Vocal Fold Polyps: Literature Review

Abstract Introduction Vocal fold polyps are one of themost frequent benign laryngeal lesions, impacting the quality of life of those affected by them, primarily the vocal production. Despite being a well-established therapy in conjunction with surgery, speech therapy alone may also be effective in treating these lesions. As such, otolaryngologists and speech therapists need updated bibliographic knowledge on the issue. Objective To describe the literature findings on vocal fold polyps that discuss prevalence, etiology, histology, physiopathology, vocal characteristics or treatment. Data Synthesis The present study is a review article based on a bibliographic search using platforms, databases and search engines, with no restrictions on means of publication, methodological quality or language. All the articles on vocal fold polyps pertaining to the object of study published in the past 15 years were included. Among the characteristics investigated, the most discussed were prevalence of men, smoking as an etiological cofactor, the possibility of histological differentiation from vocal nodules, the relationship with cover minor structural alterations, and the indication and effectiveness of different treatment options. Conclusion Despite the discrepancies found in the present literature review on vocal fold polyps, there has been a notable scientific progress in the otolaryngologic techniques and in the effectiveness of speech therapy as initial treatment, with direct and indirect techniques, corroborating the need for scientific investigation of the issue.

Fibro-epithelial Polyp - Report of Two Cases with Literature Review.

Irritation fibroma or traumatic fibroma is a common sub-mucosal response to trauma from teeth or dental prosthesis presenting as a painless, sessile or occasionally pedunculated swelling that can be firm and resilient or soft and spongy in consistency. It rarely occurs before the fourth decade and shows no preference for either sex. Its occurrence corresponds with intraoral areas that are prone to trauma such as the tongue, buccal mucosa and labial mucosa. As the lesion occurs due to continuous trauma and irritation, it important to remove the source of the irritation and then treat it by conservative surgical excision otherwise it will recur.

Is the Prevalence of Gallbladder Polyp Different between Vegetarians and General Population? / 대한소화기학회지

BACKGROUND/AIMS: Gallbladder polyps (GBP) are a common clinical finding that can express malignant potential. The aim of this study was to evaluate whether vegetarianism protects against GBP, together with other putative risk factors. METHODS: A retrospective, cross-sectional study was conducted with subjects who received a health check-up from July 2005 to December 2011. Korean Buddhist priests, who are obligatory vegetarians by religious belief, were identified as vegetarians (vegetarian group) and compared with a non-vegetarian control group sampled from those coming for health check-ups at the same institution. RESULTS: Out of 18,483 subjects, GBP were found in 810 (4.4%). Although GBP tended to be less common in the vegetarian group (23 [3.5%] out of 666) than in control group (787 [4.4%] out of 17,817), the difference was insignificant statistically (p=0.233). By logistic regression, old age (OR=1.61, 95% CI=1.19-2.26 for 30-39 years; OR=1.47, 95% CI=1.08-1.98 for 40-49 years), male gender (OR=1.51, 95% CI=1.31-1.75), high BMI (OR=1.18, 95% CI=1.00-1.39 for > or =23.0 kg/m2 and <25.0 kg/m2) and HBsAg positivity (OR=1.53, 95% CI=1.19-1.98) were independent risk factors of GBP. CONCLUSIONS: GBP was significantly associated with old age, male gender, high BMI and HBsAg positivity, but not with vegetarianism.

Premalignant and malignant lesions in endometrial polyps in patients undergoing hysteroscopic polypectomy / Lesões precursoras e câncer em pólipos do endométrio de pacientes submetidas à polipectomia histeroscópica / Lesões precursoras e câncer em pólipos do endométrio de pacientes submetidas à polipectomia histeroscópica

Objective : To evaluate the incidence of premalignant lesions and cancer in endometrial polyps, in patients undergoing hysteroscopic polypectomy. Methods : The results of 1,020 pathological examinations of patients submitted to hysteroscopic polypectomy were analyzed, as well as their diagnostic and surgical hysteroscopy findings. As to their menstrual status, 295 (28.9%) patients were in menacme. Of the total, 193 (65.4%) presented abnormal uterine bleeding, and 102 (34.6%) were asymptomatic with altered endometrial echo on transvaginal ultrasound. Out of 725 (71.1%) postmenopausal patients, 171 (23.6%) were symptomatic (abnormal uterine bleeding), and 554 (76.4%) were asymptomatic with endometrial echo >5.0mm. Results : Twenty-one (2.0%) patients presented premalignant lesions in the polyps, 13 had simple glandular hyperplasia, of which 5 had no atypia, and eight presented atypia. Eight polyps presented focal area of complex hyperplasia: 4 with atypia and 4 without lesions. Cancer was diagnosed in 5 (0.5%) polyps. Of the 21 polyps that harbored premalignant lesions, 12 were interpreted as benign in diagnostic and surgical hysteroscopy. Of the polyps with cancer, 4 were also histeroscopically interpreted as normal. Conclusion : Symptomatic polyps in menacme and in all postmenopausal women should be resected and submitted to histopathological examination, since they may have a benign aspect, even when harboring areas of cellular atypia or cancer. .

