Eight years experience of transanal endoscopic microsurgery

Introduction: Transanal Endoscopic Microsurgery (TEM) is a minimally invasive method for management of different proctologic conditions. Despite widespread use of this method, it is not used widely in Iran. This report is about to describe the application of TEM in managing different proctologic conditions in a tertiary colorectal referral center in Iran regarding methods and complications. Methods: All of the patients' documents such as procedure, method, early postop complications and further operations were actively reviewed and the data were entered in to the database. Results: Since 2012 till the end of 2020 chart review was done and 150 cases of TEM operation were found. The most frequent procedure that was done was resection procedure. Using different energy devices during surgery or suturing versus not suturing the defect were not associated with complication. There was a case of in hospital mortality and one case delayed perianal fistula following TEM. Measurement of lesion distance from anal verge was not significantly different using TEM or colonoscopy. Villous adenomas detected in colonoscopy were mostly associated with malignancy. In evaluated resected lesions most of cases had free base and distance from anal verge or using different energy devices were not associated with obtaining free base. Conclusion: TEM is a safe minimal invasive procedure with acceptable complications that could be helped in managing different proctologic conditions and the results of reviewing our patients revealed the same results that is reported from other colorectal centers. (AU)

Laparoscopic cecectomy for diseases of the appendix and cecum

Introduction: The cecum is the first part of the large bowel. Cecectomy is a sufficient treatment for some patients, avoiding overtreatment by ileocolic resection. Purpose:The goal of this study was to review a surgeon's experience with laparoscopic cecectomy and provide a technical video demonstration of this uncommon operation. Methods: A retrospective chart review was conducted of all consecutive patients treated with laparoscopic cecectomy over a 16-year period. All operations were performed using a 3-trocar technique. The cecum was transected with 1 to 2 firings of a 60 millimeters linear stapler, preserving the ileocecal valve and ascending colon. Results: 19 patients were identified including 12 females (63.2%). Median age was 42 years (range 16-84). Indication for surgery included appendiceal pathology in 12 patients (63.2%) and cecal abnormality in 7 (38.9%). There was no conversion to open surgery. Median intraoperative blood loss was 25 ml (range 0-150 ml) and no patient received a blood transfusion. No intraoperative or postoperative complication was noted. The median length stay was 1 day (range 0-6). Readmission rate was 0%. Final appendiceal histopathology revealed acute/chronic appendicitis in 5 patients, mucinous cystadenoma in 4 patients. Cecal histopathology revealed adenoma in 4 patients. Median follow-up was 16 months (range 4-53). Conclusions: Laparoscopic cecectomy is a sufficient treatment for some patients with benign conditions of the appendix and cecum. It carries minimal morbidity. It should be considered as an alternative to segmental bowel resection in a select group of patients. (AU)

Polipectomia a frio: um procedimento seguro para remover pequenas lesões colorretais não pediculadas / Cold snare polypectomy: a safe procedure for removing small non-pedunculated colorectal lesions

ABSTRACT Background: Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is re­cognized as a risk factor for interval cancer. Objective: The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. Methods: We prospectively evaluated 479 polyps <10 mm removed by CSP in 276 patients by an inexperienced endoscopist. Results: A total of 476 polyps (99.4%) were resected en bloc. A negative margin (classified as CPR) was observed in 435 polyps (90.8%). An unclear or positive margin (classified as IPR) was observed in 43 cases (9.0%) and 1 case (0.2%), respectively, for an overall IPR rate of 9.2% (44/479). The IPR rate was 12.2% in the first half of cases and 5.9% in the second half (P=0.02). Dividing into tertiles, the IPR rate was 15.0% in the first tertile, 6.9% in the second tertile, and 5.7% in the third tertile (P=0.01). Dividing into quartiles, the IPR rate was 15.8% in the first quartile and 5.9% in the fourth quartile (P=0.03). The IPR rate was 6.3% for type 0-IIa lesions and 14.1% for type 0-Is lesions (P=0.01). For serrated and adenomatous lesions, the IPR rate was 9.2%. Specimen retrieval failed in 3.6% of cases. Immediate bleeding (>30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. Conclusion: CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.

