Characteristics and risk factor analyses of high-grade intraepithelial neoplasia in older patients with colorectal polyps

BACKGROUND According to the degree of intradermal neoplasia in the colorectal exhalation,it can be divided into two grades:Low-grade intraepithelial neoplasia(LGIN)and high-grade intraepithelial neoplasia(HGIN).Currently,it is difficult to accurately diagnose LGIN and HGIN through imaging,and clinical diagnosis depends on postoperative histopathological diagnosis.A more accurate method for evaluating HGIN preoperatively is urgently needed in the surgical treatment and nursing intervention of colorectal polyps.AIM To explore the characteristics and risk factors of HGIN in older patients with colorectal polyps.METHODS We selected 84 older patients diagnosed with HGIN as the HGIN group(n=95 colonic polyps)and 112 older patients diagnosed with LGIN as the LGIN group(n=132 colonic polyps)from Shandong Provincial Hospital Affiliated to Shandong First Medical University.The endoscopic features,demographic characteristics,and clinical manifestations of the two patient groups were compared,and a logistic regression model was used to analyze the risk factors for HGIN in these patients.RESULTS The HGIN group was older and had a higher number of sigmoid colon polyps,rectal polyps,pedunculated polyps,polyps≥1.0 cm in size,polyps with surface congestion,polyps with surface depression,and polyps with villous/tubular adenomas,a higher proportion of patients with diabetes and a family history of colorectal cancer,patients who experienced rectal bleeding or occult blood,patients with elevated carcinoembryonic antigen(CEA)and cancer antigen 199(CA199),and lower nutritional levels and higher frailty levels.The polyp location(in the sigmoid colon or rectum),polyp diameter(≥1.0 cm),pathological diagnosis of(villous/tubular adenoma),family history of colorectal cancer,rectal bleeding or occult blood,elevated serum CEA and CA199 levels,lower nutritional levels and higher frailty levels also are independent risk factors for HGIN.CONCLUSION The occurrence of high-grade neoplastic transformation in colorectal polyps is closely associated with their location,size,villous/tubular characteristics,family history,elevated levels of tumor markers,and lower nutritional levels and higher frailty levels.

Missed diagnosis of early gastric cancer or high-grade intraepithelial neoplasia

AIM: To investigate the causes of missed diagnosis of early gastric cancer (EGC) or high-grade intraepithelial neoplasia (HGIN) in Chongqing, China. METHODS: The present study summarizes 103 cases of EGC/HGIN detected by esophagogastroduodenos-copy (EGD) and pathological analysis from January 2010 to December 2011. Dimethyl silicone oil was administrated orally 15 min before the EGD procedures. The stomach was cleaned by repeated washing with saline when the gastroscope entered the stomach cavity. Suspected EGC lesions were subject to conventional biopsy sampling and pathological examinations. The correlation between lesion locations, endoscopic morphology of cancerous sites, training level of the examiners, pathological biopsies, and missed diagnosis was analyzed. RESULTS: Twenty-three cases were missed among the 103 cases (22.23%) of EGC/HGIN. The rate of missed EGC in the gastroesophageal junction (8/19, 42.1%) was significantly higher than at other sites (15/84, 17.86%) (χ2 = 5.253, P = 0.022). In contrast, the rate of missed EGC in the lower stomach body (2/14, 14.29%) was lower than at other sites (21/89,23.6%), but there were no significant differences (χ2 = 0.289, P = 0.591). The rate of missed EGC in the gastric antrum (5/33, 15.15%) was lower than at other sites (18/70, 25.71%), but there were no significant differences (χ2 = 1.443, P = 0.230). Endoscopists from less prestigious hospitals were more prone to not diagnosing EGC than those from more prestigious hospitals (χ2 = 4.261, P = 0.039). When the number of biopsies was < 4, the rate of missed diagnosis was higher (20/23, 89.96%) than for when there were > 4 biopsies (3/23, 13.04%) (P < 0.001). In addition, there was no significant difference in the rate of missed diagnosis in patients with 1-3 biopsy specimens (χ2 = 0.141, P = 0.932). CONCLUSION: Endoscopists should have a clear understanding of the anatomical characteristics of the esophagus/stomach, and endoscopic identification of early lesions increases with the number of biopsies.

