Follow-up imaging and surgical costs associated with different guidelines for management of incidentally detected gallbladder polyps.

RATIONALE AND OBJECTIVES: To compare follow-up imaging and surgical cost implications of the Society of Radiologists in Ultrasound (SRU) guidelines, 2017 and 2022 European (EUR) guidelines, 2020 Canadian Association of Radiologists (CAR) recommendations, and 2013 American College of Radiology (ACR) White Paper for managing incidentally detected gallbladder polyps. MATERIALS AND METHODS: 253 consecutive patients with gallbladder polyps identified on ultrasound were independently reviewed by three radiologists for polyp size and morphology. Electronic medical records were reviewed for patient demographics, cholecystectomy (if performed) pathological findings, or any subsequent diagnosis of gallbladder cancer. For each patient, the following were calculated for each of the 5 guidelines studied: 1) number of recommended follow-up ultrasounds based on initial presentation, 2) number of surgical consultations recommended based on initial presentation, 3) number of surgical consultations recommended based on growth, and 4) associated imaging and surgical costs. Interrater agreement was calculated. RESULTS: The SRU 2022 guidelines suggested significantly fewer follow-up ultrasounds and surgical consultations, leading to a cost reduction of 96.5 % and 96.7 % compared to European 2022 and 2017, respectively; 86.5 % compared to CAR; and 86.2 % compared to ACR guidelines. With SRU Recommendations, the majority of gallbladder polyps would be classified as extremely low risk (68.4 %), 30.8 % low risk, and 0.8 % indeterminate risk. In our cohort, a single case of gallbladder cancer was identified (26 mm) which would be recommended for surgical consult by all guidelines. CONCLUSION: The SRU 2022 guidelines can lead to significant savings for patients, health systems, and society, while reducing unnecessary medical interventions for managing incidentally detected gallbladder polyps.

Polypoid Lesion Segmentation Using YOLO-V8 Network in Wireless Video Capsule Endoscopy Images.

Gastrointestinal (GI) tract disorders are a significant public health issue. They are becoming more common and can cause serious health problems and high healthcare costs. Small bowel tumours (SBTs) and colorectal cancer (CRC) are both becoming more prevalent, especially among younger adults. Early detection and removal of polyps (precursors of malignancy) is essential for prevention. Wireless Capsule Endoscopy (WCE) is a procedure that utilises swallowable camera devices that capture images of the GI tract. Because WCE generates a large number of images, automated polyp segmentation is crucial. This paper reviews computer-aided approaches to polyp detection using WCE imagery and evaluates them using a dataset of labelled anomalies and findings. The study focuses on YOLO-V8, an improved deep learning model, for polyp segmentation and finds that it performs better than existing methods, achieving high precision and recall. The present study underscores the potential of automated detection systems in improving GI polyp identification.

Xanthogranuloma in the External Auditory Canal in Childhood, an Unexpected Lesion.

Pedunculated lesions in the external auditory canal present a broad differential diagnosis. It is crucial to rule out malignant neoplasms and consider the possibility of xanthogranulomas, which are very rare in this location. Management is determined by associated complications, and otolaryngologists must consider this for appropriate treatment.

Polypoid Lymphangiectasia in the Sigmoid Colon: A Case Report of a Rare Entity.

Intestinal polypoid lymphangiectasia is an uncommon disorder involving an improperly formed enteric lymphatic system. It is characterized by lymphatic vessel dilatation with impaired drainage or obstruction of the lymph from the intestine. In this report, we present a case of a 73-year-old male patient with chronic intermittent left lower quadrant abdominal pain for one year who was found to have a sigmoid colon polyp on a colonoscopy. Upon microscopic examination, the polyp revealed dilated lymphatic vessels staining strongly for D2-40 (lymphatic vessel marker), supporting the diagnosis of polypoid lymphangiectasia. Intestinal lymphangiectasia has a broad differential diagnosis, warranting histopathological examination for a definitive diagnosis.--------------.

Infantile Tubercular Endobronchial Polypoid Obstructive Lesion.