Objetivo : Avaliar a incidência de lesões precursoras e câncer em pólipos do endométrio de pacientes submetidas à polipectomia histeroscópica. Métodos : Análise dos resultados de 1.020 exames anatomopatológicos de pacientes submetidas, em hospital público, à polipectomia histeroscópica, e achados em suas histeroscopias diagnóstica e cirúrgica. Em termos de estado menstrual, 295 (28,9%) pacientes encontravam-se na menacme. Do total, 193 (65,4%) apresentavam sangramento uterino anormal e 102 (34,6%) eram assintomáticas, com alteração da medida do eco endometrial à ultrassonografia transvaginal. Das 725 (71,1%) pacientes na pós-menopausa, 171 (23,6%) eram sintomáticas (sangramento uterino anormal) e 554 (76,4%) assintomáticas, com eco endometrial >5,0mm. Resultados : Vinte e uma (2,0%) pacientes apresentaram lesões precursoras nos pólipos, 13 com hiperplasia glandular simples, das quais 5 sem atipias e 8 com atipias. Oito pólipos apresentavam área focal de hiperplasia complexa, quatro com atipias e quatro sem lesões. Câncer foi diagnosticado em cinco (0,5%) pólipos. Dos 21 pólipos que abrigavam lesões precursoras, 12 foram interpretados como benignos nas histeroscopias diagnóstica e cirúrgica. Quatro dos pólipos com câncer também foram interpretados histeroscopicamente como normais. Conclusão : Os pólipos sintomáticos na menacme, bem como todos na pós-menopausa, devem ser ressecados para realização de exame anatomopatológico, por poderem apresentar aspecto benigno, mesmo quando abrigam áreas de atipia celular ou câncer. .

[Anatomical and histopathological distribution of gastrointestinal polyps in Gorgan, Iran [1999-2008]]

Gastrointestinal polyps have pre-carcinomatous potential. In regard to increasing rate of gastrointestinal cancers and the relation between polyps with cancers, this study was done to determine the anatomical and histopathological distribution of gastrointestinal polyps in Gorgan, Iran. This cross-sectional study was conducted on 290 patients with gastrointestinal polyps were undergoing colonoscopy or endoscopy in 5th Azar teaching hospital in Gorgan, northern Iran during 1999-2008. The diagnosis was confirmed by histopathologic method. Gender and age was recorded for each patient. 56.6% of patients were males 19.3% of polyps was diagnosed in the sixth decade of patient's age. The most frequent pathological type of gastrointestinal polyps was adenoma [54.1%] followed by hyperplastic [19.7%], acute inflammatory [13.8%] and young polyps type [11.4%]. Tubular type with 63% was the most common type of adenoma polyp followed by various villouses [19.1%] and tubulovillous [17.9%]. 87.2% and 12.8% of polyps were in colon and stomach, respectively. The most frequent anatomical position of polyps was rectum [30%] followed by sigmoid with 26/1%. Adenoma polyp in colon was the most common type in gastrointestinal tract

Shifting Prevalence of Gallbladder Polyps in Korea

Only a few studies have evaluated the population-adjusted prevalence of gallbladder polyps (GBP). This study aimed to evaluate the changes in GBP prevalence and risk factors at a single health screening center in Korea from 2002 to 2012. Of 48,591 adults who underwent health screening between 2002 and 2012, 14,250 age- and gender-matched subjects were randomly selected to evaluate prevalence. Risk factors were analyzed between the GBP-positive and GBP-negative groups during 2002-2004 (Period A) and 2010-2012 (Period B). The annual prevalence of GBP over the 11-yr period was 5.4%. Annual prevalence increased from 3.8% in Period A to 7.1% in Period B. Male gender and obesity were independent risk factors for GBP in both periods. Hepatitis B virus surface antigen (HBsAg) positivity was a risk factor for GBP in Period A but not in Period B. The risk factors for GBP changed from HBsAg positivity to lipid profile abnormalities. Other variables including age, hypertension, diabetes, impaired fasting glucose, chronic hepatitis C virus infection, and liver function tests did not correlate with GBP. In conclusion, GBP prevalence is increasing and risk factors for GBP have changed in Korea. More attention should be paid to this issue in the future.

