Most solitary gastrointestinal (GI) polyps in children are either inflammatory or hamartomatous. Solitary hyperplastic polyp, sentinel polyp and solitary adenomatous polyp have been occasionally diagnosed in adults, but very rarely reported in Korean children. We recently came across a case with adenomatous polyp in the colon, a case with hyperplastic polyp beneath the gastroesophageal junction, a case with hyperplastic polyp in the prepyloric area, and a case with sentinel polyp in the distal esophagus, which are unusual pathologic types in children. These mucosal lesions were diagnosed incidentally during elective endoscopic examinations for GI symptoms. Most polyps do not cause significant symptoms, so the diagnosis might be delayed, especially in children, in whom GI endoscopy is not commonly performed for screening purpose as in the adults.
Adenomatous Polyps ; Adult ; Child* ; Colon ; Diagnosis ; Endoscopy ; Esophagogastric Junction ; Esophagus ; Gastrointestinal Tract ; Humans ; Mass Screening ; Polyps*

BACKGROUND/AIMS: Serrated polyposis syndrome (SPS) has been shown to increase the risk of colorectal cancer (CRC). However, little is known about the characteristics of Asian patients with SPS. This study aimed to identify the clinicopathological features and risk of CRC in Korean patients with SPS as well as the differences between Korean and Western patients based on a literature review. METHODS: This retrospective study included 30 patients with SPS as defined by World Health Organization classification treated at Samsung Medical Center, Korea, between March 1999 and May 2011. RESULTS: Twenty patients (67%) were male. The median patient age at diagnosis was 56 years (range, 39–76 years). A total of 702 polyps were identified during a median follow-up of 43 months (range, 0–149 months). Serrated polyps were noted more frequently in the distal colon (298/702, 55%). However, large serrated polyps and serrated adenomas were mainly distributed throughout the proximal colon (75% vs. 25% and 81% vs. 19%, respectively); 73.3% had synchronous adenomatous polyps. The incidence of CRC was 10% (3/30 patients), but no interval CRC was detected. A total of 87% of the patients underwent esophagogastroduodenoscopy and 19.2% had significant lesions. CONCLUSIONS: The phenotype of SPS in Korean patients is different from that of Western patients. In Korean patients, SPS is more common in men, there were fewer total numbers of serrated adenoma/polyps, and the incidence of CRC was lower than that in Western patients. Korean patients tend to more frequently have abnormal gastric lesions. However, the prevalence of synchronous adenomatous polyps is high in both Western and Korean patients.
Adenoma ; Adenomatous Polyps ; Asian Continental Ancestry Group ; Classification ; Colon ; Colorectal Neoplasms ; Diagnosis ; Endoscopy, Digestive System ; Follow-Up Studies ; Humans ; Incidence ; Korea* ; Male ; Phenotype ; Polyps ; Prevalence ; Retrospective Studies ; World Health Organization

A gastric polyp is defined as a proliferative or neoplastic lesion from the mucosal membrane. Rates of gastric polyp detection are increasing due to widespread use of gastrointestinal endoscopy in Korea. There are many types of gastric polyps; the most common are fundic gland, hyperplastic, and adenomatous polyps. This article reviews the clinical and histologic features of these polyps and provides recommendations for management.
Adenomatous Polyps ; Diagnosis* ; Disease Management ; Endoscopy, Gastrointestinal ; Korea ; Membranes ; Polyps* ; Stomach

Narrow-band imaging (NBI) is a new imaging technology that was developed in 2006 and has since spread worldwide. Because of its convenience, NBI has been replacing the role of chromoendoscopy. Here we review the efficacy of NBI with/without magnification for detection, characterization, and management of colorectal polyps, and future perspectives for the technology, including education. Recent studies have shown that the next-generation NBI system can detect significantly more colonic polyps than white light imaging, suggesting that NBI may become the modality of choice from the beginning of screening. The capillary pattern revealed by NBI, and the NBI International Colorectal Endoscopic classification are helpful for prediction of histology and for estimating the depth of invasion of colorectal cancer. However, NBI with magnifying colonoscopy is not superior to magnifying chromoendoscopy for estimation of invasion depth. Currently, therefore, chromoendoscopy should also be performed additionally if deep submucosal invasive cancer is suspected. If endoscopists become able to accurately estimate colorectal polyp pathology using NBI, this will allow adenomatous polyps to be resected and discarded; thus, reducing both the risk of polypectomy and costs. In order to achieve this goal, a suitable system for education and training in in vivo diagnostics will be necessary.
Adenomatous Polyps ; Capillaries ; Classification ; Colonic Polyps ; Colonoscopy ; Colorectal Neoplasms ; Diagnosis ; Education ; Mass Screening ; Narrow Band Imaging ; Pathology ; Polyps*