Endobronchial tuberculosis is reported in 18% of adults and 30%-60% of children with primary pulmonary tuberculosis. We are reporting two infants who presented with nonspecific respiratory symptoms due to an obstructive tubercular polypoid mass which was detected on computed tomography. Bronchoscopy showed a pale friable polypoid lesion in the bronchus causing a luminal obstruction. The biopsy of the lesion was suggestive of tuberculosis. On treatment with antitubercular medications, both the babies improved and remained asymptomatic on long-term follow-up.

Differential diagnosis of gallbladder neoplastic polyps and cholesterol polyps with radiomics of dual modal ultrasound: a pilot study.

PURPOSE: To verify whether radiomics techniques based on dual-modality ultrasound consisting of B-mode and superb microvascular imaging (SMI) can improve the accuracy of the differentiation between gallbladder neoplastic polyps and cholesterol polyps. METHODS: A total of 100 patients with 100 pathologically proven gallbladder polypoid lesions were enrolled in this retrospective study. Radiomics features on B-mode ultrasound and SMI of each lesion were extracted. Support vector machine was used to classify adenomas and cholesterol polyps of gallbladder for B-mode, SMI and dual-modality ultrasound, respectively, and the classification results were compared among the three groups. RESULTS: Six, eight and nine features were extracted for each lesion at B-mode ultrasound, SMI and dual-modality ultrasound, respectively. In dual-modality ultrasound model, the area under the receiver operating characteristic curve (AUC), classification accuracy, sensitivity, specificity, and Youden's index were 0.850 ± 0.090, 0.828 ± 0.097, 0.892 ± 0.144, 0.803 ± 0.149 and 0.695 ± 0.157, respectively. The AUC and Youden's index of the dual-modality model were higher than those of the B-mode model (p < 0.05). The AUC, accuracy, specificity and Youden's index of the dual-modality model were higher than those of the SMI model (p < 0.05). CONCLUSIONS: Radiomics analysis of the dual-modality ultrasound composed of B-mode and SMI can improve the accuracy of classification between gallbladder neoplastic polyps and cholesterol polyps.

Incidental finding of a large polypoidal gallbladder mass diagnosed as papillary adenocarcinoma - A case report.

INTRODUCTION AND IMPORTANCE: Lesions which project from the gallbladder wall into its lumen are known as gallbladder polyps. Nearly 5% of all adults have gallbladder polyps, the majority are pseudo-polyps with no neoplastic potential. Although gallbladder polyps are commonly found in cholecystectomy specimen, only a very few gallbladder polyps present as carcinoma in a polypoid lesion. CASE PRESENTATION: A 48 years old male patient came for a routine health checkup and ultrasonography (USG) of abdomen showed incidental finding of a polypoid lesion measuring 43 × 28 mm in the gallbladder. Computed tomography scan revealed a soft tissue mass of similar size almost filling the lumen of the gallbladder and showed notable enhancement in post-contrast images. The mass was concluded to be suggestive of gallbladder carcinoma. Extended radical cholecystectomy was performed and histopathological examination of the polypoid lesion showed papillary adenocarcinoma with tumor staging of T2b. CLINICAL DISCUSSION: The prevalence of polypoid lesions of the gallbladder are reported to be 2-12% of all cholecystectomy specimens. Gallbladder polyps are one of the common USG findings in general population. It is difficult to differentiate between the benign and malignant polypoid lesions of the gallbladder solely depending on imaging studies. A size larger than 10 mm is the best indicator of malignancy. The most common malignant gallbladder polyp is adenocarcinoma. CONCLUSION: In majority of the cases, gallbladder polyp is an incidental finding. Even though most of the gallbladder polyps are benign in nature, cholecystectomy is the treatment of choice if the suspicion for malignancy is high.

The Role of Endoscopic Ultrasound in the Diagnosis of Gallbladder Lesions.

Gallbladder (GB) diseases represent various lesions including gallstones, cholesterol polyps, adenomyomatosis, and GB carcinoma. This review aims to summarize the role of endoscopic ultrasound (EUS) in the diagnosis of GB lesions. EUS provides high-resolution images that can improve the diagnosis of GB polypoid lesions, GB wall thickness, and GB carcinoma staging. Contrast-enhancing agents may be useful for the differential diagnosis of GB lesions, but the evidence of their effectiveness is still limited. Thus, further studies are required in this area to establish its usefulness. EUS combined with fine-needle aspiration has played an increasing role in providing a histological diagnosis of GB tumors in addition to GB wall thickness.