Prediction value of high-grade prostatic intraepithelial neoplasia for prostate cancer on repeat biopsies

Objective: The significance of isolated high-grade prostatic intraepithelial neoplasia in initial biopsy as an predic-tor for prostate cancer has been extensively research, and the true relationship remnant is no clear till now. The aim of this study is to evaluate prediction value of cancer on repeat biopsy in patients with high-grade prostatic intraepithelial neoplasia, using multivariate analysis. Methods: Thirty-eight men with a diagnosis of isolated high-grade prostatic intraepithelial neo-plasia in initial needle biopsy were studies, in the Fist Affiliated Hospital of Medical School of Xi'an Jiaotong University, from January 2003 to March 2009. These samples were using immunostaining of p63 and 34βE12 and P504s, with a median fol-low-up of 525 (range, 7 to 1650) days, and to researched the incidence of subsequent prostate cancer, and to predicted the risk of prostate cancer in clinicopathological parameters of isolated high-grade prostatic intraepithelial neoplasia on repeat biopsies by logistic regression analysis. Results: There were 10 of 38 (26.3%) men with prostate cancer on repeat biopsies after diagnosis isolated high-grade prostatic intraepithelial neoplasia in initial biopsy, of the rates of prostate cancer were 80% for micropapillary and 75% for cribriform high-grade prostatic intraepithelial neoplasia (P < 0.05), respectively. The positive cores of isolated high-grade prostatic intraepithelial neoplasia was the important for the risk of prostate cancer using Multi-factor logistic regression analysis. The time range in 30 to 690 days was stronger risk for prostate cancer detection after diagnosis isolated HGPIN in initial biopsy. p63 and 34βE12 were disrupted positive expression, and P504S was weak posi-tive expression in the 61% isolated high-grade prostatic intraepithelial neoplasia. Conclusion: Isolated high-grade prostatic intraepithelial neoplasia on repeat biopsy conferred a 26.3% risk of prostate cancer, and this risk level is lower than the previ-ously reported risk of 24% to 58%. The number of positive cores and the histopathological pattern with high-grade prostatic intraepithelial neoplasia on initial biopsy was significantly associated with the risk of cancer.

Role of pancreatic juice cytology in diagnosis of high-grade pancreatic intraepithelial neoplasia

High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.

直肠高级别上皮内瘤变经肛肿瘤手术后诊断为pT1b直肠癌患者的再手术指征分析

研究直肠高级别上皮内瘤变经肛肿瘤切除术后pT1b直肠癌患者再行补救性根治术后的临床病理特点、合理的治疗方案及手术指征。经乙状结肠镜或结肠镜活检诊断为41例直肠高级别上皮内瘤变,随后Park经肛直肠肿物切除术或经肛内镜显微手术后确诊为34例≥pT1b直肠癌,再行补救性根治术后最终诊断为29例pT1b直肠癌。pT1b直肠癌按浸润深度分为SM1-2组和SM3组,观察两组临床病理特点。Multivariate回归分析结果,发现淋巴脉管浸润是肿瘤浸润深度的独立预测因素(P<0.05)。直肠高级别上皮内瘤变需积极行经肛肿瘤切除术确诊;当其术后浸润深度为SM3的pT1b直肠癌合并淋巴脉管浸润时,建议行积极的补救性根治术等再手术干预。

Intraductal papillary neoplasm of the bile duct developing in a patient with primary sclerosing cholangitis: A case report

We report a case of intraductal papillary neoplasm of the bile duct(IPNB) that developed in a patient with primary sclerosing cholangitis. A 46-year-old woman was admitted to our hospital with obstructive jaundice. The liver function tests demonstrated increased serum liver enzyme levels. Computed tomography showed dilatation of the intrahepatic bile ducts. Abdominal ultrasonography revealed a highly echoic protruding lesion in the posterior bile duct near the right lobe of the liver. The lesion was suspected to be IPNB, but we were unable to confirm whether it was a carcinoma. A right hepatectomy was performed, and this showed that the dilated bile duct was filled with mucin and contained several yellowish papillary tumors. Histologically, the neoplastic biliary epithelium showed papillary growth in the dilated lumen. The tumor was diagnosed as IPNB, high-grade intraepithelial neoplasia secreting abundant mucin. No recurrence has been detected 3 years after surgery.

Determination of an Appropriate Endoscopic Monitoring Interval for Patients with Gastric Precancerous Conditions in China

Objective Gastric precancerous conditions such as atrophic gastritis(AG)and intestinal metaplasia(IM)are considered independent risk factors for gastric cancer(GC).The suitable endoscopic monitoring interval is unclear when we attempt to prevent GC development.This study investigated the appropriate monitoring interval for AG/IM patients.Methods Totally,957 AG/IM patients who satisfied the criteria for evaluation between 2010 and 2020 were included in the study.Univariate and multivariate analyses were used to determine the risk factors for progression to high-grade intraepithelial neoplasia(HGIN)/GC in AG/IM patients,and to determine an appropriate endoscopic monitoring scheme.Results During follow-up,28 AG/IM patients developed gastric neoplasia lesions including gastric low-grade intraepithelial neoplasia(LGIN)(0.7%),HGIN(0.9%),and GC(1.3%).Multivariate analysis identified H.pylori infection(P=0.022)and extensive AG/IM lesions(P=0.002)as risk factors for HGIN/GC progression(P=0.025).Conclusion In our study,HGIN/GC was present in 2.2%of AG/IM patients.In AG/IM patients with extensive lesions,a 1–2-year surveillance interval is recommended for early detection of HIGN/GC in AG/IM patients with extensive lesions.

