Dilated Minute Chambers in Laryngeal Vocal Fold Polyps: Histopathological and Ultrastructural Features.

In Reinke's space of human vocal fold, type III collagen forms a three dimensional network and this contains numerous minute chambers in between these fibers. These compartments are occupied by glycosaminoglycans and glycoproteins. In laryngeal fold lesions, such as Reinke's edema and vocal fold polyps, proteoglycan (PG)/hyaluronic acid (HA) components of extracellular matrix increased. We investigated the size and quantity of the minute chambers within Reinke's space, filled with PG/HA with the aid of transmission electron microscopy. Eight vocal fold polyps and 10 mucosal biopsies (as control group) were all evaluated by light microscopy and electron microscopy. We detected that PG/HA in extracellular matrix had been increased in vocal fold lesions when compared with control group, by Alcian Blue-pH 2.5 stain. The mean volume of the chambers in Reinke's space of normal larynx was measured as 0.040233 µm2 whereas the mean volume of these chambers in vocal fold polyps was measured as 6.420221 µm2. The difference between the volumes of these chambers in vocal fold polyps and in control group was statistically significant (P = 0.001). Within these chambers PG/HA were found and PG/HA filling these chambers were increased in vocal fold polyps. We think proteoglycan and glycosaminoglycans, especially HA, play an important role in determining biochemical properties of vocal fold lesions.

Ultrastructural Analysis of Urethral Polyps against the Background of Urogenital Infection.

We performed an electron microscopic study of samples of urethral polyps obtained from 90 women (mean age 52.5±4.9 years). According to PCR and culture studies, the most common infectious agent in patients with urethral polyps is U. urealyticum (100% cases). In 70% cases, this infectious agent was present as monoinfection, of these, clinically significant concentration (>106 CFU/ml) were found in 53.3% cases. In 30% cases, associations with C. trachomatis, T. vaginalis, and M. genitalium were found. We observed significant ultrastructural heterogeneity of the epithelial cells in urethral polyps, which manifested in a combination of hyperplastic and metaplastic changes and signs of cytodestruction. Detection of mycoplasma-like bodies in connective tissue mononuclear cells and viral particles in epithelial cells during ultrastructural study, including cases with negative PCR results, indicates the pathogenetic role of latent infection in the formation of urethral polyps.

Epidermal growth factor treatment of the adult brain subventricular zone leads to focal microglia/macrophage accumulation and angiogenesis.

One of the major components of the subventricular zone (SVZ) neurogenic niche is the specialized vasculature. The SVZ vasculature is thought to be important in regulating progenitor cell proliferation and migration. Epidermal growth factor (EGF) is a mitogen with a wide range of effects. When stem and progenitor cells in the rat SVZ are treated with EGF, using intracerebroventricular infusion, dysplastic polyps are formed. Upon extended infusion, blood vessels are recruited into the polyps. In the current study we demonstrate how polyps develop through distinct stages leading up to angiogenesis. As polyps progress, microglia/macrophages accumulate in the polyp core concurrent with increasing cell death. Both microglia/macrophage accumulation and cell death peak during angiogenesis and subsequently decline following polyp vascularization. This model of inducible angiogenesis in the SVZ neurogenic niche suggests involvement of microglia/macrophages in acquired angiogenesis and can be used in detail to study angiogenesis in the adult brain.

Characterization of epidermal growth factor-induced dysplasia in the adult rat subventricular zone.

Epidermal growth factor (EGF) is a mitogen widely used when culturing adult neural stem cells in vitro. Although proliferative effects can also be observed in vivo, intracerebroventricular infusion of EGF has been found to counteract neuronal determination and promote glial differentiation instead. However, EGF receptor activation has different effects on the subventricular zone (SVZ) in mice and rats, possibly because of species differences in SVZ cell composition. Specifically in the rat, EGF stimulation of the SVZ induces the formation of hyperplastic polyps. The present study aims at molecular and morphological characterization of these subventricular polyps. Using immunohistochemistry, electron microscopy, and gene expression analysis, we demonstrate in hyperplastic EGF-induced polyps an upregulation in protein expression of Sox2, Olig2, GFAP, nestin, and vimentin. We found polyp-specific dysplastic changes in the form of coexpression of Sox2 and Olig2. This highly proliferative, Sox2/Olig2 coexpressing dysplastic cell type is >10-fold enriched in the hyperplastic polyps compared with control SVZ and most likely causes the polyp formation. Unique ultrastructural features of the polyps include a lack of ependymal cell lining as well as a large number of cells with large, light, ovoid nuclei and a cytoplasm with abundant ribosomes, whereas other polyp cells contain invaginated nuclei but fewer ribosomes. EGF also induced changes in the expression of Id genes Id1, Id2, and Id4 in the SVZ. Taken together, we here demonstrate dysplastic, structural, and phenotypical changes in the rat SVZ following EGF stimulation, which are specific to hyperplastic polyps.