Occurrence of a Duodenal Polypoid Lesion During Long-Term Acid Suppression Therapy and Its Regression After Drug Discontinuation.

Formation of multiple fundic gland polyps or hyperplastic polyps in the gastric mucosa is one of the well-known adverse effects of the long-term acid suppression therapy for peptic ulcer disease. However, similar phenomenon has not been reported to occur in the duodenum. We report a case of duodenal polypoid lesion that developed after the long-term use of acid suppressants and disappeared after the cessation of the treatment. The patient was a 76-year-old man with a history of heavy cigarette smoking and excessive alcohol intake who had been treated with medication of gastric acid suppressants, including proton pump inhibitors and potassium-competitive acid blockers, for refractory gastroesophageal reflux disease. After receiving the acid suppression therapy for 3 years, a polypoid lesion of 10 mm in diameter was found at the portion of the duodenal bulb. This polypoid lesion disappeared 1.5 months after the cessation of treatment. We hypothesized that changes in serum gastrin levels caused by acid suppression therapy might have been associated with the development and regression of the duodenal polypoid lesion.

Polypoid lesions detected in the upper gastrointestinal endoscopy: A retrospective analysis in 19560 patients, a single-center study of a 5-year experience in Turkey.

OBJECTIVE: In our study, we aimed to evaluate the endoscopic features such as prevalence and localization of polypoid lesions determined by us using esophagogastroduodenoscopy and histopathological characteristics of biopsy specimens taken in detail. METHODS: The data of 19,560 patients undergoing upper gastrointestinal endoscopy for any reason between 2009 and 2015 in our endoscopy unit were screened retrospectively and endoscopic and histopathological findings were analyzed in detail. RESULTS: In our study, the polypoid lesion was detected in 1.60% (n=313) of 19,560 patients. The most common localization of the polypoid lesions was determined to be gastric localization (n=301, 96.2%) and antrum with a rate of 33.5% (n=105). When 272 patients in whom biopsy specimen could be taken was investigated, the most frequently seen lesion was polyp (n=115, 43.4%). Hyperplastic polyps (n=81, 29.8%) were the most frequently seen type among all polyps. In histopathological evaluation of the lesions, the prevalence rates of intestinal metaplasia (IM), surrounding tissue IM, atrophy, dysplasia, and neoplasia (adenocarcinoma, squamous cell carcinoma, gastrointestinal stromal tumor, neuroendocrine tumor, and metastatic tumor) among premalignant lesions were determined to be 16.9%, 11.2%, 4.1%, 1.1%, and 3.7%, respectively. CONCLUSION: Polypoid lesions can be seen in endoscopic investigations. In histopathological investigations, while the vast majority of these lesions are benign polyps, some of them are diagnosed as premalignant or malignant lesions. In our study, we determined malignant lesions higher than the similar studies in the literature. This condition shows how effective endoscopic procedure and histopathological evaluation are of vital importance.

How Can We Manage Gallbladder Lesions by Transabdominal Ultrasound?

The most important role of ultrasound (US) in the management of gallbladder (GB) lesions is to detect lesions earlier and differentiate them from GB carcinoma (GBC). To avoid overlooking lesions, postural changes and high-frequency transducers with magnified images should be employed. GB lesions are divided into polypoid lesions (GPLs) and wall thickening (GWT). For GPLs, classification into pedunculated and sessile types should be done first. This classification is useful not only for the differential diagnosis but also for the depth diagnosis, as pedunculated carcinomas are confined to the mucosa. Both rapid GB wall blood flow (GWBF) and the irregularity of color signal patterns on Doppler imaging, and heterogeneous enhancement in the venous phase on contrast-enhanced ultrasound (CEUS) suggest GBC. Since GWT occurs in various conditions, subdividing into diffuse and focal forms is important. Unlike diffuse GWT, focal GWT is specific for GB and has a higher incidence of GBC. The discontinuity and irregularity of the innermost hyperechoic layer and irregular or disrupted GB wall layer structure suggest GBC. Rapid GWBF is also useful for the diagnosis of wall-thickened type GBC and pancreaticobiliary maljunction. Detailed B-mode evaluation using high-frequency transducers, combined with Doppler imaging and CEUS, enables a more accurate diagnosis.

Risk factors to discriminate neoplastic polypoid lesions of gallbladder: A large-scale case-series study.

