1
|
Alkhiari R, Alharbi AM, Albadrani H, Alsaud JS, Alkhiari K. Obstructive Giant Inflammatory Polyp of the Colon in Ulcerative Colitis. Cureus 2023; 15:e45535. [PMID: 37868504 PMCID: PMC10585189 DOI: 10.7759/cureus.45535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Inflammatory polyps, also known as pseudo-polyps, are a common benign condition affecting 10-20% of patients with inflammatory bowel disease. Chronic, repeated inflammation and ulceration associated with healing lead to the formation of polyp-like structures in the colon. Although there are no common symptoms accompanying these pseudo-polyps, they can present with anemia, weight loss, diarrhea, intussusception, palpable mass, abdominal pain, discomfort, and melena, not to mention bowel obstruction that happens infrequently. Finally, it is important to recognize giant inflammatory polyps as they may occasionally be mistaken for colon cancer, leading to unnecessary surgical interventions. We present the case of a 38-year-old woman who was diagnosed with ulcerative colitis 10 years back, treated with oral mesalamine for five years, and had no follow-up after this period. She came to our clinic complaining of recurrent obstructive symptoms for a few months. Examination shows tenderness in the left lower quadrant with normal vital signs and bowel sounds.
Collapse
Affiliation(s)
| | | | | | | | - Khaled Alkhiari
- Department of Medicine, King Fahad Medical City, Riyadh, SAU
| |
Collapse
|
2
|
Bratanic A, Despalatovic BR, Pavic B, Bozikovic T, Ardalic Z, Grubisic DA, Vilovic K. Obstructive Giant Inflammatory Polyposis as a First Manifestation of Crohn's Disease: A Case Report. Healthcare (Basel) 2022; 10:healthcare10101995. [PMID: 36292442 PMCID: PMC9601997 DOI: 10.3390/healthcare10101995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 11/04/2022] Open
Abstract
Colonic inflammatory polyps (pseudopolyps) are common feature of inflammatory bowel diseases. They usually do not grow excessively, rarely reaching more than 15 mm in size, at which point they are termed giant inflammatory polyps. Clinical presentation of these polyps can vary greatly, ranging from being completely asymptomatic, usually detected incidentally, to abdominal cramps, rectal bleeding or intestinal obstruction. More importantly, giant inflammatory polyps can be easily mistaken for colonic malignancy, although without having malignant potential themselves. These polyps rarely regress with successful medical treatment of inflammatory bowel diseases and often require surgical treatment. We present an unusual case of giant inflammatory polyps which was the first presentation of inflammatory bowel disease. It was initially mistaken for colonic malignancy with intestinal obstruction, which led to surgical treatment.
Collapse
Affiliation(s)
- Andre Bratanic
- Department of Gastroenterology, University Hospital Split, 21000 Split, Croatia
| | - Bruna Rosic Despalatovic
- “J&J MEDICI” Polyclinic for Internal Medicine, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-915795288
| | - Berna Pavic
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Tina Bozikovic
- “J&J MEDICI” Polyclinic for Internal Medicine, 21000 Split, Croatia
| | - Zarko Ardalic
- Department of Gastroenterology, University Hospital Split, 21000 Split, Croatia
| | | | - Katarina Vilovic
- Department of Pathology, University Hospital Split, 21000 Split, Croatia
| |
Collapse
|
3
|
Ma YR, Polydorides AD. Clinicopathologic Characteristics and Neoplasia Risk of Colorectal Inflammatory Polyposis in Inflammatory Bowel Disease. Arch Pathol Lab Med 2021; 146:172-181. [PMID: 33946102 DOI: 10.5858/arpa.2020-0745-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/11/2022]
Abstract
CONTEXT.— Inflammatory polyps (IPs) in inflammatory bowel disease may have been associated in the past with increased neoplasia risk. Additionally, colonic mucosa in filiform polyposis and giant inflammatory polyposis may be difficult to visualize during endoscopic surveillance, perhaps contributing to early colectomy in these patients. OBJECTIVE.— To examine the clinicopathologic characteristics and significance of IPs and inflammatory polyposis in inflammatory bowel disease. DESIGN.— We identified 336 resections from inflammatory bowel disease patients (212 [63.1%] male; mean age, 40.3 years; 175 [52.1%] with ulcerative colitis), including 78 with rare/few (<10) IPs, 141 with multiple (≥10) IPs, and 117 with inflammatory polyposis (including 30 with filiform polyposis/giant inflammatory polyposis) and compared them with 100 controls without IPs along various parameters, including overall and occult (unexpected) dysplasia. RESULTS.— There was no increased neoplasia in resections with IPs compared with controls, given similar age, disease duration, degree of inflammation, anatomical extent of colitis, prevalence of primary sclerosing cholangitis, and tissue sampling. Increasing numbers of IPs and inflammatory polyposis were significantly associated in multivariate analysis with ulcerative and indeterminate colitis (P = .003) and shorter disease duration (P = .01), but also, and independently, with lower rates of dysplasia overall, including all grades (P = .001) and advanced neoplasia (P = .04). There were no instances of occult dysplasia (any grade) among inflammatory polyposis cases. CONCLUSIONS.— These findings support the conclusion that the presence of IPs per se, and inflammatory polyposis in particular (including filiform polyposis and giant inflammatory polyposis), should not be considered an independent risk factor for the development of neoplasia in inflammatory bowel disease patients, outside the context of disease duration and inflammatory burden.