Pólipos endometriais e seu risco de malignização: aspectos epidemiológicos, clínicos e imunoistoquímicos / Endometrial polyps and the risk of malignancy: epidemiological, clinical and immunohistochemical aspects

Pólipos endometriais são neoformações resultantes de uma hiperplasia focal da camada basal do endométrio associada a um hiperestímulo hormonal. Sua etiologia ainda não está bem estabelecida, não havendo consenso sobre sua história natural, seu real significado como entidade patológica e sua relação com a neoplasia endometrial. Os pólipos endometriais são a principal indicação de histeroscopia cirúrgica, sem que haja, no entanto, um protocolo definido para seu melhor manejo. Uma visão abrangente sobre essa condição pode auxiliar na escolha da conduta mais adequada. (AU)

Endometrial polyps are neoformations that result from focal hyperplasia of the endometrial basal layer associated with hormonal hyperstimulation. Their pathogenesis is still unclear, and there is no consensus on their natural history, actual relevance as pathologic entities, and relationship with endometrial neoplasia. Endometrial polyps are the most frequent indication of surgical hysteroscopy, but their optimal management remains controversial. Therefore, an overview of this condition may help choosing the most adequate treatment strategies.(AU)

Gastric Fundic Gland Polyps and Their Relationship to Colorectal Neoplasia in Koreans: A 16-year Retrospective Study / 대한소화기학회지

BACKGROUND/AIMS: There is an ongoing debate on the relationship between gastric fundic gland polyps and increased incidence of colorectal neoplasia in Caucasians. However, there was no report on the relationship between gastric fundic gland polyp and colorectal neoplasia in Korea. The aim of this study was to identify the characteristics of gastric fundic gland polyps and whether a relationship exists between fundic gland polyps and colorectal neoplasia in Korean population. METHODS: Persons who underwent an esophagogastroduodenoscopy and colonoscopy from 1992 to 2007 at the Health Promotion Center of Incheon St. Mary's Hospital, The Catholic University of Korea were reviewed retrospectively. The relationship between gastric fundic gland polyps and colorectal neoplasia were analyzed. RESULTS: Among 22,451 subjects, fundic gland polyps were found in 328 subjects (1.5%). Fundic gland polyps were more common in women than in men (odds ratio of 6.25; 95% CI of 4.68-8.34). The odds ratios for colorectal neoplasia in all subjects with gastric fundic gland polyps were 0.56 (95% CI of 0.33-0.95) and men who were 50 years of age or older had an odds ratio of 2.81 (95% CI of 1.03-7.66) as compared to the control group. However, age and sex-adjusted odds ratios for all gastric fundic gland polyps were 0.73 (95% CI of 0.42-1.26), for men 1.78 (95% CI of 0.80-3.98), and for women 0.37 (95% CI of 0.16-0.87). CONCLUSIONS: Surveillance colonoscopy in patients with fundic gland polyps can be performed in the same manner as general population in Korea.

Pólipos endometriais: aspectos clínicos, epidemiológicos e pesquisa de polimorfismos / Endometrial polyps: clinical and epidemiological aspects and analysis of polymorphisms

OBJETIVO: avaliar as variáveis clínicas e epidemiológicas de risco para câncer de endométrio em mulheres com pólipos endometriais na pós-menopausa, bem como a presença do polimorfismo do receptor da progesterona (PROGINS). MÉTODOS: estudo caso-controle desenhado com 160 mulheres na pós-menopausa com pólipos endometriais, comparado a Grupo Controle de 400 mulheres na pós-menopausa. A genotipagem do polimorfismo PROGINS foi determinada pala reação em cadeia da polimerase (PCR). Aspectos clínicos e epidemiológicos foram comparados entre as mulheres com pólipos endometriais benignos e 118 dos controles normais. Estas variáveis foram também comparadas entre mulheres com pólipos benignos e pólipos malignos. RESULTADOS: a comparação entre o grupo de pólipos benignos e o Grupo Controle mostrou diferença significativa (p<0,05) para as varáveis: idade, raça não-branca, anos da menopausa, paridade, hipertensão arterial, uso de tamoxifeno e antecedente de câncer de mama, todas mais prevalentes no grupo de pólipos endometriais. Após o ajuste para a idade, permaneceram com diferença significativa a paridade (OR=1,1), hipertensão arterial (OR=2,2) e o antecedente de câncer de mama (OR=14,4). Houve seis casos de pólipos malignos (3,7 por cento). A frequência de sangramento para pólipos benignos e malignos foi de 23,4 e 100 por cento, respectivamente, sendo o pólipo grande encontrado em 54,5 por cento dos casos benignos e em 100 por cento dos malignos. A frequência de hipertensão arterial foi de 54,5 por cento para pólipos benignos e 83,3 por cento para pólipos malignos. As frequências do polimorfismo PROGINS T1/T1, T1/T2 e T2/T2 foram 79,9 por cento, 19,5 por cento e 0,6 por cento respectivamente para pólipos benignos e 78,8 por cento, 20,8 por cento e 0,5 por cento para o Grupo Controle. CONCLUSÕES: os pólipos endometriais se mostraram mais frequentes em mulheres de idade avançada, hipertensas e com antecedente de câncer de mama. A presença do polimorfismo PROGINS não mostrou associação significativa com pólipos endometriais. A incidência de pólipos malignos foi baixa, estando fortemente associada à presença de sangramento, tamanho grande do pólipo e hipertensão arterial.