RESUMO Contexto: A polipectomia é uma importante opção terapêutica na prevenção do câncer colorretal (CCR). A ressecção incompleta do pólipo (RIP) é reconhecida como fator de risco para o câncer de intervalo. Objetivo: O principal objetivo foi avaliar o índice de ressecção completa da polipectomia a frio (PF) em pequenos pólipos não pediculados e, secundariamente, a recuperação do espécime e índice de complicações. Métodos: Avaliamos prospectivamente 479 pólipos <10 mm removidos por PF em 276 pacientes, por um endoscopista sem experiência com este método. Resultados: Foram ressecados em bloco 476 pólipos (99,4%). Tivemos margem negativa, considerada ressecção completa do pólipo (RCP), em 435 (90,8%) casos. Margem indefinida ou positiva (classificada como RIP) foi observada em 43 (9,0%) casos e em 1 (0,2%) caso, respectivamente, com um índice global de RIP de 9,2% (44/479). O índice de RIP foi de 12,5% na primeira metade dos casos e 5,9% na última metade (P=0,02). Dividindo em tercis, o índice de RIP foi de 15,0% no primeiro terço, 6,9% no segundo terço e 5,7% no terceiro quarto, P=0,01. Dividindo em quartis, o índice de RIP foi de 15,8% no primeiro quarto, enquanto o último quarto foi de 5,9%, P=0,03. O índice de RIP foi de 6,3% para lesões tipo 0-IIa e de 14,1% para lesões tipo 0-Is, P=0,01. O índice de RIP foi de 9,2% para lesões serrilhadas e adenomatosas. Houve falha na recuperação dos espécimes em 3,6% dos casos. Sangramento imediato (>30 s) ocorreu em um caso (0,2%), controlado com plasma de argônio. Sem sangramento tardio e perfuração. Conclusão: PF é uma técnica segura que apresenta bons resultados para a ressecção de pequenas lesões não pediculadas, com uma curta curva aprendizado.

The association of polypoid growth pattern with lymphnode involvement in endometrioid type endometrial adenocarcinoma

Background: Tumor size is an independent predictor of lymph node metastasis and survival in the endometrioid type endometrial adenocarcinoma (EC). However, some of the ECs tend to grow towards the cavity in the polypoid pattern, which can reach very large sizes. In this study, we aimed to analyze the association of growing in the polypoid pattern of the tumor with the proportion of lymph node metastasis and extrauterine tumor spread. Methods: Four hundred seven patients were analyzed retrospectively. The effect of tumor size, tumor growing pattern, myometrial invasion, grade, and lymphovascular space invasion on the lymph node metastasis and extrauterine tumor spread were investigated. Statistical analysis consisted of unpaired t?tests for parametric data and Mann Whitney?U test for non?parametric data, whereas the Chi?square test for categorical variables. Logistic Regression, Cox Regression and multivariate analysis were used to estimate the risk predictors. Results: No association was found between the growing in polypoid pattern and lymph node metastasis (P > 0.05). In the analysis of endometrioid type EC patients who had myometrial invasion less than � as a subgroup, no association was found between the growing pattern and lymph node metastasis and extrauterine disease. Tumor size was found to be a statistically significant predictor of lymph node metastasis and extrauterine disease (P < 0.05). Conclusions: Lymphovascular space invasion, grade, and myometrial invasion are associated with a higher proportion of lymph node metastasis. The polypoid growth pattern of the tumor does not correlate with any histopathological parameters

Efficacy of glucocorticoid stent implantation in ethmoid sinus after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps / 临床耳鼻咽喉头颈外科杂志

Objective:To evaluate the efficacy of glucocorticoid sinus stents implanted 2 weeks after functional endoscopic sinus surgery（FESS） for the treatment of chronic rhinosinusitis with nasal polyps（CRSwNP）. Methods:CRSwNP patients with similar bilateral lesions were randomly divided into two groups, with a stent group of 25 patients and a control group of 24 patients. Patients in the stent group had glucocorticoid sinus stents implanted into the bilateral ethmoid sinuses 2 weeks after FESS, while the control group underwent postoperative debridement only. Follow-up assessments occurred at postoperative weeks 2, 4, 8, and 12. Patients were asked to assess their sensation of nasal symptoms using a 10-point visual analog scale. Efficacy was assessed by endoscopic evaluations. Sinus obstruction, crusting/coagulation, polyp formation, middle turbinate position, adhesions, mucosa epithelialization, and postoperative intervention were assessed as efficacy outcomes. GraphPad Prism 9 was applied for statistical analysis. Results:At 4 and 8 weeks postoperatively, the stent group showed significant improvement in VAS scores of nasal congestion and runny nose compared with the control group（P<0.05）. No significant difference was observed in the VAS scores of head and facial stuffiness, loss of smell, or nasal dryness/crusting between the two groups（P>0.05）. Compared with the control group, the stent group had a lower rate of polypoid formation at 4, 8, and 12 weeks postoperatively. At postoperative week 12, the rate of mucosal epithelialization in the ethmoid cavity was significantly higher in the stent group. During the follow-up, the frequency of postoperative intervention was significantly lower in the stent group than in the control group（P<0.05）. Besides, a lower incidence of middle turbinate lateralization was found in the stent group at 8 and 12 weeks postoperatively. At 8 weeks postoperatively, the stent group had a percentage of adhesion lower than that of the control group（all P<0.05）. Conclusion:Implantation of glucocorticoid sinus stents after FESS can maintain sinus cavity patency, improve the inflammatory status of the operative cavity, reduce postoperative interventions, and promote benign regression of the operative cavity.