BACKGROUND: Polypoid lesion of gallbladder (PLG) size larger than 10 mm is considered to be one of the surgical indications, but the final pathological results are mostly non-neoplastic polyps. The aim of the study was to define the risk factors to discriminate neoplastic PLG and create more precise criteria for surgical indications. METHODS: A large scale, case-series study based on 2704 patients who underwent cholecystectomy for PLG was designed. Logistic regression analysis and receiver operating characteristic curve (ROC) was adopted to identify risk factors and the optimal size criteria for predicting neoplastic PLG. RESULTS: Patients in the neoplastic group were significantly older than those in the non-neoplastic group and the average PLG size is much larger in the neoplastic group (18.5 ± 4.7 mm vs 12.6 ± 3.6 mm). Neoplastic PLGs are prone to be single and non-neoplastic polyps are usually multiple. On Multivariate logistic regression analysis, PLG size larger than 15 mm and age older than 43 years were found to be the independent risk factors to discriminate neoplastic PLG （Odds ratio 3.546 and 2.77 respectively）. The ROC curve showed that 12 mm might be the more reasonable PLG size threshold for the surgical suggestion. CONCLUSIONS: Considering its moderate diagnostic accuracy, the size of gallbladder polyp larger than 10 mm is insufficient to indicate surgical therapy for PLG and 12 mm should be the more optimal polyp's size threshold. Patients older than 43 years have a higher risk of having neoplastic polyps.

Role of conventional ultrasonography in the diagnosis of gallbladder polypoid lesions.

The major role of conventional ultrasonography (US) can be divided into three processes: cancer screening, differential diagnosis, and assessment of the depth of tumor invasion. As US is a simple and minimally invasive modality, it is widely used for cancer screening and health checkups. Both gallbladder (GB) polyps and thickened wall of the GB are common US findings. On the contrary, US is prone to interference from gas echoes, and its diagnostic accuracy depends on both the US technology and the ability of sonographers. It is also important to be well acquainted with characteristic artifacts and how to manage their influence. Furthermore, magnified images acquired using high-resolution US (HRUS) are strongly helpful to pick up small lesions. As for differential diagnosis, classification of GB polypoid lesions (GPLs) into pedunculated or sessile (broad-based) types is very important. Cholesterol polyps in pedunculated lesions and localized adenomyomatosis (ADM) in sessile lesions are the most important targets to be differentiated. Furthermore, significant findings including number, size, growth rate, shape, internal echo, surface contour, and internal structure should be evaluated and judged as a whole. Usually, US delineates the GB wall as a two- or three-layer structure. However, as the inner hypoechoic layer includes not only the mucosa and muscularis propria but also the fibrous layer of subserosa, the differentiation between T1 (confined to the mucosa or muscularis propria) and T2 (invading the subserosa) based on the layer structure is difficult. Shape, size, and internal echo structure may be helpful for further assessment.

Multifocal gastrointestinal epithelioid angiosarcomas diagnosed by endoscopic mucosal resection: A case report.

BACKGROUND: Epithelioid angiosarcoma is a vascular neoplasm that is among the most aggressive subtypes of sarcomas. Its involvement in the gastrointestinal tract is rare. We here report a case of multifocal gastrointestinal epithelioid angiosarcomas presenting with gastrointestinal bleeding. CASE SUMMARY: A 77-year-old woman was admitted because of melena and dizziness for three months. Gastroscopy and colonoscopy were performed, revealing a centrally ulcerated hemorrhagic polypoid lesion in the gastric body and multiple polypoid lesions with blood clots and hemorrhagic tendency in the colon. Histopathological examination of routine endoscopic biopsy samples showed inflammation in the gastric mucosa and tubular adenomas in the colon. The polypoid lesions were removed by endoscopic mucosal resection. Immunohistochemistry suggested a final diagnosis of epithelioid angiosarcomas. The patient refused chemotherapy and died after three months. CONCLUSION: Epithelioid angiosarcomas are characterized by highly vascular nature and tendency to cause gastrointestinal bleeding. Efforts to obtain histological findings using endoscopic mucosal resection are of great importance.

Revisiting the distinct histomorphologic features of inflammatory bowel disease-associated neoplastic precursor lesions in the SCENIC and post-DALM Era.