PURPOSE: to evaluate the clinical and epidemiological risk factors for endometrial cancer in postmenopausal women with endometrial polyps, as well as the genetic polymorphism of the progesterone receptor (PROGINS). METHODS: a case-control study was designed with 160 postmenopausal women with endometrial polyps, compared to a normal Control Group of 400 postmenopausal women. The genotyping of PROGINS polymorphism was determined by the polymerase chain reaction. Clinical and epidemiological data were compared between benign endometrial polyps and 118 of the control subjects. Variables were also compared with regard to benign and malignant endometrial polyps. RESULTS: comparison of the epidemiological variables between groups showed a significant difference for age, ethnicity, time since menopause, parity, tamoxifen use, hypertension and breast cancer, all of them more prevalent in the polyp group. After adjustment for age, statistical significance remained only for parity (OR=1.1), hypertension (OR=2.2) and breast cancer (OR=14.4). There were six cases of malignant polyps (3.7 percent). The frequency of bleeding was 23.4 percent for benign polyps and 100 percent for malignant polyps, with large polyps being detected in 54.6 percent of the benign cases and in 100 of the malignnat ones. The frequency of arterial hypertension was 54.5 percent for benign polyps and 83.3 percent for the malignant ones. The frequency of PROGINS T1/T1, T1/T2 and T2/T2 polymorphism was 79.9 percent, 19.5 percent and 0.6 percent, respectively, for the polyp group, and 78.8 percent, 20.8 percent and 0.5 percent for the Control Group. CONCLUSIONS: elderly age, hypertension, and breast cancer were significantly associated with endometrial polyps. The presence of PROGINS polymorphism was not significantly associated with endometrial polyps. The incidence of malignant polyps was low and strongly associated with bleeding, large-sized polyp and arterial hypertension.

Neoplasias benignas de vesicula biliar, un paradigma nacional / Benign neoplasms of gallbladder, a national paradigm

INTRODUCCION: En Chile, la indicación quirúrgica más frecuente corresponde a patología vesicular biliar, donde es posible encontrar tumores benignos y malignos, de morfología similar, lo que dificulta el diagnóstico diferencial. OBJETIVO: Caracterizar los hallazgos anatomopatológicos referentes a lesiones tumorales benignas de vesícula encontradas por colecistectomía. MATERIAL Y METODOS: Estudio observacional analítico, se analizaron retrospectivamente 5.699 biopsias correspondientes a todas las vesículas recibidas en Laboratorio de Anatomía Patológica de Concepción (LAP) durante los años 1998 y 2007. Estudio extrapolable al total de población chilena colecistectomizada anualmente con un 95 por ciento de confiabilidad y 80 por ciento de poder (p=0.05). RESULTADOS: 4.730 (83 por ciento) correspondieron a mujeres, conrelación hombre/mujer de 1: 4.9 (p<0.001). 279 vesículas presentaron lesiones tumorales benignas (4.9 por ciento). Las lesiones predominantes fueron las pseudotumorales (92.8 por ciento). La alteración más frecuente correspondió a pólipo (45.8 por ciento), en su mayoría de colesterol (53.1 por ciento) y múltiples (86.7 por ciento); seguido por la hiperplasia adenomiomatosa (41.2 por ciento). Dentro de los tumores epiteliales solo se encontraron adenomas (6 por ciento), manifestándose en su totalidad como pólipo acompañado en un 47 por ciento de displasia y en solo un caso de carcinoma in situ. De las lesiones de aspecto polipoídeo, la mayoría fueron lesiones pseudotumorales (87.1 por ciento), seguidas por adenomas (10.4 por ciento) y un 2.5 por ciento de cáncer. CONCLUSIONES: Destacan la baja frecuencia de lesiones tumorales benignas en el grupo estudiado, con incidencias menores a las internacionales para pólipos e hiperplasia adenomiomatosa, pero más altas que las reportadas para adenomas. La aparición de cáncer manifestado como pólipo de pequeño tamaño suma importancia al diagnóstico diferencial de estas lesiones en dicha localización.