Can the growth rate of a gallbladder polyp predict a neoplastic polyp?

GOALS: The aim of this study was to evaluate whether the growth rate of a gallbladder (GB) polyp is a predictive indicator for neoplastic polyps. BACKGROUND: Cholecystectomy for GB polyps that are larger than 10 mm is generally recommended because of the high probability of neoplasm. In contrast, a follow-up strategy is preferred for GB polyps smaller than 10 mm. However, there are no treatment guidelines for polyps that grow in size during the follow-up period. STUDY: We retrospectively investigated 145 patients with GB polyps who underwent at least 1 ultrasonographic follow-up examination over an interval greater than 6 months, before cholecystectomy at Samsung medical center, South Korea, from 1994 to 2007. The growth rate was determined based on the change in size per time interval between 2 ultrasonographic examinations (mm/mo). RESULTS: The median age of the patients was 48 years (range: 25 to 75). One hundred twenty-five non-neoplastic polyps and 20 neoplastic polyps were found. Neoplastic polyps were more frequently found in patients older than 60 years, those with hypertension, a polyp size greater than 10 mm, and a rapid growth rate greater than 0.6 mm/mo. On multivariate analysis, however, the growth rate was not related to the neoplastic nature of a polyp, but older age (>60 y) and large size (>10 mm) were significantly associated with neoplastic polyps. CONCLUSIONS: Patient's age (>60 y) and large polyp size (>10 mm) were significant predictive factors for neoplastic GB polyps. GB polyps less than 10 mm in diameter do not require surgical intervention simply because they grow.

[Electron microscopic observation of vocal fold polyps].

OBJECTIVE: The purpose of this study was to observe the ultrastructure of the fibroblasts, collagen and elastic fibers in vocal fold polyps. METHODS: Ten vocal fold polyps and 3 normal vocal fold specimens obtained from total laryngectomy were studied by means of transmission electron microscope and scanning electron microscope. RESULTS: The result showed that in vocal fold polyps, the quantity of fibroblasts increased and there were abundant organelles, suggesting that the fibroblast were in the status of activation. As the main cell to produce lamina propria extracellular matrix, the representation suggested that the extracellular matrix metabolism was active. Leucocytes soakage was observed, suggesting that the inflammation may play a role in the lesion. It was found by scanning electron microscopy that in case of lesions, collagen fibers and elastic fibers arrayed irregularly. CONCLUSIONS: Under pathologic circumstance, fibroblasts, collagen and elastic fibers altered in morphology, which possibly induced the functional alteration.

Symptomatic gastric leiomyoma mimicking giant gastric polyp: endoscopic diagnosis and removal.

Gastric leiomyoma is an uncommonly found benign submucosal neoplasm which may cause hemorrhage in rare cases. A 67-years-old patient was admitted to our attention due to two episodes of hematemesis and melena occurred in the previous two days. Esophagogastroduodenoscopy showed a giant semi-pedunculated gastric polyp (diameter of 4 centimeters) located at the distal body. A large ulcer with a clot was seen on the polyp. We treated endoscopically the giant polyp using the new two-steps-technique recently described by us for the treatment of the large pedunculated gastric and colorectal polyps, and the polypectomy was successfully performed without immediate or delayed complications. Histological evaluation of the transected polyp revealed morphology according to a gastric submucosal leiomyoma. Endoscopic control, performed one and four weeks and 12 months later, showed complete reepithelization of the gastric mucosa, without any sign of endoscopic, endosonographic and histological recurrence of the disease. This case report shows that our endoscopic approach may be successfully used also for giant semi-pedunculated gastric polyps.

Polipectomía endometrial simplificada sin histeroscopía quirúrgica / Simple endometrial polypectomy without surgical hysteroscopy

Presentamos nuestra experiencia preliminar en técnica quirúrgica destinada al diagnóstico y extracción de pólipos endometriales. Dicha técnica se apoya en el ultrasonido y en la histerosonografía. Realizamos extracción simple, con instrumental ginecológico convencional, sin uso de histeroscopía quirúrgica.