PURPOSE: Colonoscopic polypectomy and surveillance are important to prevent colorectal cancer and identify additional relative risk factors for adequate surveillance. In this study, we evaluated risk factors related to recurrent high-risk polyps during the surveillance of patients with high-risk polyps. MATERIALS AND METHODS: We included 434 patients who had high-risk polyps (adenoma > or =10 mm, > or =3 adenomas, villous histology, or high-grade dysplasia) on the baseline colonoscopy and underwent at least one surveillance colonoscopy from 2005 to 2011 at Severance Hospital. Data regarding patient characteristics, bowel preparation and polyp size, location, number, and pathological diagnosis were retrospectively collected from medical records. Patients with recurrent high-risk polyps were compared with patients with low-risk or no polyps during surveillance. RESULTS: Patients were predominantly male (77.4%), with a mean age of 61.0+/-8.6 years and mean follow-up of 1.5+/-0.8 years. High-risk polyps recurred during surveillance colonoscopy in 51 (11.8%) patients. Results of multivariate analysis showed that male gender, poor bowel preparation, and a larger number of adenomas were independent risk factors for recurrent high-risk polyps (p=0.047, 0.01, and <0.001, respectively). Compared with high-risk polyps found during initial colonoscopy, high-risk polyps on surveillance colonoscopy had higher proportions of small adenomas, low-risk pathology, and fewer adenomas overall, but there was no difference in location. CONCLUSION: Male patients and those with poor bowel preparation for colonoscopy or higher numbers of adenomas were more likely to experience recurrent high-risk polyps.
Adenomatous Polyps/pathology/*surgery ; Aged ; *Colectomy ; Colonic Neoplasms/*pathology ; Colonic Polyps/pathology/*surgery ; *Colonoscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local/*diagnosis ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: A diagnosis of acute diverticulitis is based on computed tomography (CT). Colonoscopy is commonly performed after the acute event to exclude other diagnoses. This study aimed to determine whether colonoscopy is necessary and what additional information is gained from a colonoscopy after acute diverticulitis. METHODS: Acute diverticulitis was diagnosed by clinical criteria and characteristic CT findings. We analyzed the number of patients in whom colorectal cancers were diagnosed and other incidental findings of polyps and other diseases. RESULTS: A total of 177 patients were analyzed retrospectively. The mean age was 43.3+/-15.3 years (range, 13-82 years) and 97 patients (54.8%) were male. Sixty-one patients had undergone a colonoscopy within 1 year of the acute attack. Advanced adenomatous lesions and colonic malignancy were not detected. Nineteen patients (31.1%) had > or =1 polyp and 11 patients (18.0%) had an adenomatous polyp. No new or different diagnosis was made after colonoscopy. None of the 116 patients who did not undergo colonoscopy within a year after acute diverticulitis had a diagnosis of colorectal cancer registered with the Korea Central Cancer Registry. CONCLUSIONS: Routine colonoscopy yields little benefit in patients with acute diverticulitis diagnosed by typical clinical symptoms and CT. The current practice of a colonoscopy after acute diverticulitis needs to be reevaluated.
Adenomatous Polyps ; Colon ; Colonoscopy* ; Colorectal Neoplasms ; Diagnosis* ; Diverticulitis* ; Humans ; Incidental Findings ; Korea ; Male ; Polyps ; Retrospective Studies

adenomatous polyposis. It causes lesions in bones, skin, and teeth, as well as multiple gastrointestinal polyps, which, if left untreated, become malignant. Because patients with colorectal cancer have a low survival rate, early diagnosis and treatment of Gardner syndrome is critical. Therefore, the characteristic lesions of Gardner disease that appear on the face, jaws, and oral cavity must be understood; these can be evaluated by oral and maxillofacial clinicians. This report describes a case that was diagnosed and treated earlier with the help of a routine oral and maxillofacial examination and has had a seemingly good prognosis so far.]]>
Adenomatous Polyposis Coli ; Colorectal Neoplasms ; Early Diagnosis ; Gardner Syndrome ; Humans ; Jaw ; Mouth ; Osteoma ; Polyps ; Prognosis ; Skin ; Survival Rate ; Tooth

