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Lu Y, Huang L, Lou X, Chen C, Sun J. Clinical, endoscopic, pathological characteristics and management of cap polyposis: experience from a Tertiary Hospital in China. Front Pharmacol 2024; 15:1391367. [PMID: 38783946 PMCID: PMC11111883 DOI: 10.3389/fphar.2024.1391367] [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] [Received: 02/25/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Background and aims Cap polyposis (CP) is a rare kind of benign disease, and the majority of previously published relevant articles involve a small number of patients. Hence, we summarized our experience to contribute additional data, hoping to raise awareness of this disease. Methods From 1 January 2017 to 1 November 2021, consecutive patients diagnosed with CP were retrospectively reviewed. Their medical histories, and laboratory, imaging, endoscopic, and pathology results were analyzed. We made telephone calls to the patients and searched for the information in our electronic medical records to obtain the follow-up results. Results Forty-one patients were chosen for analysis. The median age of the patients was 20 years old, and 90.24% (37 patients) of the patients were male. The majority of the patients presented with hematochezia. The rectum was the most commonly affected site, and the Helicobacter pylori infection rate was high. There were multiple and combined treatments for these patients. These treatments can be divided into 3 main categories: medical therapy, endotherapy and surgery. Medical therapy helped to diminish the size of but the polyps were difficult to resolve; however, the patients' symptoms could be diminished. Twenty-three patients underwent surgical resection, and 12 patients received endotherapy. We further compared the two methods of polyp resection. Both endotherapy and surgery were safe, and the recurrence risk was not significantly different between the two kinds of therapy (p = 0.321). Conclusion The clinical improvement of medical treatments was not satisfactory, and endotherapy or surgical resection could remove the polyposis and provide temporary relief, but the recurrence rates were high.
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Affiliation(s)
- Yi Lu
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lingyu Huang
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoying Lou
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chunyu Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiachen Sun
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Arredondo Montero J, Carracedo Vega E, Razquin Lizarraga S, Bronte Anaut M, Hernández-Martín S, de Lima Piña G, Guarch Troyas R. Pediatric Rectosigmoid Atypical Juvenile Polyps Presenting With Rectal Prolapse and Acute Bleeding: A Case Report and a Comprehensive Literature Review. Pediatr Dev Pathol 2024:10935266241235383. [PMID: 38468551 DOI: 10.1177/10935266241235383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Rectosigmoid solitary juvenile polyps are benign lesions, relatively frequent in childhood. The clinical debut of a pediatric polyp with bleeding is relatively frequent, but there are very few reports of rectal prolapse of polyps. We present the case of a 7-year-old female patient with no previous history who presented with rectal prolapse of a polyp with acute bleeding. An urgent endoscopic examination was performed and 2 rectosigmoid polypoid lesions were found and resected. The anatomopathological study showed that these were 2 hamartomatous polyps with mild dysplasia. The patient is asymptomatic and is being followed up. The literature concerning rectal prolapse of polyps in the pediatric population is scarce. In a pediatric patient with a rectal prolapse, this entity should be considered in the differential diagnosis.
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Affiliation(s)
- Javier Arredondo Montero
- Pediatric Surgery Department, Complejo Asistencial Universitario de León, León, Castilla y León, Spain
| | - Elena Carracedo Vega
- Pathology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | | | - Mónica Bronte Anaut
- Pathology Department, Hospital General Río Carrión, Palencia, Navarra, Spain
| | - Sara Hernández-Martín
- Pediatric Surgery Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Gina de Lima Piña
- Pathology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Rosa Guarch Troyas
- Pathology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
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Cap Polyposis: An Elusive Diagnosis in a Pediatric Patient Successfully Managed With Endoscopic Treatment. ACG Case Rep J 2022; 9:e00918. [PMID: 36699631 PMCID: PMC9742084 DOI: 10.14309/crj.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/31/2022] [Indexed: 01/27/2023] Open
Abstract
Cap polyposis is a rare condition of the rectum or sigmoid colon manifested by inflammatory polyps covered by a thick layer of fibrinopurulent mucus. This condition typically presents as mucoid diarrhea and rectal bleeding, and patients are often prescribed antibiotics (such as those for Helicobacter pylori), steroids, infliximab, or aminosalicylates. Surgical management is an option for unresponsive disease, but endoscopic management has been rarely reported. For cases of cap polyposis in which conservative medical management fails, wide-field endoscopic mucosal resection is a viable option.
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Živković G, Trivić I, Mišak Z, Mesić M, Tomas D, Hojsak I. Cap Polyposis: Can the Problem of Recurrent Rectal Bleeding Be Solved? Clin Pediatr (Phila) 2022; 61:578-581. [PMID: 35524347 DOI: 10.1177/00099228221094371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Ivana Trivić
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
| | - Zrinjka Mišak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marko Mesić
- Department of Pediatric Surgery, Children's Hospital Zagreb, Zagreb, