AIM: To clarify the molecular mechanism involved in pathogenesis of colorectal cancer as well as clinical significance of genetic analysis of histological samples.
Gallbladder adenomas are rare lesions(0.5%)associated with potential malignant transformation,particularly with gallbladder adenomas that are≥1 cm in size.Early detection and management are crucial for preventing let...Gallbladder adenomas are rare lesions(0.5%)associated with potential malignant transformation,particularly with gallbladder adenomas that are≥1 cm in size.Early detection and management are crucial for preventing lethal carcinoma de-velopment.These polyps can often be distinguished from the more often nonneo-plastic cholesterol pseudopolyps(5%-10%),which are benign.Ultrasonography is the first-line tool for initial diagnosis and follow-up when indicated.The question is whether cholecystectomy is always necessary for all adenomas.The manage-ment of gallbladder adenomas is determined according to the size of the tumor,the growth rate of the tumor,the patient’s symptoms and whether risk factors for malignancy are present.Adenomas≥1 cm in size,an age>50 years and a familial history of gallbladder carcinoma are indications for immediate laparoscopic chole-cystectomy.Otherwise,ultrasound follow-up is indicated.For adenomas 6-9 mm in size,the absence of≥2 mm growth at 6 months,one year,and two years,as well as an adenoma sized<5 mm without existing risk factors indicates that no further surveillance is required.However,it would be preferable to individualize the management in doubtful cases.Novel interventional modalities for preserving the gallbladder need further evaluation,especially to determine the long-term outcomes.展开更多
Background and Aims:Gallbladder polyp(GBP)assessment aims to identify the early stages of gallbladder carcinoma.Many studies have analyzed the risk factors for malignant GBPs.In this retrospective study,we aimed to es...Background and Aims:Gallbladder polyp(GBP)assessment aims to identify the early stages of gallbladder carcinoma.Many studies have analyzed the risk factors for malignant GBPs.In this retrospective study,we aimed to establish a more accurate predictive model for potential neoplastic polyps in patients with GBPs.Methods:We devel-oped a nomogram-based model in a training cohort of 233 GBP patients.Clinical information,ultrasonographic find-ings,and blood test findings were analyzed.Mann-Whitney U test and multivariate logistic regression analyses were used to identify independent predictors and establish the nomogram model.An internal validation was conducted in 225 consecutive patients.Performance and clinical bene-fit of the model were evaluated using receiver operating characteristic curves and decision curve analysis(DCA),re-spectively.Results:Age,cholelithiasis,carcinoembryonic antigen,polyp size,and sessile shape were confirmed as independent predictors of GBP neoplastic potential in the training group.Compared with five other proposed predic-tion methods,the established nomogram model presented better discrimination of neoplastic GBPs in the training co-hort(area under the curve[AUC]:0.846)and the validation cohort(AUC:0.835).DCA demonstrated that the greatest clinical benefit was provided by the nomogram compared with the other five methods.Conclusions:Our developed preoperative nomogram model can successfully be used to evaluate the neoplastic potential of GBPs based on simple clinical variables that maybe useful for clinical decision-making.展开更多
A 69-year-old male with chronic lymphocytic leukemia presented with iron deficiency anemia and post-prandial abdominal fullness. Endoscopy showed a large polyp on a stalk, protruding through the pylorus into the duode...A 69-year-old male with chronic lymphocytic leukemia presented with iron deficiency anemia and post-prandial abdominal fullness. Endoscopy showed a large polyp on a stalk, protruding through the pylorus into the duodenum causing intermittent gastric outlet obstruction. While prolapsing gastric antral polyps are usually benign and hyperplastic, inflammatory or regenerative in type, excisional snare polypectomy here led to complete resolution of his symptoms, but showed a malignant polyp.展开更多
基金Supported by Capital Public Health Project Cultivation Program,No.Z111107067311051
文摘AIM: To clarify the molecular mechanism involved in pathogenesis of colorectal cancer as well as clinical significance of genetic analysis of histological samples.
文摘Gallbladder adenomas are rare lesions(0.5%)associated with potential malignant transformation,particularly with gallbladder adenomas that are≥1 cm in size.Early detection and management are crucial for preventing lethal carcinoma de-velopment.These polyps can often be distinguished from the more often nonneo-plastic cholesterol pseudopolyps(5%-10%),which are benign.Ultrasonography is the first-line tool for initial diagnosis and follow-up when indicated.The question is whether cholecystectomy is always necessary for all adenomas.The manage-ment of gallbladder adenomas is determined according to the size of the tumor,the growth rate of the tumor,the patient’s symptoms and whether risk factors for malignancy are present.Adenomas≥1 cm in size,an age>50 years and a familial history of gallbladder carcinoma are indications for immediate laparoscopic chole-cystectomy.Otherwise,ultrasound follow-up is indicated.For adenomas 6-9 mm in size,the absence of≥2 mm growth at 6 months,one year,and two years,as well as an adenoma sized<5 mm without existing risk factors indicates that no further surveillance is required.However,it would be preferable to individualize the management in doubtful cases.Novel interventional modalities for preserving the gallbladder need further evaluation,especially to determine the long-term outcomes.
基金supported by the National Natural Science Foundation of China(81702323 and 81672469)the Changzhou Medical Innovation Team(CCX201807)the Changzhou Sci&Tech Program(CE20165020).
文摘Background and Aims:Gallbladder polyp(GBP)assessment aims to identify the early stages of gallbladder carcinoma.Many studies have analyzed the risk factors for malignant GBPs.In this retrospective study,we aimed to establish a more accurate predictive model for potential neoplastic polyps in patients with GBPs.Methods:We devel-oped a nomogram-based model in a training cohort of 233 GBP patients.Clinical information,ultrasonographic find-ings,and blood test findings were analyzed.Mann-Whitney U test and multivariate logistic regression analyses were used to identify independent predictors and establish the nomogram model.An internal validation was conducted in 225 consecutive patients.Performance and clinical bene-fit of the model were evaluated using receiver operating characteristic curves and decision curve analysis(DCA),re-spectively.Results:Age,cholelithiasis,carcinoembryonic antigen,polyp size,and sessile shape were confirmed as independent predictors of GBP neoplastic potential in the training group.Compared with five other proposed predic-tion methods,the established nomogram model presented better discrimination of neoplastic GBPs in the training co-hort(area under the curve[AUC]:0.846)and the validation cohort(AUC:0.835).DCA demonstrated that the greatest clinical benefit was provided by the nomogram compared with the other five methods.Conclusions:Our developed preoperative nomogram model can successfully be used to evaluate the neoplastic potential of GBPs based on simple clinical variables that maybe useful for clinical decision-making.
文摘A 69-year-old male with chronic lymphocytic leukemia presented with iron deficiency anemia and post-prandial abdominal fullness. Endoscopy showed a large polyp on a stalk, protruding through the pylorus into the duodenum causing intermittent gastric outlet obstruction. While prolapsing gastric antral polyps are usually benign and hyperplastic, inflammatory or regenerative in type, excisional snare polypectomy here led to complete resolution of his symptoms, but showed a malignant polyp.