Polipectomias endoscópicas: estudo histopatológico e complicações / Endoscopic polypectomy: histopatologic study and complications

Objetivos: Avaliar em estudo retrospectivo, 2277 videocolonoscopias realizadas no Serviço de Coloproctologia do Hospital Prof. Edmundo Vasconcelos, relacionando o procedimento de polipectomia endoscópica com as características do pólipo encontrado, afecções coloproctológicas concomitantes e complicações relacionadas à polipectomia. Pacientes e métodos: De um total de 2277 videocolonoscopias, realizadas no período de abril de 1996 a agosto de 2002, evidenciaram-se 542 pólipos em 379 destes exames, nos quais foram realizadas polipectomias endoscópicas e enviado material para análise histopatológica. Resultados e conclusões: Histologicamente, os pólipos eram neoplásicos em 236 casos (43,50por cento) e não neoplásicos em 306 casos (56,50por cento). Dos pólipos neoplásicos, pelo menos 29 pólipos tinham algum grau de atipia (12,30por cento), sendo que 4 deles apresentavam atipia intensa (2,40por cento), ou seja, foram classificados como carcinomas in situ. As complicações após a polipectomia foram raras e ocorreram em 5 pacientes, representadas pela ocorrência da síndrome pós- polipectomia em 2 casos (0,52por cento) e hemorragia digestiva baixa em 3 casos (0,79por cento). Não houve nenhum caso de perfuração intestinal neste estudo. Conclui-se, portanto, que todos os pólipos encontrados devem ser retirados durante o exame videocolonoscópico, devido ao alto risco de malignização, e que a polipectomia endoscópica é um método seguro, factível e eficaz demonstrado pelos baixos índices de complicações.

Surface structures of aural polyps: a scanning electron microscopic study.

Surfaces of aural polyps collected from 30 patients were examined by scanning electron microscopy. In the polyps not associated with cholesteatoma, the epithelial lining showed individually variable metaplasia towards cuboidal 'cobblestone'-type and squamous epithelium covered with microvilli of various shapes and sizes. Squamous epithelium was present on the surface of all polyps with underlying cholesteatoma, with superficial cells possessing elongated microvilli, microplicae of different sizes, grooves and pits. Such surface structures reflect different stages of the keratinization process that seems to be characteristic for the epithelial lining of polyps with underlying cholesteatoma. Incomplete epithelium accompanied by granulation tissue was found in several polyps; in two cholesteatoma-associated polyps plate-like cholesterol crystals were observed.

Clinicopathological correlation of polypoidal choroidal vasculopathy revealed by ultrastructural study.

AIMS: To describe the clinical and histopathological findings in a patient with polypoidal choroidal vasculopathy. METHODS: A 76 year old Japanese man had a discrete, orange-red lesion of 1 disc diameter in the macula, with the fluorescein and indocyanine green angiographic and optical coherence tomographic findings compatible with polypoidal choroidal vasculopathy. He underwent a surgical removal of the macular lesion, followed by light and electron microscopic examinations. RESULTS: The histopathological examination revealed that the specimen consisted of degenerated retinal pigment epithelium-Bruch's membrane-choriocapillaris complex and inner choroid. A tortuous, unusually dilated venule was present adjacent to an arteriole with marked sclerotic changes, appearing to form arteriovenous crossing. These vessels seemed to represent native inner choroidal vessels, and had haemorrhage per diapedesis. Blood cells and fibrin filled the lumina of the vessels and accumulated in the extravascular spaces, indicating vascular stasis. CONCLUSION: Hyperpermeability and haemorrhage due to stasis of a dilated venule and an arteriole involved by sclerosis at the site where they cross in the inner choroid might cause oedema and degeneration of the tissue. Voluminous accumulation of blood cells and fibrin might generate elevation of tissue pressure sufficient to displace the weakened lesion anteriorly. The result suggests that the polypoidal vessels in this case represent abnormality in the inner choroidal vasculature.

Ultrastructural changes in malignant transformation of oral mucosa.

Transmission electron microscopy (EM) has been used to identify the ultrastructural details of normal and cancerous human oral mucosa. However, inconsistent reports of structural descriptions have rendered transmission EM valueless in the diagnosis of oral squamous cell carcinoma (SCC) or as a prognostic indicator. To identify features of dysplasia for diagnostic purposes, normal mucosa, severe dysplasia, oral SCC and normal margin adjacent to oral SCC were used to compare the ultrastructural features of normal and premalignant oral mucosa and oral SCC. The preparatory stages of dehydration, embedding, cutting and positive staining for transmission EM were modified and tested to improve ultrastructural definition. Thin and discontinuous basal laminas were found in mucosa with severe dysplasia and normal margin adjacent to oral SCC. No basal lamina was identified in oral SCC. This study has shown that there are some ultrastructural changes during malignant transformation of oral mucosa. Together with other laboratory investigative techniques, transmission EM may be helpful in detecting malignant changes in oral mucosa.