Pólipo endometrial metaplásico: hallazgo histeroscópico de enfermedad premaligna en mujeres jóvenes. Reporte de tres casos / Endometrial metaplastic polyps: findings of premalignant disease on histeroscopy in young women, a report of 3 cases

ANTECEDENTES: Los pólipos endometriales son sobrecrecimientos de la mucosa endometrial, una de las causas más comunes de hemorragia uterina anormal, pueden estar asociados con lesiones premalignas y malignas del endometrio. Existen características histeroscópicas que ayudan a diferenciar una lesión benigna o maligna. El pólipo metaplásico es un hallazgo histeroscópico caracterizado por superficies laminares e hiperqueratosis, con zonas blancas e hiperrefringentes. CASOS CLÍNICOS: Tres casos clínicos de pacientes menores de 40 años, con hemorragia uterina anormal donde el hallazgo histeroscópico común fue el pólipo metaplásico, hallazgo premaligno que se confirmó mediante el análisis patológico y la positividad del marcador de inmunohistoquímica p63. Caso 1. Paciente de 28 años, nulípara, obesa, con antecedente de síndrome de ovario poliquístico, con engrosamiento endometrial e histeroscopia, con pólipo con superficie hiperqueratósica, a manera de láminas irregulares, con excrecencias y lesiones exofíticas. Caso 2. Paciente de 25 años, con endometrio irregular engrosado e histeroscopia con hallazgo de pólipos transparentes, con cambios vasculares leves y superficie con zonas hiperrefringentes blanquecinas. Caso 3. Paciente de 38 años, con antecedente de síndrome de ovario poliquístico y obesidad. En la histeroscopia el endometrio se encontró hiperplásico, irregular, con cambios vasculares y pólipos con zonas superficiales hiperrefringentes, sólidas y blancas. CONCLUSIONES: En pacientes jóvenes, con hallazgo histeroscópico de pólipo metaplásico debe considerarse y descartar la enfermedad premaligna y maligna endometrial. El estudio debe completarse con marcadores de inmunohistoquímica (p63), específicos de la metaplasia escamosa.

Abstract BACKGROUND: Endometrial polyps are overgrowths of the endometrial mucosa, one of the most common causes of abnormal uterine bleeding and may be associated with premalignant and malignant endometrial lesions. There are hysteroscopic features that help differentiate a benign or malignant lesion. Metaplastic polyp is a hysteroscopic finding characterized by lamellar surfaces and hyperkeratosis, with white and hyperreflective areas. CLINICAL CASES: Three clinical cases of patients under 40 years of age, with abnormal uterine bleeding where the common hysteroscopic finding was metaplastic polyp, a premalignant finding that was confirmed by pathological analysis and positivity of the immunohistochemistry marker p63. Case 1. 28-year-old female, nulliparous, obese, with a history of polycystic ovary syndrome, with endometrial thickening and hysteroscopy, with polyp with hyperkeratotic surface, in the form of irregular sheets, with excrescences and exophytic lesions. Case 2. 25-year-old patient, with irregular thickened endometrium and hysteroscopy with finding of transparent polyps, with mild vascular changes and surface with whitish hyperrefringent areas. Case 3. 38-year-old patient with a history of polycystic ovary syndrome and obesity. At hysteroscopy the endometrium was found to be irregularly hyperplastic, with vascular changes and polyps with hyper-refringent, solid, white superficial areas. CONCLUSIONS: In young patients, with hysteroscopic finding of metaplastic polyp should be considered and premalignant and malignant endometrial disease should be ruled out. The study should be completed with immunohistochemical markers (p63), specific for squamous metaplasia.