BACKGROUND: In Chile, the most common surgical indication is the pathology of the gallbladder, where is likely to find benign and malignant lesions of similar morphology, making it difficult the differential diagnosis. OBJETIVE: To characterize the anatomo pathological findings of benign lesions of the gallbladder encountered by cholecystectomy. MATERIAL AND METHODS: Observational analytic study, 5.699 biopsies were hindsightanalyzed for all the gallbladders received at the Pathology Laboratory of Concepción (LAP) from 1998 to 2007. The study can be extrapolated to all the chilean cholecystectomized population with a reliability of 95 percent and 80 percent of power (p=0.05). RESULTS: 4,730 (83 percent) were women with a male/female ratio of 1: 4.9 (p<0.001). 279 gallbladders showed benign tumoral lesions (4.9 percent). The pseudotumoral lesions were predominant (92.8 percent). The most frequent alteration was polyp (45.8 percent), mostly of cholesterol (53.1 percent) and multiple (86.7 percent), followed by adenomatous hyperplasia (41.2 percent). Within the epithelial tumors, only adenomas were found (6 percent), expressed entirety as polyps, 47 percent with accompanying dysplasia and in just a case of carcinoma in situ. Of the polypoid lesions, most were pseudotumoral (87.1 percent), followed by adenomas (10.4 percent) and 2.5 percent of cancer. CONCLUTIONS: It is highlighting the low frequency of benign tumoral lesions in the studied group, with lower incidences than internationaly reported for polyps and adenomatous hyperplasia, but higher for adenomas. The emergence of cancer manifested as polyp greats the importance to the differential diagnosis of these injuries in that location.

Prevalência de lesões endometriais em mulheres obesas assintomáticas / Prevalence of endometrial injury in asymptomatic obese women

OBJETIVOS: A obesidade representa importante fator de risco para alterações endometriais. O presente estudo teve por objetivo avaliar a prevalência de lesões endometriais, como pólipos, hiperplasia e câncer de endométrio em mulheres obesas assintomáticas, assim como reconhecer os fatores de risco associados. MÉTODOS: Entre dezembro de 2004 e fevereiro de 2006, em estudo transversal foram avaliadas 94 mulheres obesas (índice de massa corpóreo >30Kg/m²), divididas em dois grupos com 47 participantes cada: em idade reprodutiva e após a menopausa. Foram analisados: história clínica, exame físico (antropométrico/ginecológico), determinações bioquímicas e avaliação do endométrio por ultra-sonografia endovaginal, biópsia e histeroscopia (para confirmar patologia endometrial). RESULTADOS: Nas mulheres em idade reprodutiva foram encontrados 12,8 por cento de casos de patologia endometrial, que se associaram significativamente com as elevações da idade, hipertensão arterial (HAS), colesterol e LDL-c. Após a menopausa, foram identificadas 40,4 por cento de lesões endometriais que se associaram significativamente com pressão arterial sistólica (PAS) > 140mmHg, elevação do LDL-c e da estrona. Dois casos de câncer de endométrio foram constatados, sendo um em cada grupo. CONCLUSÃO: O aumento de incidência da obesidade nos últimos anos tem elevado os fatores de risco para o câncer de endométrio. Na idade reprodutiva tivemos um pequeno tamanho amostral de alterações endometriais; com isso, poderíamos apenas sugerir, uma maior atenção àquelas com idade superior a 40 anos, que apresentem HAS e/ou elevação do LDL-c. O status menopausal eleva o risco de lesão endometrial; associado com elevações da PAS, LDL-c e/ou estrona, elas se tornarão candidatas à biópsia de endométrio, visando o diagnóstico precoce do câncer, decisivo para o prognóstico favorável da mulher.

OBJECTIVE: Obesity represents the most important risk factor for endometrial pathology. This study aimed to evaluate the prevalence of endometrial injuries, such as polyps, hyperplasia and endometrial cancer in asymptomatic obese women, as well as to recognize the associated risk factors . METHODS: A cross-sectional study was conducted between December 2004 and February 2006. Ninety-four obese (body mass index > 30 kg/m²) women were evaluated, divided in two groups of 47 participants each: pre-menopausal and postmenopausal women. Clinical characteristics, physical exams (anthropometric and gynecological), blood count and endometrial assessment by vaginal ultrasonography, biopsy, and hysteroscopy (only for confirmed endometrial pathology), were the variables appraised. RESULTS: In pre-menopausal women, 12.8 percent of cases had endometrial pathology statistically associated to age, hypertension, hypercholesterolemia and LDL-c increase. In the post-menopausal women, 40.4 percent of cases had a pathology identified as statistically associated with hypertension, LDL-c and estrone increase. Two cases of endometrial cancer were identified, one in each group. CONCLUSIONS: The increased incidence of obesity over recent years has increased risk factors of endometrial cancer. In pre-menopausal women only a small number of cases with endometrial alterations was observed. Therefore, it is suggested that greater attention be given to those over 40 years of age, associated with hypertension and/or higher LDL-c . The menopausal status increases risk of endometrial injury, and when associated with hypertension, LDL-c and/or estrone increase, women become candidates to biopsy aiming for an early diagnosis of cancer, a decisive factor for a favorable prognosis.