Imaging of fibrosis of the oral mucosa by 20 MHz sonography.

OBJECTIVES: To compare the ultrasonographic (US) appearances of the oral mucosa in health with patients with systemic sclerosis (SSc). METHODS: An innovative 20 MHz US scanner was used to examine the lips, cheeks and oral vestibule of ten healthy persons and ten patients with SSc. The clinical, US and histopathological features of one patient with a fibro-epithelial polyp of the buccal mucosa are reported in detail. RESULTS: Two patients with SSc displayed increased echogenicity due to fibrotic deposits. A similar echo pattern was seen in the case of the histopathologically verified fibro-epithelial polyp of the buccal mucosa. CONCLUSION: 20 MHz sonography may be suitable as a non-invasive tool for evaluation of fibrosis of the oral mucosa.

Motilin-producing liver and bone metastases evidenced 14 years after resection of a rectal polyp.

A 62-year-old man with a history of a resected rectal polyp was diagnosed 14 years later with right liver and multiple bone metastases. The liver biopsy showed a malignant epithelial tumor that was positive for neuron-specific enolase immunostaining and negative for chromogranin. Electron microscopy was characteristic of that for an endocrine tumor. Most circulating hormonal peptide levels were within normal ranges and only motilin level was elevated. On the right hepatectomy, the three large metastases had a histologic picture suggestive of an endocrine tumor. Immunohistochemistry revealed in some areas numerous tumor cells expressing motilin, and a few cells were strongly positive for pancreatic polypeptide and somatostatin. The retrospective analysis of the rectal polyp showed a similar histology and immunohistochemical profile, indicating that this lesion was the primary tumor. Motilin-positive cells from one of the hepatic lesions were identified on semithin sections and further processed for electron microscopy. Neurosecretory granules were numerous in all cells. Immunoelectron localization enabled us to characterize the motilin-containing neurosecretory granules, which had a mean diameter of 168.3x38.1 nm. Although not all tumor cells were motilin-positive, a diagnosis of motilinoma for the rectal polyp and its hepatic and bone metastases was proposed.

[Rating of transvaginal sonography in the evaluation of postmenopausal bleeding]. / Stellenwert der Vaginosonographie in der Abklärung von Postmenopauseblutungen.

OBJECTIVE: The purpose of this study was to evaluate transvaginal ultrasonography (TVS) in differential diagnosis of vaginal bleedings in postmenopausal patients. MATERIAL AND METHODS: Between January 1990 and December 1996, 1198 postmenopausal patients with vaginal bleedings were sent to our clinic for a histological evaluation. Eight hundred and seventy-nine patients (73.4%) were preoperatively scanned by transvaginal probe, and endometrial thickness (< 5, 5-7, 8-10, > 10 mm) was measured. RESULTS: Atrophy was found in 46.3%, endometrial polyps in 19.8%, endometrial cancer in 17.5%, and hyperplasia in 6.7%. An endometrial thickness of lower than 5 mm (p < 0.0001) was shown in TVS patients with atrophy in 71%, with endometrial polyps in 10.9%, with endometrial cancer in 3.9% and hyperplasia in 6.8%. In 55.2% of these eases with endometrial cancer the preoperatively estimated thickness was 10 mm or more. The additionally morphologic examination in cases with an endometrium smaller than 5 mm was false positive in 75% (9/12). Thus an endometrial thickness of > 5 mm had a sensitivity of 92.5%, specificity of 71.0%, positive and negative predictive value of 75.6, respectively 90.9% for the detection of endometrial pathology. CONCLUSIONS: TVS allows the detection of an endometrial pathology in the vast majority of patients with postmenopausal bleedings. In cases with a single postmenopausal bleeding and an endometrium smaller than 5 mm we recommend expectative procedures with repeated ultrasound examination of the endometrium.

Atypical cervical polyp with intracytoplasmic inclusions.

Benign polyps containing atypical stromal cells are described at many anatomical sites and some such lesions have been shown to contain intracytoplasmic actin-rich inclusions, believed to represent deranged filament metabolism in proliferating myofibroblastic cells. We present a case of an atypical cervical polyp with intracytoplasmic inclusions, occurring in a 23 year old female, and provide support for the proposal that these inclusions are composed of actin filaments, identical to those initially reported in infantile digital fibromatosis. This report emphasises the need to recognise the benign nature of such stromal proliferations and expands the range of myofibroblastic lesions in which actin inclusions may occur. Characterisation of the inclusions will provide further insight into the complexities of actin metabolism.