Frequency and pattern of intrauterine hysteroscopic lesions among women coming for IVF in the city of Yaoundé

Background: Hysteroscopy is an essential tool to make intrauterine assessment in infertile patients. Diagnosis and appropriate correction of intrauterine anomalies are considered essential in order to increase chances of conception. Ourobjective was to determine the frequency and pattern of intra uterine anomalies identified among women attending hysteroscopy at the Gynaecological Endoscopic Surgery and Human Reproduction Teaching Hospital Paul et Chantal Biya ­Yaoundé (GESHRTH). Methodsand results.Thiswas a cross sectional retrospective study of 96 women attending diagnostic or operative hysteroscopy at the GESHRTH between January 2020 and December 2021.The mean age was 38.7 ±7.6 years. Fifty-nine (61.5%) of the patients were nulliparous. Primary and secondary infertility were found respectively in fifty-two patients (54.2%) and forty-four patients (45.4%). Eleven patients (11.5%) were post-menopausal. Concerning previous surgery, 29 patients (30.2%) have had a myomectomy, 28 patients (29.1%) curettage,16 patients (16.6%) laparoscopy, eight (8.3%) hysteroscopy and one (1%) caesarean section. In all, 92 patients (95.8%) had abnormal intra uterine findings consisting of endometrial polyps (43.7%), sub-mucosal fibroids (42.7%), uterine cavity adhesions (20.8%), endometrial atrophy (4.1%), foetal bone (2%), uterine septum (1%) and non-absorbable suture thread (1%).Conclusion: Abnormal uterine findings were identified in 95.8% of patients attending hysteroscopy at GESHRTH. Most frequent findings were polypsin 43.7%, sub-mucosal fibroids in 42.7% and synechiae in 20.8%. The overall per operatory complication rate was 6.2%.

Introduction. Le recours à l'hystéroscopie constitue une étape indispensable au bilan cavitaire des patientes infertiles. Le diagnostic et la prise en charge adéquate des lésions intra cavitaires permettent d'améliorer les chances de conception.L'objectif de cette étude était de déterminer la fréquence et les caractéristiques des anomalies intra cavitaires chez les patientes opérées d'une hystéroscopie au Centre Hospitalier de Recherche et d'Application en Chirurgie Endoscopique et Reproduction Humaine Paul et Chantal Biya ­Yaoundé (CHRACERH).Méthodes et résultats. Nous avons mené une étude descriptive transversale de Janvier 2020 à Décembre 2021 et recruté 96 patientes. L'âge moyen était de38,7 ±7,6 ans. Soixante-neuf patientes (61,5%) étaient nullipares. Cinquante-deux (54,2%) et quarante-quatre (45,5%) présentaient une infertilité primaire et secondaire respectivement. Onze patientes (11,5%) étaient ménopausées. Concernant les antécédents chirurgicaux,nous avons identifié une myomectomie chez 29 patientes (30,2%), un curetage utérin chez 28 (29,1%), une cœlioscopie chez 16 (16,6%), une hystéroscopie chez huit (8,3%) et une césarienne chez une (1%). Au total, 92 (95,8%) des patientes avaient des anomalies cavitaires objectivées. Il s'agissait de polypes endométriaux (43,7%), fibromes sous-muqueux (42,7%), synéchies utérines (20,8%), atrophie de l'endomètre (4,1%), métaplasie osseuse (2%), cloison utérine (1%) et corps étranger à type de fil de suture nonrésorbable (1%).Conclusion.Les anomalies intra-cavitaires étaient retrouvées chez 95,8% des patientes réalisant une hystéroscopie au CHRACERH. Les anomalies les plus représentées étaient les polypes endométriaux (43,7%), les fibromes sous-muqueux (42,7%) et les synéchies utérines (20,8%). Le taux global de complications opératoires était de 6,2%.

Chinese translation of benefits and challenges in implementation of artificial intelligence in colonoscopy: World Endoscopy Organization position statement / 中华消化杂志

The number of artificial intelligence (AI) tools for colonoscopy on the market is increasing with supporting clinical evidence. Nevertheless, their implementation is not going smoothly for a variety of reasons, including lack of data on clinical benefits and cost-effectiveness, lack of trustworthy guidelines, uncertain indications, and cost for implementation. To address this issue and better guide practitioners, the World Endoscopy Organization has provided its perspective about the status of AI in colonoscopy as the position statement.

Giant hyperplastic gastric polyp: A diagnostic dilemma!!