Collapse
Affiliation(s)
- Yihong R Ma
- From the Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Ma is now at West Florida Hospital in Pensacola
| | - Alexandros D Polydorides
- From the Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
4
|
Phull MS, Jadav SS, Gundla R, Mainkar PS. A perspective on medicinal chemistry approaches towards adenomatous polyposis coli and Wnt signal based colorectal cancer inhibitors. Eur J Med Chem 2021; 212:113149. [PMID: 33445154 DOI: 10.1016/j.ejmech.2020.113149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 12/24/2022]
Abstract
Colorectal cancer (CRC) is one of the major causes of carcinogenic mortality in numbers only after lung and breast cancers. The mutations in adenomatous polyposis coli (APC) gene leads to formation of colorectal polyps in the colonic region and which develop as a malignant tumour upon coalition with patient related risk factors. The protein-protein interaction (PPI) of APC with Asef (A Rac specific guanine nucleotide exchange factor) overwhelms the patient's conditions by rapidly spreading in the entire colorectal region. Most mutations in APC gene occur in mutated cluster region (MCR), where it specifically binds with the cytosolic β-catenin to regulate the Wnt signalling pathway required for CRC cell adhesion, invasion, progression, differentiation and stemness in initial cell cycle phages. The current broad spectrum perspective is attempted to elaborate the sources of identification, development of selective APC inhibitors by targeting emopamil-binding protein (EBP) & dehydrocholesterol reductase-7 & 24 (DHCR-7 & 24); APC-Asef, β-catenin/APC, Wnt/β-catenin, β-catenin/TCF4 PPI inhibitors with other vital Wnt signal cellular proteins and APC/Pol-β interface of colorectal cancer. In this context, this perspective would serve as a platform for design of new medicinal agents by targeting cellular essential components which could accelerate anti-colorectal potential candidates.
Collapse
Affiliation(s)
- Manjinder Singh Phull
- Department of Chemistry, School of Science, GITAM (Deemed to Be University), Hyderabad, 502329, Telangana, India
| | - Surender Singh Jadav
- Department of Organic Synthesis & Process Chemistry, CSIR-Indian Institute of Chemical Technology, Tarnaka, Hyderabad, 500007, Telangana, India
| | - Rambabu Gundla
- Department of Chemistry, School of Science, GITAM (Deemed to Be University), Hyderabad, 502329, Telangana, India
| | - Prathama S Mainkar
- Department of Organic Synthesis & Process Chemistry, CSIR-Indian Institute of Chemical Technology, Tarnaka, Hyderabad, 500007, Telangana, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, Utter Pradesh, India.