We tested the correlation between diabetes and aggressiveness of colorectal polyps in diabetic patients and matched non-diabetic controls. We retrospectively studied 3,505 type 2 diabetes (T2DM) patients without gastrointestinal symptoms who underwent colonoscopy for colorectal cancer at Samsung Medical Center, Seoul, Korea from August 1995 to August 2009. We matched 495 non-diabetic subjects with colon polyps to the diabetic patients in whom polyps were detected by year of colonoscopy, age, sex and body mass index (BMI). Among the 3,505 T2DM patients screened, 509 were found to have 1,136 colon polyps. Those with diabetes had a greater proportion of adenomatous polyps (62.8% vs 53.6%) compared to the control. Multivariate logistic regression analysis identified DM, male gender, age and BMI as independent risk factors for multiple polyps (more than three polyps). Polyp multiplicity in diabetic patients was significantly associated with male gender (OR 2.360, P = 0.005), age (OR 1.033, P = 0.005) and BMI (OR 1.077, P = 0.028). Neither aspirin nor metformin use affected either size or number of polyps in diabetic patients. Male patients older than 65 yr with T2DM and BMI greater than 25 have increased risk for multiple adenomatous polyps and should be screened with colonoscopy to prevent colorectal cancer.
Adenomatous Polyps/*complications/*diagnosis/epidemiology ; Adult ; Age Factors ; Aged ; Body Mass Index ; Colonic Polyps/diagnosis ; Colonoscopy ; Colorectal Neoplasms/*complications/*diagnosis/epidemiology ; Diabetes Mellitus, Type 2/*complications/*diagnosis ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Sex Factors

Adenomatous Polyposis Coli ; genetics ; pathology ; Colonic Neoplasms ; classification ; genetics ; pathology ; Colorectal Neoplasms, Hereditary Nonpolyposis ; diagnosis ; genetics ; DNA Glycosylases ; metabolism ; Humans ; Intestinal Polyps ; pathology ; Lymphatic Metastasis ; Neoplasm Staging ; Neuroendocrine Tumors ; classification ; pathology ; Precancerous Conditions ; pathology ; Rectal Neoplasms ; classification ; genetics ; pathology ; World Health Organization

BACKGROUND AND OBJECTIVEThe colorectum is long and its position is not fixed. The thickness of the colorectal wall is unfixed because it changes following wall contractions. The metabolism of the colorectum is not stable and abnormal metabolism results from smooth muscle movement, gland action, spasm, inflammation, and so on. These anatomic and physiologic factors can bring a few difficulties in correctly judging colorectal information on 18F-FDG positron emission tomography/computed tomography (PET/CT) scans. This study was to discuss the imaging characteristics of colorectal hypermetabolic lesions in 18F-FDG PET/CT and their value to clinical diagnosis.

METHODSAccording the metabolic characteristics and the shape of the lesion, 118 colorectal hypermetabolic lesions of 74 patients were detected by 18F-FDG PET/CT and separated to 6 groups (localized/CT+, localized/CT-, segmented/CT+, segmented/CT-, diffuse/CT+, diffuse/CT-). To contrast groups and the qualitative data, a RxC Chi2 test was performed to judge statistical differences.

RESULTSIn the 118 lesions, 50 were determined to be malignant and 68 nonmalignant. A total of 30 lesions were in the localized/CT+ group (23 malignant, 7 non), 35 to the localized/CT- group (22 malignant, 13 non), 4 to the segmented/CT+ group (4 malignant, 0 non), 35 to the segmented/CT- group (1 malignant, 34 non), 0 to the diffuse/CT+ group, 14 to the diffuse/CT- group (0 malignant, 14 non). The rates of nonmalignant lesions in the segmented/CT- and diffuse/CT- groups (97.1%, 100%) and of malignant lesions in the segmented/CT+ groups (100%) were similar, so these three groups were combined to a nonlocalized group. The group of diffuse/CT+ was deleted. There were significant differences among the three groups of nonlocalized, localized/CT+, and localized/CT-(P < 0.001). The localized/CT+ and localized/CT- groups were combined into one localized group because no significant difference was found between them (P = 0.229). There was a significant difference between the nonlocalized and the localized groups (P < 0.001).

CONCLUSIONSOn 18F-FDG PET/CT, colorectal hypermetabolic lesions in the diffuse/CT- or segmented/CT- groups were highly likely to be nonmalignant and those in the segmented/CT+ group were highly likely to be malignant. Lesions in the localized/CT+ or localized/CT- groups had only a normal likelihood of being malignant. To correctly diagnose colorectal hypermetabolic lesions, it is necessary to analyze the PET of the metabolism and the CT of the anatomy together. Especially for the metabolic lesions of the localized/CT- group, we cannot easily make the judgment of malignant or nonmalignant unless we refer to the relevant clinical data.

Adenocarcinoma ; diagnosis ; diagnostic imaging ; Adenomatous Polyps ; diagnosis ; diagnostic imaging ; Colorectal Neoplasms ; diagnosis ; diagnostic imaging ; Diagnosis, Differential ; Female ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Humans ; Lymphoma, Large B-Cell, Diffuse ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Multimodal Imaging ; methods ; Positron-Emission Tomography ; Tomography, X-Ray Computed