Câncer colônico - epidemiologia, diagnóstico, estadiamento e gradação tumoral de 490 pacientes / Epidemiology, diagnosis, staging and graduation of colon cancer in 490 patients

O objetivo deste trabalho é estudar 490 pacientes portadores de câncer colônico, analisando incidência absoluta e topográfica do câncer nos cólons; distribuição por décadas etárias e sexos dos pacientes; sintomatologia; gradação e estadiamento por exame proctológico, exames de imagens, achados cirúrgicos e exame histopatológicos de biópsias e peças cirúrgicas; distribuição por topografias e gradação tumoral; concomitância e contemporaneidade de pólipos; modalidades de pólipos e poliposes colorretais concomitantes e contemporâneos; irressecabilidade de 29 tumores e inoperabilidade de 10 pacientes por topografias colônicas e incidência topográfica de complicações dos cânceres nos cólons. Dentre as várias conclusões inferidas pelo estudo, pelo menos as seguintes foram de valor: Os tumores foram mais comuns nos cólons (53,1 por cento) que no reto (41,2 por cento) e no ânus e canal anal (5,7 por cento). Os tumores foram mais comuns no hemicólon esquerdo (77,8 por cento) que no cólon direito (22,2 por cento), sendo o sigmóide e a junção retossigmoideana as topografias mais comuns (61,6 por cento). A idade média foi de 60,6 anos, com 86,7 por cento dos pacientes entre 40 e 80 anos, mais comuns entre homens (52,2 por cento) que entre mulheres (47,8 por cento). os sintomas mais comuns foram a alteração do hábito intestinal (70,6 por cento), a cólica abdominal (59,6 por cento), o sangue nas fezes (58,6 por cento) e a alteração da matéria fecal (55,5 por cento). A doença localizada (grupos A e B de Dukes) foi mais comum (69,4 por cento) que a disseminada (30,6 por cento). Quanto mais distais menos disseminados foram os tumores, sendo a doença localizada mais comum no hemicólon esquerdo (73,2 por cento) que no hemicólon direito (55,9 por cento). A incidência de pólipos colorretais concomitantes e contemporâneos ao câncer colônico foi de 16,3 por cento, sendo mais comuns durante os 5 anos de acompanhamento pós-operatório (8,3 por cento) que antes...

The author had the opportunity in a 31-year period of practice in Coloproctology, from 1965 to 1996, to attend 24,200 patients, being 923 (3.8 percent) patients bearing cancer of the large bowel. Eight hundred and seventy (870 - 3.6 percent) of them were colorectal cancer (adenocarcinoma) and 53 (0.2 percent) were carcinoma of the anus. In 490 cases (56.3 percent) cancer were localized in the colon and 380 (43.7 percent) in the rectum. The aim of this work is to study these 490 patients bearing colon cancer as far as several data are concerned as topographic distribution, complications, graduation, stage and no resectability of tumors, age, gender, symptoms, clinical and proctologic findings and survival rates and coincidence of polyps in the patients. Colon cancer were more common (53,1 percent)in the rectum (41,2 percent) than in the anus(5,7 percent). Colon cancer were far more common in the left colon (77,8 percent) than in the right colon (22,2 percent), the sigmoid and rectosigmoid were the most common topography of colonic cancer (61,6 percent). The mean age of the patients was 60,6 years, far more common between 40 and 80 years of age (86,7 percent) and with little difference between men (52.2 percent) and women (47.8 percent). The most frequent symptoms were constipation and diarrhea (70.6 percent), abdominal cramps (59.6 percent), blood in the stools (58.6 percent) and alteration of shape of the feces (55.5 percent). Localized A and B Dukes disease were more common (69.4 percent) than Dukes C and D (30.6 percent). Distal tumors (left colon) were more disseminated (73.2 percent) than proximal tumors (right colon) (55.9 percent). The coincidence of polyps and colon cancer reached 16.3 percent, they were more common during 5 years after surgery (8.3 percent) than before (1.4 percent) and by the occasion of the surgery (6.6 percent). Isolated polyps (up to 3 polyps) were more common (76.3 percent) than multiple polyps...

Naturaleza de los pólipos de la vesícula biliar sometidos a colecistectomía / Clinical and pathological features of gallbladder polyps

Existen distintos protocolos para el manejo de los pólipos vesiculares, colecistectomía para todo paciente con pólipo vesicular, sólo para sintomáticos, o para aquellos que midan sobre 10 mm. El objetivo de este trabajo es aportar datos que contribuyan a optar entre colecistectomía sistemática o selectiva, caracterizando los pólipos vesiculares, especialmente en relación a la presencia de adenocarcinoma. Se realizó un estudio descriptivo revisando 118 fichas de todos los pacientes con pólipos vesiculares colecistectomizados en Hospital Naval Almirante Nef entre Enero de 1995 y Diciembre de 2004. La frecuencia de pólipos fue 3,1 por ciento. La relación hombre mujer fue 1:1.1. El tamaño promedio fue 4.1 mm. El 54,2 por ciento fueron hallazgos en el estudio anátomo-patológico. Los pólipos de colesterol (67,9 por ciento) y los hiperplásticos (20,3 por ciento) fueron los más frecuentes. Los adenomas correspondieron al 9,3 por ciento. Encontramos 3 pacientes con cáncer vesicular in situ (2,5 por ciento) en pólipo adenomatoso, 2 asociados a litiasis. La frecuencia de pólipos encontrada en nuestro estudio es superior a otras publicaciones. Destaca una menor diferencia en la proporción hombre mujer. Nos parece importante el hallazgo de cáncer en pólipos adenomatosos de 5 mm, incluso en un caso no asociado a litiasis. Aunque el porcentaje de cáncer en pólipos no asociados a litiasis vesiculares bajo (2,1 por ciento), el hallazgo de dos casos con pólipos de 5 mm (uno no asociado a litiasis), cuestiona una conducta contemplativa, enfatizando la necesidad de vigilancia ecográfica, e incluso plantea la posibilidad de considerar la colecistectomía laparoscópica como un método diagnóstico y terapéutico adecuado frente a todo pólipo vesicular.

Prevalence and Risk Factors of Gallbladder Polyp in Adults Living in Daegu and Gyeongbuk Provinces / 대한소화기학회지

BACKGROUND/AIMS: Although there are various reports on the prevalence of gallbladder (GB) polyp according to the race or area, there is no report on Daegu and Gyeongbuk provinces. Therefore, we investigated the prevalence and related risk factors of GB polyp in health screening population of Daegu and Gyeongbuk provinces. METHODS: Of 28,911 adult health screening examinees from January 1997 to May 2003, age and gender-matched 8,008 (3,896 men, 4,112 women) were randomly selected to evaluate the prevalence. Independent risk factors were analyzed by comparing various variables between the GB polyp positive and negative groups. RESULTS: The prevalence of GB polyp was 2.2% (175/8,008). Those were 2.7% (104/3,896) among men and 1.7% (71/4,112) among women. Independent risk factors related with GB polyp were male gender (OR 1.434, p<0.001), obesity (OR 1.237, p=0.024), and hepatitis B carrier (OR 1.888, p<0.001) CONCLUSIONS: Prevalence of GB polyp in Daegu and Gyeongbuk provinces is 2.2%. Male, obesity, and hepatitis B carrier may be the risk factors related with GB polyp in this region.

Contemporaneidade de pólipos em 380 pacientes portadores de câncer retal / Comtemporaneousness of polyps in 380 carrying patients of rectal cancer

Estudos recentes sobre o câncer colorretal (CR) mostram que, independentemente de sua etiologia, o início do tumor pelo pólipo parece ser, da mesma forma que a displasia epitelial, uma etapa patogênica inquestionável. No decurso de 31 anos de prática em coloproctologia, de 1965 a 1996, o autor acumulou um fichário com 24.200 pacientes, 923 (3,8por cento) dos quais eram portadores de câncer no intestino grosso, e destes, 870 (3,6por cento) eram adenocarcinomas colorretais, dos quais 490 (56,3por cento) localizavam-se nos cólons e 380 (43,7por cento) no reto. Estes 380 pacientes foram catalogados dentro de quatro décadas em que foram atendidos: 82 pacientes (21,6por cento) na década de 60, entre 1965 e 1970; 140 pacientes (36,8por cento) na década de 70, entre 1971 e 1980; 102 pacientes (26,8por cento) na década de 80, entre 1981 e 1990 e 56 pacientes (14,8por cento) na década de 90. O objetivo deste trabalho é estudar a contemporaneidade de 75 casos de pólipos e poliposes colorretais entre estes 380 pacientes que se submeteram à amputação abdominoperineal por câncer retal, ao longo destas 4 décadas, analisando o advento da colonoscopia a partir do início da terceira década. A incidência de pólipos e poliposes colorretais, antes (2,1por cento), por ocasião (9,2por cento) e depois (8,4por cento) do diagnóstico do CR totalizou 19,7por cento (75 pacientes), com aumento estatisticamente significativo na terceira (22,5por cento, 23 pacientes) e quarta (32,1por cento, 18 pacientes) décadas em relação à primeira (18,3por cento, 15 pacientes) e segunda décadas (13,6por cento, 19 pacientes). Foi verificada uma diminuição estatisticamente significativa no uso do enema opaco, paralelamente ao aumento no uso da colonoscopia como meio de diagnóstico e seguimento ao longo da terceira e quarta décadas.O aumento da incidência de pólipos colorretais ocorreu par e passo, de forma estatisticamente significativa, ao aumento incremento do uso da colonoscopia, ao longo das duas últimas décadas.

Experiencia en pólipos gástricos / Gastric polips

En 1824 se describe por primera vez un pólipo gástrico, pero hasta 1965 se logra diferenciar un pólipo gástrico de cualquier lesión prominente por Yamada Fukutomi. Los pólipos gástricos son hallazgos endoscópicos y radiológicos, ya que no dan síntomas. Se dividen en dos grupos, los hiperplásicos y los adenomatosos, la importancia de su diagnóstico es por la posibilidad de malignizarse.Se realizó un estudio prospectivo entre diciembre de 1996 y marzo de 1998. Se realizó panendoscopia a pacientes mayores de 15 años, que ameritaran este estudio por otro diagnóstico; se incluyeron a todos los pacientes que presentaban pólipos gástricos, se valoró el número de ellos, la localización, el tamaño, las características de la mucosa adyacente, y se realizó polipectomía.Durante el periodo de 16 meses, se realizaron 1,622 panendoscopias, dentro de las cuales se detectaron 30 pacientes con pólipos gástricos que corresponde a una frecuencia de 1.84 por ciento. Se encontraron 10 portadores masculinos y 20 femeninos, la edad más frecuente fue en la cuarta y sexta década de la vida, la localización más frecuente fue en el cuerpo gástrico 18 (60 por ciento), antro 9 (30 por ciento), fondo 3 (10 por ciento). Sólo en cinco pacientes se encontró pólipo único, en 25 fueron múltiples pero no más de cinco; en un 80 por ciento los pólipos eran sésiles. En cuanto al resultado histopatológico se encontró que de los 30 pacientes, 20 (66.6 por ciento) tenían gastritis crónica, cuatro (13.3 por ciento) eran pólipos hiperplásicos, tres (10 por ciento) tenían metaplasia intestinal, uno (3.6 por ciento) con gastritis folicular, otro (3.6 por ciento) con gastritis crónica sin atrofia y uno (3.6 por ciento) fue pólipo hamartomatoso.Comparando los resultados obtenidos en este estudio, podemos observar que la frecuencia en esta población no difiere de otras cifras publicadas. La localización más frecuente corresponde al sitio donde tienen menor posibilidad de malignizarse, y la edad más frecuente entre los 40 y 50, lo que hace mucho más importante el seguimiento.

Significance of rectosigmoid polyp as a predictor of proximal colonic polyp

The association between rectosigmoid polyps and polyps in the more proximal colon is still a matter of debate, and the need for colonoscopy in patients with rectosigmoid polyps that are detected by flexible sigmoidoscopy is controversial. The aim of this study was to determine whether or not certain characteristics of rectosigmoid polyps are associated with the presence and characteristics of proximal colonic polyps. Seven hundred and twenty-eight patients who underwent total colonoscopy between October 1995 and June 1998 and who had colorectal polyps were retrospectively analyzed. Patients with inflammatory bowel diseases, familial adenomatous polyposis, or any advanced cancer were excluded. The odds ratio (OR) and 95% confidence interval (CI) of prevalence of proximal colonic polyps according to the patients age and sex, as well as the characteristics of rectosigmoid polyps, were calculated. Advanced adenoma was defined as an adenoma larger than 10 mm or an adenoma of any size with villous component, high-grade dysplasia or invasive carcinoma. Among 728 patients with colorectal polyps, 356 patients (48.9%) had polyps only in the rectosigmoid region, 193 patients (26.5%) had polyps only in the proximal colon, and 179 patients (24.6%) had polyps in both the rectosigmoid and proximal colon. In 535 patients with rectosigmoid polyps, the prevalence of proximal colonic polyps, neoplastic polyps and advanced adenomas were 33.4%, 27.3% and 2.9%, respectively. The prevalence of proximal colonic polyps in patients with rectosigmoid polyps was found to be significantly related to the male gender and elderly patients, in addition to the neoplastic histology of the rectosigmoid polyps. However, the prevalence of the proximal colonic polyps was not related to the size, number and shape of rectosigmoid polyps. In 179 patients with both rectosigmoid and proximal colonic polyps, the characteristics of proximal colonic polyps such as size, number and shape were similar to those of rectosigmoid polyps. We recommend total colonoscopic examination in all patients with rectosigmoid adenomas, regardless of the size, number, and shape, especially in elderly males.

Pólipos vesiculares: segundo taller de consenso de la Asociación Chilena de Hepatología / Gallbladder polyps: second consensus workshop of the chilean hepatology association

During workshop, hepatologists analyzed and gave recomendations about gallbladder polyps. They arrived to the following agreements: gallbladder polyps of less than 10 mm should be followed with ultrasonography at 3, 6 and 12 months if there is no enlargement. If there is enlargement, a cholecystectomy should be performed. Polyps larger than 10 mm should be subjected to cholecystectomy

Pólipos gástricos. Revisión de 5 años Hospital General Universitario de La Samaritana

Presentamos en esta revisión la prevalencia de los pólipos gástricos en la Unidad de Gastroenterología y Endoscopia Digestiva del Hospital General Universitario la Samaritana (HGUS). Se analizaron las características de los mismos y los hallazgos histológicos, al igual que su manejo