| |
Collapse
|
5
|
Okuno T, Kanazawa T, Kishi H, Anzai H, Yasuda K, Ishihara S. Filiform polyposis with sigmoid colon adenocarcinoma: a case report. Surg Case Rep 2019; 5:184. [PMID: 31782007 PMCID: PMC6883011 DOI: 10.1186/s40792-019-0747-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/11/2019] [Indexed: 11/30/2022] Open
Abstract
Background Filiform polyposis is a rare form of inflammatory polyposis, which is occasionally formed in the colon of patients with history of inflammatory bowel disease (IBD). It is characterized by presence of several to hundreds of slender, worm-like polyps in the colon lined by histologically normal colonic mucosa and often coalesce, resulting in a tumor-like mass. Filiform polyposis is most frequently associated with a post-inflammatory reparative process in patients with IBD history, and only cases of filiform polyposis occurring in patients without IBD history have been reported. Filiform polyposis has been considered as a benign inflammatory polyposis without any risk of dysplasia, while the possibility of carcinogenesis of inflammatory polyps is not fully excluded. To date, only three cases of filiform polyposis coexisting with dysplasia have been reported. Case presentation A 59-year-old male patient with no past medical history of IBD underwent laparoscopic sigmoidectomy for obstructive filiform polyposis, which was associated with sigmoid colon adenocarcinoma. Based on the histological findings of the resected specimen, invasive sigmoid colon adenocarcinoma was surrounded by filiform polyposis, and adenocarcinoma also scattered uniformly on the surface of filiform polyposis. In immunohistochemistry, abnormal p53 expression was observed in adenocarcinoma, while it was not shown in mucosa on filiform polyposis. Conclusions This is the fourth case of filiform polyposis that is closely associated with colon dysplasia or adenocarcinoma based on histological findings. However, immunohistochemical findings did not support the theory that inflammation initiates adenocarcinoma in filiform polyposis like IBD. Hence, further immunohistochemical and genetic analyses are needed to clarify the association between filiform polyposis and carcinogenesis.
Collapse
Affiliation(s)
- Takayuki Okuno
- Department of Surgery, Douai Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan.
| | - Takamitsu Kanazawa
- Department of Surgery, Douai Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
| | - Hirohisa Kishi
- Department of Pathology, Douai Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
| | - Hiroyuki Anzai
- Department of Surgery, Douai Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
| | - Koji Yasuda
- Department of Surgery, Douai Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Tokyo, Japan
| |
Collapse
|
6
|
Rezapour M, Quintero MA, Khakoo NS, Sussman DA, Barkin JA, Clarke J, Varma T, Deshpande AR, Kerman DH, Damas O, Abreu MT. Reclassifying Pseudopolyps in Inflammatory Bowel Disease: Histologic and Endoscopic Description in the New Era of Mucosal Healing. CROHN'S & COLITIS 360 2019; 1:otz033. [PMID: 31667471 PMCID: PMC6798790 DOI: 10.1093/crocol/otz033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION In this study, we identify the frequency of pseudopolyps (PPs) with normal histology and their association to surrounding tissue. METHODS Patients were enrolled in a study identifying endoscopic characteristics of PPs (n = 29) or were collected as part of our IBD biobank (n = 16). Statistical analysis included Stata v.15.0. chi-square and Student t-test. RESULTS A total of 45 patients with 117 PP biopsies were identified. More patients with healed PP were in endoscopic remission compared with those with inflammatory PP (82.6% vs 17.4%, respectively). CONCLUSION This is the first study to find mucosal healing of PPs and its association with deep remission.
Collapse
Affiliation(s)
- Mona Rezapour
- Department of Gastroenterology and Hepatology, University of California Los Angeles, Los Angeles, California
| | | | - Nidah S Khakoo
- Department of Medicine, University of Miami, Miami, Florida
| | - Daniel A Sussman
- Department of Gastroenterology and Hepatology, University of Miami, Miami, Florida
| | - Jodie A Barkin
- Department of Gastroenterology and Hepatology, University of Miami, Miami, Florida
| | - Jennifer Clarke
- Nebraska Food for Health Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska
| | | | - Amar R Deshpande
- Department of Gastroenterology and Hepatology, University of Miami, Miami, Florida
| | - David H Kerman
- Department of Gastroenterology and Hepatology, University of Miami, Miami, Florida
| | - Oriana Damas
- Department of Gastroenterology and Hepatology, University of Miami, Miami, Florida
| | - Maria T Abreu
- Department of Gastroenterology and Hepatology, University of Miami, Miami, Florida
| |
Collapse
|
7
|
Politis DS, Papamichael K, Katsanos KH, Koulouridis I, Mavromati D, Tsianos EV, Christodoulou DK. Presence of pseudopolyps in ulcerative colitis is associated with a higher risk for treatment escalation. Ann Gastroenterol 2019; 32:168-173. [PMID: 30837789 PMCID: PMC6394261 DOI: 10.20524/aog.2019.0357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/27/2018] [Indexed: 12/17/2022] Open
Abstract
Background Pseudopolyps in ulcerative colitis (UC) are considered as indicators of previous episodes of severe inflammation and ulceration of the mucosa. The aim of the study was to investigate the long-term outcomes of patients treated for UC, with or without pseudopolyps. Methods This was a retrospective single-center study. Consecutive patients with UC and available endoscopic data from 2000 until 2016 were eligible for the study and were followed until June 2017. Patients with incomplete medical/endoscopic charts or interrupted follow up were excluded from the study. Primary outcomes included time to treatment escalation, treatment escalation to biological agents or surgery, and UC-related hospitalization. Results Eighty-three UC patients were included in the study, of whom 25 (30%) had pseudopolyps. The median duration of follow up was 2.8 years (interquartile range: 1.1-4.9). Multiple Cox regression analysis identified the presence of pseudopolyps as the only variable independently associated with treatment escalation (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.2-4.3; P=0.014) and escalation to biological agents or surgery (HR 6.3, 95%CI 1.9-20.7; P=0.002). Conclusion This retrospective single-center study provides the first preliminary evidence that patients with UC and pseudopolyps may represent a subpopulation with a higher inflammatory burden and a greater need for treatment escalation, including to biological agents or surgery. Large, prospective multicenter studies are certainly warranted to confirm these findings.