Gastric hyperplastic polyps (GHP) account for a majority of benign gastric polyps. Most of the GHPs are <2 cm, asymptomatic, and incidentally detected on endoscopy or radiologically. With increasing size, these polyps manifest as upper gastrointestinal bleeding, iron deficiency anemia, and gastric outlet obstruction (GOO). We report an unusual case of giant GHP simulating gastric carcinoma and posing as a diagnostic challenge for the surgeons emphasizing the diagnostic role of histopathology. A 46-year-old female presented with clinical features of progressive GOO for 1 year. Endoscopy revealed an eccentric proliferative lesion in the antrum. Computed tomography showed a polypoidal, enhancing mural thickening involving distal body and antro-pyloric region measuring 8.4 cm × 6.6 cm × 1.8 cm. Subtotal gastrectomy was done in view of clinical features of GOO and having a clinical suspicion of malignancy. Gross examination showed a giant sessile hyperplastic polyp with lobulated surface. Microscopy revealed features of a large, sessile hyperplastic polyp without any evidence of dysplasia. The patient was symptomatically relieved and is on follow-up. To conclude, giant GHPs can mimic gastric carcinoma on endoscopy and radiology. The possibility of giant GHP should be kept in mind in the presence of an intensely contrast-enhancing polypoidal lesion in the gastric antrum. Long-term endoscopic follow-up is recommended.

Intranasal glioma (Nasal heterotopia): A rare cause of nasal polyp in neonates

A 3-month-old boy presented with an intranasal polypoidal mass protruding out of the nostril which was present since birth and growing slowly. The mass was non-pulsatile and soft to firm in consistency. It did not increase in size on coughing, crying, or compression of the jugular vein. Magnetic resonance imaging and contrast-enhanced computed tomography (CT) revealed a lobulated well-circumscribed soft tissue mass in the left nasal cavity with no intracranial communication. Complete surgical excision of the mass was carried out via an intranasal endoscopic approach. Histopathological examination confirmed the diagnosis of intranasal glioma.

Sporadic rectocolic polyps prevalence and management

Objective: To evaluate the prevalence of polyps and their treatments. Materials and Method: This is a retrospective study conducted in our department over 20 years and 3 months between January 2000 and March 2021. All patients with colorectal polyps who underwent endoscopic resection were included. We evaluated the resection techniques and the management of complications. Results: The total number of patients was 273, with a mean age of 57.26 ± 14.058 (18-90) and a M/W sex ratio of 2. The prevalence was 3.35% and the mean number of polyps was 1.33 ± 0.69. The most frequent symptoms were rectal bleeding (23.5%) and constipation (12.1%). The median size was 6 mm (4-12 mm). The left colonic location was the most frequent site (43%). All polyps were classified according to the Paris classification, with a predominance of sessile polyps in 45.75%, followed by pedunculated polyps, representing 42.4%. Endoscopic resection was performed either by biopsy forceps, polypectomy, or mucosectomy in 30.2%, 27.4%, and 25.4% of cases, respectively. Our study noted immediate bleeding in 1.5% of cases, and no perforations or late complications. All complications were treated endoscopically, and no patient required blood transfusion or surgical intervention. Conclusion: Endoscopic resection of rectocolic polyps is the ideal treatment for these lesions. In our department, the prevalence was 3.35%, the most used resection techniques were forceps resection and polypectomy, and the complication rate was 1.5%. (AU)

Pólipo solitario con inserción en techo de fosa nasal / Solitary polyp with insertion into the roof of the nostril

Pólipo coanal es el término utilizado para una masa de tejido blando, solitaria y benigna que se extiende hacia la unión de la cavidad nasal y la nasofaringe; es decir, la coana. Los pólipos coanales nasales se presentan típicamente en tres formas diferentes: pólipos antrocoanales, esfenocoanales y etmoidocoanales. Sitios atípicos de origen han sido reportados en la literatura; por ejemplo, el tabique nasal y el cornete inferior. El conocimiento de los médicos sobre la existencia de pólipos coanales de sitios inusuales puede ayudar en el diagnóstico de los mismos, considerando crucial descartar previamente otros potenciales diagnósticos para estos casos de presentación atípica. A continuación reportamos el caso de un pólipo inflamatorio de inserción en techo de fosa nasal en un paciente de 65 años diagnosticado y tratado en nuestro servicio, cuyo caso es el primero reportado en la literatura.