Distinct histomorphologic features of colitis-associated dysplasia (CAD) or neoplastic precursors in inflammatory bowel disease (IBD) have never been clearly identified. In this study, we tried to further explore the differentiating morphologic features of CAD by retrospectively reviewing the lesions that were clearly associated with carcinomas (carcinoma-related lesions) and by comparing between endoscopically nonpolypoid (non-adenoma-like) lesions and polypoid (adenoma-like) lesions and sporadic conventional adenomas found in the noncolitic mucosa and in patients without IBD. Our study results have revealed that (1) precursor lesions related to IBD-associated colorectal carcinomas were almost always nonpolypoid in macroscopic/endoscopic appearance; (2) nearly half of the carcinoma-related lesions and nonpolypoid lesions were similarly nonadenomatous (nonconventional) lesions, largely serrated type, with no or only mild/focal adenomatous dysplasia, and commonly had mixed adenomatous and nonadenomatous features; (3) carcinoma-related and nonpolypoid adenomatous dysplastic lesions frequently showed some peculiar histocytologic features that we observed and described for the first time, including mixed features of inflammatory pseudopolyps or granulation tissue, pleomorphic and disarrayed nuclei, micropapillary or hobnailing surface epithelial cells, and microvesicular or bubbling cytoplasm of dysplastic cells; and (4) polypoid lesions in the colitic mucosa were identical to sporadic adenomas in the noninflamed mucosa and in patients without IBD, and they lacked the aforementioned features. The seemingly distinctive morphologic characteristics that we proposed here, although still not absolutely specific or unique, can be used as the features of inclusion for identifying CAD on endoscopic biopsies when the endoscopy images are not readily available to pathologists and thus to alert clinicians for a closer follow-up.

Gallbladder metastasis of renal cell carcinoma presenting as a hypervascular polypoid lesion: case report of two cases with immunohistochemical analysis.

BACKGROUND: Metastasis of renal cell carcinoma (RCC) to the gallbladder is rare, and its clinicopathological feature remains poorly understood. We here present two cases of gallbladder metastasis from RCC presenting as a hypervascular polypoid lesion. CASE PRESENTATION: The first case was a 73-year-old man who had undergone right nephrectomy for clear cell RCC. Imaging studies detected a hypervascular polypoid lesion in the gallbladder 6 years after nephrectomy. Laparoscopic cholecystectomy was done. The pathological findings of the polypoid lesion showed proliferation of clear cells in the submucosal layer. Immunohistochemically, the tumor was positive for carbonic anhydrase 9 (CA9) but negative for cytokeratin 7 (CK7), suggestive of metastatic RCC. The second case was a 43-year-old man who had undergone right nephrectomy for clear cell RCC. Imaging studies revealed a hypervascular polypoid lesion of 20 mm in diameter in the gallbladder 1 year after nephrectomy. The patient underwent expanded cholecystectomy and extra-hepatic bile duct resection with lymphadenectomy. Microscopically, the polypoid lesion of the gallbladder was composed of clear cells in the submucosal layer. Immunohistochemical analysis showed positive staining for epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA) but negative staining for CK7, leading to the diagnosis of metastatic RCC. CONCLUSIONS: Gallbladder metastasis from RCC is rare but should be considered when a hypervascular polypoid lesion in the gallbladder is detected during the follow-up period after RCC treatment.

Usefulness of virtual enteroscopy for the detection of small polypoid lesion in the small bowel, a case report.

INTRODUCTION: Virtual enteroscopy (VE) has been developed to explore the entire small bowel. We have previously reported that VE can reveal elevated lesions measuring >10 mm in diameter. However, data on the existence of smaller polypoid lesions is scarce. This study aimed to report a case of pyogenic granuloma in the ileum detected by VE. PRESENTATION OF CASE: A 55-year-old woman presented to our hospital with iron deficiency anemia. Esophagogastroduodenoscopy, colonoscopy, and abdominal contrast-enhanced computed tomography did not indicate any bleeding sources. Video capsule endoscopy revealed a small polypoid lesion in the small bowel. VE was subsequently performed and a polypoid lesion was detected at 119 cm from the ileocecal valve. Its size was estimated to be 6 mm. Based on VE findings, laparoscopic-assisted surgery for the small bowel tumor was performed. During surgery, the polypoid lesion, at 120 cm from the end of the ileum, was barely palpable. The resected specimen showed a 5.5 × 5.0 mm polypoid lesion. Microscopically, the polypoid lesion was diagnosed as pyogenic granuloma. DISCUSSION: We detected a 5.5 × 5.0 mm polypoid lesion in the small bowel, and this is the minimum size of the lesion visualized on VE. This imaging technique provides surgeons with data on the location, number, and size of polypoid lesions. CONCLUSION: VE is a new useful tool for the preoperative collection of data on small polypoid lesions in the small bowel.

Differential diagnosis of benign and malignant gallbladder polypoid lesions with maximum diameter ≥1 cm based on CT radiomics / 中国医学影像技术

Objective: To explore the value of radiomics based on CT in differential diagnosis of benign and malignant polypoid lesions of the gallbladder (PLG). Methods: Totally 145 patients with PLG ≥1 cm who underwent abdominal enhanced CT examination and confirmed by pathology were collected. Among them, benign PLG was found in 82 cases, while malignant ones were detected in 63 cases. The patients were randomly divided into training set and test set. 3D ROIs of portal vein phase CT images were manually segmented using ITK-SNAP software. AK software was introduced to extract high-dimensional radiomics features. Then Lasso regression was used to reduce the dimension of the features. Logistic regression model was established and tested with R language software. Finally, the diagnostic performance of the model was evaluated with ROC. Results: Seven features related to benign and malignant identification of gallbladder polyps were obtained. The optimal threshold based on training set was 0.370. After the model was established, the threshold was used for test set with accuracy was 0.886, the specificity and sensitivity was 0.880 and 0.895, respectively, and AUC was 0.924. Conclusion: CT radiomics can effectively identify benign and malignant PLG with the maximum diameter ≥1 cm.

Large polypoid angiomyofibroblastoma of the vulva: report of a case.

We report a case of angiomyofibroblastoma which arose in the vulva of a 46-year-old woman. The tumor formed a large pedunculated polypoid mass, measuring 14 cm in maximal dimension, which hung down from the right labium majus. It consisted of a dense or loose proliferation of fibroblastic and myofibroblastic cells on an edematous background, and the tumor cells occasionally exhibited an increased cellularity around well-developed, medium-sized or small blood vessels. In small areas, conglomerates of capillaries exhibited an appearance resembling that of capillary hemangioma. Tumor cells were immunoreactive for vimentin, desmin, estrogen receptor, and progesterone receptor, but not for α-smooth muscle actin, CD34, CD10, S-100 protein, calretinin, podoplanin, or cytokeratin. Angiomyofibroblastoma usually appears as a small subcutaneous nodule, and the formation of a large pedunculated polypoid mass is rare. The differential diagnosis from aggressive angiomyxoma and other mesenchymal tumors which preferentially involve the vulvo-vaginal region was briefly discussed.

Gallbladder polypoid lesions >15mm as indicators of T1b gallbladder cancer risk.

BACKGROUND AND STUDY AIMS: Gallbladder polyps (GBPs) are found in 5-7% of the adult population. However, it is very important to differentiate between benign and malignant polyps to establish an appropriate treatment. The present study aimed to determine the relevance of the 10-mm size criterion and attempted to determine the cut-off diameter of T1b tumours, which requires additional surgical intervention. PATIENTS AND METHODS: Cases with GBPs were collected between January 2005 and January 2015. A total of 109 patients were enroled retrospectively. Information on age, sex, ultrasound findings, and blood laboratory tests was reviewed. The 10-mm criterion and T1b tumours were examined. RESULTS: Sixty-nine females and 40 males were included in the study. Patient age was 45±10.7years (range 27-70years). The 10-mm cut-off sensitivity and specificity for predicting malignant polyps was 93.6% and 85.2%, respectively. Fifteen patients had malignant pathologic results, and one patient had GBP <10mm (intraepithelial, 8mm). Two patients had intraepithelial tumours of 12 and 13mm. Twelve malignant patients had T1b tumours with polyp sizes >15mm. CONCLUSION: Gallbladder cancer may occur in polyps of <10mm. Larger size and older age were predictors of neoplastic GBPs. We suggest 15mm as the optimal cut-off point to predict T1b cancer.