Collapse
Affiliation(s)
- Dimitrios S Politis
- Department of Gastroenterology, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Dimitrios S. Politis, Konstantinos H. Katsanos, Epameinondas V. Tsianos, Dimitrios K. Christodoulou)
| | - Konstantinos Papamichael
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (Konstantinos Papamichael)
| | - Konstantinos H Katsanos
- Department of Gastroenterology, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Dimitrios S. Politis, Konstantinos H. Katsanos, Epameinondas V. Tsianos, Dimitrios K. Christodoulou)
| | - Ioannis Koulouridis
- Center for Clinical Evidence Synthesis, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA (Ioannis Koulouridis)
| | | | - Epameinondas V Tsianos
- Department of Gastroenterology, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Dimitrios S. Politis, Konstantinos H. Katsanos, Epameinondas V. Tsianos, Dimitrios K. Christodoulou)
| | - Dimitrios K Christodoulou
- Department of Gastroenterology, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Dimitrios S. Politis, Konstantinos H. Katsanos, Epameinondas V. Tsianos, Dimitrios K. Christodoulou)
| |
Collapse
|
8
|
Obstructive Giant Inflammatory Polyposis: Is It Related to the Severity or the Duration of the Inflammatory Bowel Disease? Two Case Reports. Case Rep Gastrointest Med 2018; 2018:3251549. [PMID: 29984012 PMCID: PMC6015717 DOI: 10.1155/2018/3251549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/17/2018] [Indexed: 02/07/2023] Open
Abstract
We report two cases of giant inflammatory polyposis (GIP) with totally different presentation and evolution. The first patient had two giant pseudopolyps after one year of the diagnosis of UC. The second patient had one obstructive giant pseudopolyp secondary to CD at the level of the transverse colon, being totally asymptomatic years before the presentation. GIP is a rare complication of inflammatory bowel disease (IBD). It consists of numerous filiform polyps that look like a "mass of worms" or a "fungating" mass. Surgical resection is inevitable when GIP presents with obstructive symptoms.
Collapse
|
9
|
Politis DS, Katsanos KH, Tsianos EV, Christodoulou DK. Pseudopolyps in inflammatory bowel diseases: Have we learned enough? World J Gastroenterol 2017; 23:1541-1551. [PMID: 28321155 PMCID: PMC5340806 DOI: 10.3748/wjg.v23.i9.1541] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/20/2017] [Accepted: 02/16/2017] [Indexed: 02/06/2023] Open
Abstract
Pseudopolyps are a well described entity in the literature and even though the exact pathogenesis of their formation is not completely understood, they are considered non-neoplastic lesions originating from the mucosa after repeated periods of inflammation and ulceration associated with excessive healing processes. Their occurrence is less common in Crohn's disease than in ulcerative colitis, and their overall prevalence ranges from 4% to 74%; moreover, they are found more often in colon but have been detected in other parts of the gastrointestinal tract as well. When their size exceeds the arbitrary point of 1.5 cm, they are classified as giant pseudopolyps. Clinical evaluation should differentiate the pseudopolyps from other polypoid lesions, such as the dysplasia-associated mass or lesion, but this situation represents an ongoing clinical challenge. Pseudopolyps can provoke complications such as bleeding or obstruction, and their management includes medical therapy, endoscopy and surgery; however, no consensus exists about the optimal treatment approach. Patients with pseudopolyps are considered at intermediate risk for colorectal cancer and regular endoscopic monitoring is recommended. Through a review of the literature, we provide here a proposed classification of the characteristics of pseudopolyps.