Coanal polyp is the term used for a solitary, benign soft tissue mass extending into the junction of the nasal cavity and nasopharynx, i.e., the choana. Nasal coanal polyps typically present in three different forms: antrochoanal, sphenocoanal, and ethmoidocoanal polyps. Atypical sites of origin have been reported in the literature; these include the nasal septum and inferior turbinate. Physicians' awareness of the existence of coanal polyps from unusual sites may help in the diagnosis of coanal polyps considering it crucial to previously rule out other potential diagnoses for these cases of atypical presentation. Here we report the case of an inflammatory polyp of insertion in the roof of the nostril in a 65-year-old patient diagnosed and treated in our department, which is the first case reported in the literature.

Apéndice cecal invertida: hallazgos en colonoscopía / Inverted cecal appendix: colonoscopy findings

Introducción. El apéndice cecal invertido, inversión apendicular o intususcepción apendicular, corresponde a una condición anatómica descrita en 1859. La primera operación de invaginación apendicular se realizó en 1890, y desde entonces se han descrito diferentes técnicas quirúrgicas y endoscópicas para el tratamiento de esta alteración. Casos clínicos. Se presentandos casos de pacientes a quienes se les indicó colonoscopia como parte de estudio de dolor abdominal y diarrea y se identificó una intususcepción apendicular completa y apendicitis y una inversión del muñón apendicular. Resultados. Mediante la colonoscopia se hizo el diagnóstico de apendicitis aguda en una de las pacientes, quien presentaba inversión apendicular completa tipo 5, que fue tratada con manejo farmacológico y seguimiento clínico. En la otra paciente hubo un hallazgo incidental de inversión del muñón apendicular tipo 3. Conclusiones. Durante la realización de estudios colonoscópicos, se debe tener en cuenta el diagnóstico de intususcepción apendicular o apéndice invertido, para evitar intervenciones erróneas, como polipectomías, que generen riesgo potencial en los pacientes.

Introduction. Inverted cecal appendix, appendicular inversion or appendicular intussusception, corresponds to an anatomical condition described in 1859. The first appendicular invagination operation was performed in 1890, and since then different surgical and endoscopic techniques have been described for its treatment. Clinical cases. We present two patients who underwent colonoscopy as part of the study of abdominal pain and diarrhea and in whom were identified a complete appendicular intussusception and appendicitis, and an inversion of the appendicular stump. Results. Through colonoscopy, the diagnosis of acute appendicitis was made in one of the patients, who presented type 5 complete appendicular inversion, which was treated with pharmacological management and clinical follow-up. In the other patient, the incidental finding of inversion of the appendicular stump type 3 was made. Conclusions. During colonoscopy, the diagnosis of appendicular intussusception or inverted appendix must be taken into account to avoid erroneous interventions such as polypectomies that generate potential risk in patients.

Choanal Polyps Originating from Unusual Sites: A Rural Tertiary Care Center Experience

Abstract Introduction Choanal polyps are benign lesions arising from the sinonasal mucosa, extending through the choana into the nasopharynx. Though polyps arising from the maxillary sinus and extending to the choana are common, polyps arising from the sphenoid sinus ostium, posterior part of middle turbinate, and inferior and middle meatus are quite uncommon. Objective To document the site of origin of choanal polyps arising from unusual sites; their clinical, radiological, and histopathological characteristics, as well as diagnostic challenges and management. Methods This retrospective, single-center study included 14 patients aged 16 to 75-years-old with choanal polyps. After obtaining informed consent, their clinical, radiological and surgical details and histopathology reports were reviewed. Patients were followed for at least 6 months after surgery. Results The predominant symptoms were unilateral nasal obstruction (n = 9), snoring, rhinorrhea, and epistaxis. Though anterior rhinoscopy was unremarkable, a mass could be visualized during posterior rhinoscopy in the nasopharynx in 11 patients, and a mass could be directly visualized in the oropharynx in 2 patients. After diagnostic by nasal endoscopy, these polyps were noted to arise from the posterior aspect of the middle meatus (n = 6), middle turbinate (n = 3), posterior septum (n = 3), sphenoid sinus ostium (n = 1), and inferior meatus (n = 1). All patients were managed surgically. The histopathological examination revealed inflammatory polyp (n = 12), actinomycosis (n = 1), and rhinosporidiosis (n = 1). Patients were followed up for 6 to 22 months. We observed no complications or recurrence. Conclusion Diagnostic nasal endoscopy should be performed in all patients presenting with nasal obstruction, to rule out choanal polyps arising from unusual sites. Complete polyp removal and appropriate treatment based on histopathology prevents recurrence.

