.R.)
| | - Federica Grillo
- Pathology Unit, Department of Surgical and Diagnostic Sciences, University of Genoa and Ospedale Policlinico San Martino University Hospital, 16132 Genoa, Liguria, Italy; (F.G.); (L.M.)
| | - Daniela Furlan
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Lombardy, Italy;
| | - Giovanni Arpa
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Lombardy, Italy; (G.A.); (O.G.); (C.G.); (R.R.)
| | - Oneda Grami
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Lombardy, Italy; (G.A.); (O.G.); (C.G.); (R.R.)
| | - Camilla Guerini
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Lombardy, Italy; (G.A.); (O.G.); (C.G.); (R.R.)
| | - Roberta Riboni
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Lombardy, Italy; (G.A.); (O.G.); (C.G.); (R.R.)
| | - Luca Mastracci
- Pathology Unit, Department of Surgical and Diagnostic Sciences, University of Genoa and Ospedale Policlinico San Martino University Hospital, 16132 Genoa, Liguria, Italy; (F.G.); (L.M.)
| | - Antonio Di Sabatino
- Department of Internal Medicine, University of Pavia and Fondazione IRCCS San Matteo Hospital, 27100 Pavia, Lombardy, Italy;
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