Collapse
|
10
|
Recurrent Obstructive Giant Inflammatory Polyposis of the Colon. ACG Case Rep J 2016; 3:e89. [PMID: 27807551 PMCID: PMC5062662 DOI: 10.14309/crj.2016.62] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/04/2016] [Indexed: 01/06/2023] Open
Abstract
Inflammatory polyps are relatively common in patients with inflammatory bowel disease. The term giant inflammatory polyposis is used to describe inflammatory polyps greater than 1.5 cm in any dimension. Their clinical presentation can be varied, ranging from asymptomatic, with incidental detection on radiological or endoscopic testing, to symptomatic, with rectal bleeding and colonic obstruction. Although giant inflammatory polyposis is a rare finding, it is of clinical importance, since it is easily mistaken for colon cancer, with patients sometimes undergoing radical surgeries. We describe an unusual case of giant inflammatory polyposis causing recurrent symptomatic obstruction despite multiple segmental colectomies in a patient with indeterminate colitis. This is the first such reported case in English literature to the best of our knowledge.
Collapse
|
11
|
Jiang JW, Wang GY, Zhu YP, Chen RB, Zhang ZQ, Zhang YJ. Diffuse filiform polyposis of the small intestine without inflammatory bowel disease. World J Surg Oncol 2014; 12:396. [PMID: 25540051 PMCID: PMC4364679 DOI: 10.1186/1477-7819-12-396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 12/03/2014] [Indexed: 11/10/2022] Open
Abstract
Filiform polyposis is a rare disease, which typically occurs in patients with inflammatory bowel disease. We report a case of filiform polyposis occurring in a 56-year-old man with no history or evidence of inflammatory bowel disease. The patient’s main symptoms were melena and anemia. We performed an emergency exploratory laparotomy, in which we observed worm-like polyps spread almost along the entire small intestine, and a partial resection of the small intestine to treat bleeding in the bowel was carried out. Two days later, the patient was noted to have melena again, and we performed an abdominal angiographic embolization, successfully stopping the bleeding. Histologic evaluation of the excised specimen revealed chronic inflammatory cells within the lamina propria without hyperplastic or adenomatous epithelial changes. Although the surgery was very successful, careful management of the patient was required, owing to the great risk of re-bleeding.
Collapse
Affiliation(s)
| | | | | | | | | | - Yu-Jie Zhang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, East Qingchun Road, Hangzhou 310016, Zhejiang Province, China.
| |
Collapse
|
12
|
Naymagon S, Mikulasovich M, Gui X, Ullman TA, Harpaz N. Crohn's-like clinical and pathological manifestations of giant inflammatory polyposis in IBD: a potential diagnostic pitfall. J Crohns Colitis 2014; 8:635-40. [PMID: 24368253 DOI: 10.1016/j.crohns.2013.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/25/2013] [Accepted: 11/26/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Giant inflammatory polyposis (GIP), characterized by mass-like agglomerations of inflammatory polyps, is a rare complication of inflammatory bowel disease (IBD). We reviewed a series of cases of GIP to determine its diagnostic impact on the clinical and pathologic distinction between ulcerative colitis (UC) and colonic Crohn's disease (CD). METHODS All colons with GIP resected over a 13-year period were identified prospectively and the corresponding clinical and pathologic records were reviewed. RESULTS Twelve cases of GIP were identified, accounting for 0.8% of colectomies for IBD during the same time interval. Preoperatively, 6 (50%) patients were diagnosed with UC, 2 (17%) with CD and 4 (33%) with indeterminate colitis (IC). Postoperatively, 6 of the diagnoses (50%) were revised based on strict histopathologic criteria: all 4 diagnoses of IC to UC, one diagnosis of CD to UC, and one diagnosis of UC to CD, for a total of 10 diagnoses of UC (83%) and two of CD (17%). Significantly, 7 of 10 cases with postoperative diagnoses of UC (70%) had Crohn's-like transmural inflammation exclusively within the polyposis segments attributed to fecal entrapment and stasis and accounting for the Crohn's-like clinical complications in these cases. CONCLUSIONS This case series of GIP, the largest reported from a single center, highlights the high rate of Crohn's-like clinical and pathological manifestations of GIP and their potential to confound the accurate classification of patients with IBD. A diagnosis of UC should not be amended to CD based on the findings of the polyposis segment alone.