经肛门内镜微创手术治疗直肠上皮内瘤变和早期直肠癌

目的探讨经肛门内镜微创手术（TEM）治疗直肠上皮内瘤变（IN）和早期直肠癌的临床价值。方法选择15例直肠肿瘤患者采用TEM行局部切除术。根据活检病理结合直肠腔内超声检查（EUS）术前诊断低级别IN8例，高级别IN4例，早期直肠癌3例。肿瘤距肛缘的距离4—15（平均7．2）cm，肿瘤直径1—4（平均1．8）cm，肿瘤占据肠腔周径比例10％～40％（平均20％）。结果15例直肠肿瘤均获完整切除（黏膜下切除5例，全层切除10例），各切缘均阴性。手术时间为40．90（平均57）min；术中出血量为10-60（平均35）ml。术后住院时间为2-9（平均4．5）d。术后病理确诊：直肠低级别IN5例，高级别IN6例，早期黏膜下浸润癌（pT1期）和进展期癌（pT2期）各2例。术前EUS评估肿瘤浸润肠壁深度的准确率为86．7％（13／15）。15例术后随访2．10（平均6）个月，肿瘤无局部复发。结论TEM微创、显露良好、切除精确、能获取高质量的肿瘤标本用于准确的病理分期，是治疗直肠IN和早期直肠癌的理想术式。术前EUS检查对TEM病例的选择十分重要。

hMLH1在直肠上皮内瘤变和早期直肠癌组织中的表达

目的探讨hMLH1在直肠上皮内瘤变与早期直肠癌组织中的表达情况及其早期诊断价值。方法采用PV-9000二步法免疫组织化学检测技术对术后确诊的28例早期浸润性直肠癌、36例直肠上皮内瘤变和30例正常直肠黏膜组织的石蜡切片进行hMLHl蛋白表达的检测。结果正常直肠黏膜组织、直肠上皮内瘤变组织和早期浸润性直肠癌组织hMLH1蛋白的阳性表达率分别为100％（30／30）、77．8％（28／36）和39．3％（11／28），3组比较差异有统计学意义（P〈0．05）。直肠上皮内瘤变组织hMLH1的阳性表达与患者的年龄、性别、肿瘤最大径、异型增生、肿瘤类型和距肛缘的距离均无关（P〉0．05）；早期直肠癌组织hMLH1阳性表达与其分化程度有关（P〈0．05）。结论hMLHI基因表达缺失可能是直肠癌发生的早期事件之一,hMLH1蛋白检测对于上皮内瘤变和早期直肠癌中两种疾病的早期诊断有一定的临床价值。

直肠癌黏膜下浸润癌与直肠高级别上皮内瘤变的病理特征比较

目的比较直肠癌黏膜下浸润癌与直肠高级别上皮内瘤变的病理特征。方法回顾性分析2015年1月至2017年1月本院收集的直肠肿瘤性病变黏膜活检标本240例资料,经病理确诊为浸润性腺癌标本161例(观察组)及高级别上皮内瘤变标本79例(对照组),对比两组HE染色处理后病理形态学特征。结果观察组及对照组中可见黏膜肌结构的标本占比分别为39.1%(63/161)、31.6%(25/79),差异无统计学意义(P>0.05)。观察组中可见黏膜肌且未穿过黏膜肌层占比显著低于对照组,差异有统计学意义(P<0.05)。观察组异常腺体结构,包括筛状结构腺体、锐角形腺体及腺性结构消失检出率均明显高于对照组,差异均有统计学意义(均P<0.05)。两组腺体分支出芽占比差异无统计学意义(P>0.05)。对照组未见黏膜间质病理化改变特征,观察组均表现出不同程度的黏膜间质病理化改变特征,其中观察组标本间质纤维化、厚壁血管检出率明显高于对照组,差异均有统计学意义(均P<0.05)。结论在直肠肿瘤性病变标本中出现的腺体呈筛状结构变化、黏膜间质纤维化等特征,对于鉴别直肠癌黏膜下浸润癌与直肠高级别上皮内瘤变具有一定的参考价值。