A neglected cause of anaemia: hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu syndrome is an inherited disorder characterized by vascular dysplasiasleading to hemorrhages. If affects approximately 1 in10,000 Caucasian people. The most common presentation is chronic and recurrent epistaxis whereas bleeding from other sites can lead to life-threatening complications.

Intususcepción intestinal en adultos. Un desafío para el cirujano general. Reporte de caso / Intestinal Intussusception in Adults. A Challenge for the General Surgeon: Case Report

Resumen La intususcepción intestinal es la invaginación de un segmento de intestino en el interior de otro segmento inmediato, asociado a una alteración en la pared intestinal, siendo en intestino delgado más común por patologías benignas y en intestino grueso por patologías malignas. Presentamos caso de paciente femenino de 30 años, con dolor abdominal de 1 semana de evolución y datos de oclusión intestinal, se somete a laparotomía de urgencia, donde se encuentra intususcepción intestinal en íleon terminal. La intususcepción intestinal generalmente se va a presentar como un cuadro de obstrucción intestinal. El tratamiento es la resección del segmento afectado.

Abstract The intestinal intussusception is the invagination of one segment of the bowel into an immediately adjacent segment, associated to an alteration into the wall, the small intestinal is the most associated a benign pathology and large intestinal by malignant pathologies. We present the case of a 30-year-old female patient, who came to the emergency room due to intense abdominal pain of 1 week of evolution and evidence of intestinal occlusion, who underwent emergency laparotomy, where intestinal intussusception was found in the terminal ileum. Generally, the clinical presentation like an intestinal obstruction. Treatment is resection of the affected segment.

Presentación polipoide de un tumor neuroendocrino: reporte de caso y revisión de la literatura / Neuroendocrine Tumor Polypoid Presentation: Case Report and Literature Review

Resumen Debido a la implementación de las colonoscopias como método de tamizaje, ha aumentado el diagnóstico de tumores neuroendocrinos rectales (TNER), la mayoría tiene un tamaño menor de 1 centímetro en el momento del diagnóstico, confinado a la submucosa y bien diferenciado; generalmente tienen un curso benigno y en su mayoría se tratan por métodos endoscópicos. Las metástasis son raras y dependen del tamaño tumoral y otros factores como la invasión a la submucosa, diseminación linfática y clasificación histológica, lo cual determinará el pronóstico y tratamiento a elección. Se presenta el caso de un tumor neuroendocrino rectal presentado en forma de pólipo durante un tamizaje endoscópico de rutina y una aproximación de la literatura actual.

Abstract Diagnosis of rectal neuroendocrine tumor (NET) has increased due to the implementation of colonoscopies as a screening method. Most rectal NETs are less than 1cm at diagnosis time, confined to the submucosa, and well differentiated. They generally have a benign course and are treated mainly using endoscopic methods. Metastases are rare and depend on tumor size and other factors such as submucosal invasion, lymphatic spread, and histologic classification, which will determine the prognosis and treatment. We present a case of a rectal neuroendocrine tumor as a polyp during routine endoscopic screening and a review of the current literature.

Pólipo Nasofaríngeo Primário: Apresentação Incomum / Primary Nasopharyngeal Polyp: Uncommon Presentation

Os pólipos inflamatórios não neoplásicos da nasofaringe são patologias raras e de consistência frágil, que normalmente são confundidos com outras lesões desta região. Entre essas, está o nasoangiofibroma, que possui consistência firme e sangra à manipulação. J.I.R.B., 17 anos, sexo masculino, estudante, com história de dor na faringe, com obstrução nasal noturna há 2 meses, associado à queixa de volume na garganta há 1 mês. À inspeção e oroscopia, encontrou-se uma volumosa lesão de aspecto polipoide, projetando-se da orofaringe. A ressonância magnética (RM) revelou lesão volumosa com componentes císticos, hiperintenso em T1 e hipointenso em T2, de aproximadamente 8,0 cm no seu maior diâmetro no corte sagital, que se estendia da nasofaringe até a orofaringe, chegando à região da epiglote. São descritos na literatura vários estudos relatando pólipos nasofaríngeos em felinos, mas apenas um estudo na literatura médica inglesa fala sobre as propriedades clínicas e histológicas dos pólipos inflamatórios primários da nasofaringe humana. Assim, o presente caso tem grande importância, principalmente pela sua raridade, local de acometimento do pólipo inflamatório benigno, bem como o tamanho da lesão. Na abordagem de massas naso e orofaríngeas em jovens e adultos, os pólipos inflamatórios primários fazem parte dos diagnósticos a serem considerados. Apesar do pequeno número de casos, as características radiológicas e patológicas dessa lesão devem ser lembradas, minimizando o risco de serem diagnosticados incorretamente.