Collapse
Affiliation(s)
- Steven Naymagon
- Department of Medicine and The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, United States.
| | - Michael Mikulasovich
- Department of Pathology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, United States
| | - Xianyong Gui
- Department of Pathology and Laboratory Service, University of Calgary, Calgary, AB, Canada
| | - Thomas A Ullman
- Department of Medicine and The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, United States
| | - Noam Harpaz
- Department of Medicine and The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, United States; Department of Pathology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, United States
| |
Collapse
|
13
|
Boulagnon C, Jazeron JF, Diaz-Cives A, Ehrhard F, Bouché O, Diebold MD. Filiform polyposis: A benign entity? Case report and literature review. Pathol Res Pract 2014; 210:189-93. [PMID: 24315830 DOI: 10.1016/j.prp.2013.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 08/23/2013] [Accepted: 11/06/2013] [Indexed: 12/29/2022]
Abstract
Filiform polyposis (FP) is a distinctive and unusual form of benign non syndromic polyposis that is occasionally encountered in the colon of patients with inflammatory bowel disease (IBD) history. FP is characterized by one to hundreds, slender, arborizing, vermiform projections in the colon lined by normal or inflammatory colonic mucosa. Only rare cases without history or evidence of IBD have been reported. In those cases, the sigmoid colon was the most common location and none of them showed dysplasia or malignancy neither at first evaluation nor during follow-up. In this report, we present the first case of FP associated with six adenomas developed on filiform polyps and invasive adenocarcinoma in the right colon of a 54 year-old man without a past medical history of IBD.
Collapse
Affiliation(s)
| | | | - Ana Diaz-Cives
- Digestive Surgery Department, Academic Hospital, Reims, France
| | - Florent Ehrhard
- Gastroenterology Department, Robert Debré Academic Hospital, Reims, France
| | - Olivier Bouché
- Gastroenterology Department, Robert Debré Academic Hospital, Reims, France
| | | |
Collapse
|
14
|
Marques I, Lagos A, Reis J, Medeiros F, Pinto A, Neves B. Giant pseudopolyposis in ulcerative colitis: Case report and review of literature. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.jpg.2012.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Choi YS, Suh JP, Lee IT, Kim JK, Lee SH, Cho KR, Park HJ, Kim DS, Lee DH. Regression of giant pseudopolyps in inflammatory bowel disease. J Crohns Colitis 2012; 6:240-3. [PMID: 22325179 DOI: 10.1016/j.crohns.2011.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 08/03/2011] [Accepted: 08/11/2011] [Indexed: 12/13/2022]
Abstract
Inflammatory pseudopolyps are formed in the regenerative and healing phases of ulcerated epithelium. Giant pseudopolyposis of the colon (pseudopolyp larger than 1.5 cm in size) is a very rare complication of inflammatory bowel disease and it may lead to colonic intussusception or luminal obstruction, but the more important clinical significance is that it can be endoscopically confused with a malignancy, although it is generally regarded as having no malignant potential. It has been reported that giant pseudopolyposis of the colon rarely regresses with medical management alone and this sometimes require surgical or endoscopic resection. This report illustrates 2 unusual cases of giant pseudopolyps associated with Crohn's disease and ulcerative colitis, and these giant pseudopolyps were initially confused with villous adenoma or adenocarcinoma, but they showed regression after adequate medical therapy.
Collapse
Affiliation(s)
- Yong Sung Choi
- Department of Gastroenterology, Daehang Hospital, Seoul, South Korea.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Rectal localized giant inflammatory polyposis with indeterminate colitis. Clin J Gastroenterol 2011; 4:95-8. [DOI: 10.1007/s12328-011-0213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
|
17
|
Occult dysplasia in a localized giant pseudopolyp in Crohn's colitis: a case report. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:477-8. [PMID: 19623327 DOI: 10.1155/2009/814894] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Localized giant pseudopolyposis of the colon (pseudopolyp larger than 1.5 cm in size) is a rare complication of inflammatory bowel disease. There is one report of an occult carcinoma within such a lesion, and no reports of sole dysplasia. A case of a 42-year-old man with longstanding Crohn's colitis who underwent a colonoscopy revealing a large, multilobulated mass at the splenic flexure that was not amenable to endoscopic removal, is described. Multiple biopsies showed no dysplasia and histology was consistent with an inflammatory pseudopolyp. Computed tomographic colonography demonstrated a mass resembling a large villous tumour. A decision for surgery was made. The surgical specimen was a complex anastomosing inflammatory pseudopolyp 5 cm x 4 cm x 3 cm in size, with a focus of low-grade dysplasia in an area free of inflammation. The present case is the first reported occult dysplasia in a giant pseudopolyp. Occult dysplasia without superficial dysplasia may exist in these lesions and further studies are needed to examine risk factors that make a giant pseudopolyp more likely to harbour dysplasia and/or carcinoma.
Collapse
|
18
|
Biondi A, Persiani R, Paliani G, Mattana C, Vecchio FM, D'Ugo D. Giant inflammatory polyposis as the first manifestation of inflammatory bowel disease. Am J Gastroenterol 2009; 104:2359-60. [PMID: 19727099 DOI: 10.1038/ajg.2009.245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
19
|
Abstract
We present a case of a 19-year-old female who developed subacute obstruction due to giant inflammatory polyps, having undergone treatment for left-sided ulcerative colitis. This is followed by a review of the literature.
Collapse
|
20
|
Maggs JRL, Browning LC, Warren BF, Travis SPL. Obstructing giant post-inflammatory polyposis in ulcerative colitis: Case report and review of the literature. J Crohns Colitis 2008; 2:170-80. [PMID: 21172208 DOI: 10.1016/j.crohns.2007.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Accepted: 10/17/2007] [Indexed: 12/24/2022]
Abstract
BACKGROUND Post-inflammatory polyps >15 mm in diameter or length are termed "giant". This benign and rare sequel of ulcerative colitis or colonic Crohn's disease can mimic colorectal carcinoma. OBJECTIVE To illustrate this rare complication of inflammatory bowel disease and outline the characteristic radiological, endoscopic and histopathological features, by reviewing all previously published cases of giant post-inflammatory polyps in the English literature. RESULTS Reports of 81 giant post-inflammatory polyps in 78 patients were identified by systematic review of the literature. The incidence of giant post-inflammatory polyps is related to the extent of ulcerative colitis (incidence: 0%, 30%, and 70%, in proctitis, left-sided, and extensive disease, respectively). These lesions are typically located in the transverse or descending colon. Giant post-inflammatory polyps are as common in Crohn's disease (n=36) as in ulcerative colitis (n=42, 54%). Clinical presentations varies, including pain (n=29), rectal bleeding (n=20), diarrhoea (n=19), luminal obstruction (n=15), or a palpable mass (n=11). Symptomatic presentation results in surgical resection. Clinical details and outcomes are comprehensively tabulated. CONCLUSION Recognition of this rare entity will prevent unnecessary radical surgical resection for presumed carcinoma. It highlights the need for clinical, radiological, endoscopic and histopathological correlation.
Collapse
Affiliation(s)
- James R L Maggs
- Department of Gastroenterology, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | | | | | | |
Collapse
|
21
|
Fumimoto Y, Tamagawa K, Ito T, Sawa Y, Nishida T. Localized giant inflammatory polyposis of the ileocecum associated with Crohn's disease: report of a case. Case Rep Gastroenterol 2008; 2:128-33. [PMID: 21490852 PMCID: PMC3075180 DOI: 10.1159/000122588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Although inflammatory polyposis is one of the common complications in patients with inflammatory bowel disease, it is rare that each poly grows up to more than 1.5 cm. We describe a case of localized giant inflammatory polyposis of the ileocecum associated with Crohn's disease. A 40-year-old man who had been followed for 28 years because of Crohn's disease was hospitalized for right lower abdominal pain after meals. Barium enema and colonoscopy showed numerous worm-like polyps in the ascending colon which grew up to the hepatic flexure of the colon from the ileocecum, causing an obstruction of the ileocecal orifice. Since histology of a biopsy specimen taken from the giant polyps showed no dysplasia, he was diagnosed with ileus due to the localized giant inflammatory polyposis. A laparoscopically assisted ileocecal resection was performed. The resected specimen showed that the giant polyps grew up into the ileocecum. Histological examination revealed inflammatory polyposis without neoplasm. Generally, conservative treatment is indicated for localized giant inflammatory polyposis because this lesion is regarded as benign. However, occasionally serious complications arise, requiring surgical treatment.