Non-neoplastic inflammatory polyps of the nasopharynx are rare pathologies of fragile consistency, which are usually confused with other lesions of this region. Among these, the nasopharyngeal angiofibroma, which has firm consistency and bleeds to manipulation. J.I.R.B., 17 years old, male, student, with a history of pain pharynx, and nocturnal nasal obstruction for 2 months, associated with the complaint of volume in the throat for 1 month. Inspection and oroscopy, a polypoid lesion was found, protruding from the oropharynx. Magnetic resonance imaging (MRI) revealed a massive lesion with cystic, hyperintense components on T1-weighted images and hypointense at T2, approximately 8.0 cm in its largest diameter in the sagittal section, which was out of the nasopharynx to the oropharynx, reaching the epiglottis region. Several studies reporting nasopharyngeal polyps in felines have been described in the literature, but only one study in the English medical literature talks about the clinical and histological properties of the primary inflammatory polyps of the human nasopharynx. Thus, the present case is of great importance mainly, due to its rarity, site of involvement of benign inflammatory polyp, as well as the size of the lesion. In the approach of nasopharynx and oropharyngeal masses in young and adult, the primary inflammatory polyps are part of the diagnoses to be considered. Despite the small number of cases, the radiological and pathological characteristics of this lesion should be remembered, minimizing the risk of being misdiagnosed.

Antrochoanal polyp among elderly age group: Our experiences at a tertiary care teaching hospital of Eastern India

Background: Antrochoanal polyps (ACPs) are benign polypoidal mass originating from the maxillary sinus and they extend into the choana. The etiopathogenesis of ACP is not clear. These are found more commonly in children and young adults. ACP is almost always unilateral and common symptoms include nasal obstruction and nasal discharge. These lesions are extremely rare in the older adult age group. Materials and Methods: This is a retrospective study of 14 cases of ACPs managed between June 2017 and July 2022. Detailed clinical presentations, investigations, and treatment with surgical interventions for ACPs were studied. Results: Out of 14 cases of older adult patients with ACPs, there are 8 (57.14%) cases with a polyp on the left side and 6 (42.85%) cases on the right side of the nasal cavity. The most common symptom was constant and unilateral nasal obstruction in 12 (85.71%) patients, followed by purulent nasal discharge in 7 (50%) cases, clear rhinorrhea in 5 (35.71%) cases, facial pain in 4 (28.57%) cases, snoring in 3 (21.42%) cases, sneezing in 3 (21.42%) cases, and halitosis in 2 (14.28%) cases. Conclusion: ACPs are uncommon in the older adult age group. Diagnostic nasal endoscopy and computed tomography scans are important tools for the diagnosis of ACP. Functional endoscopic sinus surgery and power instrumentation are helpful for the complete removal of ACPs and are considered extremely safe procedures. Clinicians and otolaryngologists are often not aware of the prevalence of ACPs among the older adult age group.

Serum long-noncoding RNA H19 and beta-catenin as biomarkers for early diagnosis of colorectal cancer in egyptian patients: a case control study

Colorectal cancer (CRC) is the third most prevalent cancer and the second most common cause of cancer death; however, its early detection can improve the survival. Colonic polyps are considered one of the CRC's major risk factors. Throughout many biological processes and malignancies, the non-coding RNAs have essential functions. Certain long noncoding RNAs (lncRNAs), including H19, were supposed to be CRC possible biomarkers. Also, H19 has been reported to play a role in regulating the activity of beta-catenin, a protein that regulates cell-to-cell adhesion, as well as gene transcription. The current work aimed to investigate the potential significance of LncRNA H19 relative serum expression level by quantitative polymerase chain reaction (q-PCR) and beta-catenin by enzyme-linked immunosorbent assay (ELISA) as noninvasive biomarkers to discriminate between colorectal cancer and colonic polyps. The statistical analysis of the studied factors revealed that the serum expression of H19 and beta-catenin in cancer cases were substantially greater than colonic polyp cases and normal control. Conclusion: The relative expressions of H19 and beta-catenin in the serum can significantly discriminate patients with CRC from those with polyp and normal controls, which could help when screening for CRC. (AU)