Collapse
Affiliation(s)
- Yuichi Fumimoto
- Department of Surgery (E1), Osaka University Graduate School of Medicine, Suita, Japan
| | | | | | | | | |
Collapse
|
22
|
Macaigne G, Boivin JF, Cheaib S, Auriault ML, Deplus R. [Single filiform polyp revealed by severe haemorrhage in a patient with normal colon. Report of a case and review of the literature]. ACTA ACUST UNITED AC 2006; 30:913-5. [PMID: 16885880 DOI: 10.1016/s0399-8320(06)73343-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Filiform polyposis or giant inflammatory polyp is an uncommon benign lesion that has principally been reported in patients with evidence of inflammatory bowel disease, Crohn's disease or ulcerative colitis. It appears to be a sequella of diffuse mucosal inflammation. More rarely, PF found in association with colonic non specific inflammation. PF has rarely been reported in patients without previous colonic disease. We report the case of a 60-year-old woman without history of colonic disease who presented a PF revealed by hematochesia.
Collapse
Affiliation(s)
- Gilles Macaigne
- Service d'Hépato-Gastroentérologie, Hôpital de Lagny-Marne-la-Vallée.
| | | | | | | | | |
Collapse
|
23
|
Sheikholeslami MR, Schaefer RF, Mukunyadzi P. Diffuse giant inflammatory polyposis: a challenging clinicopathologic diagnosis. Arch Pathol Lab Med 2005; 128:1286-8. [PMID: 15504066 DOI: 10.5858/2004-128-1286-dgipac] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Giant inflammatory polyposis of the colon is an uncommon manifestation of inflammatory bowel disease. We report a unique case of localized diffuse giant inflammatory polyposis in a 58-year-old white man, which was characterized by recurrence following initial surgical resection. The patient presented with symptoms of abdominal pain and passing blood per rectum. Colonoscopic examination revealed a near-obstructing, "fungating" mass in the sigmoid colon, which clinically was thought to represent colon carcinoma. Histology of several colon biopsies revealed marked acute inflammation with microabscess formation of the polyps and the adjacent mucosa. There was no evidence of dysplasia or malignancy. Because malignancy was strongly suspected and to relieve the obstructive symptoms, the patient underwent a segmental colectomy. The histologic features of the resected mass showed giant polyps with acute inflammation diagnostic of giant inflammatory polyposis. Again, there was no evidence of malignancy. Seven months later, following an uneventful initial postoperative recovery, the patient developed a recurrence of the mass with obstructive symptoms and required further surgical resection. The gross and histologic features of the lesion were similar to the previous findings. This case highlights the varied presenting symptoms and deceptive gross colonoscopic and radiologic features of localized diffuse giant inflammatory polyposis. Finally, the presence of inflammation at the resection margins appears to predict recurrence or persistence of the disease.
Collapse
Affiliation(s)
- Mohammad-Reza Sheikholeslami
- Department of Pathology, University of Arkansas for Medical Sciences and Central Veterans Healthcare System, Little Rock 72204, USA
| | | | | |
Collapse
|
24
|
Kosugi I, Tada T, Tsutsui Y, Sato Y, Mitsui T, Itazu I. Giant inflammatory polyposis of the descending colon associated with a Crohn's disease-like colitis. Pathol Int 2002; 52:318-21. [PMID: 12031089 DOI: 10.1046/j.1440-1827.2002.01348.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A case of giant inflammatory polyposis associated with a localized inflammatory bowel disease of the descending colon in a 49-year-old man is presented. Lower abdominal distension rapidly appeared without any previous history of gastrointestinal disease. Two months later, he underwent a left hemicolectomy. Postoperative recovery was complete and he remains in good health more than 2 years later. The resected colon showed a giant and bizarre polyposis measuring up to 12 cm in length and 2 cm in height and covering the entire circumference of the colon. The polyposis consisted of narrow worm- or noodle-like polyps that bridged over the irregularly shaped ulcers, which sometimes extended into muscularis propria. Although longitudinal ulcers or scars, stricture, and a cobble-stone appearance were not observed, transmural inflammation and deep fissures were found in the interpolypoid area. From these findings, this case seems to be more similar to Crohn's disease than other inflammatory bowel diseases.
Collapse
Affiliation(s)
- Isao Kosugi
- Department of Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | | | | | | | | | | |
Collapse
|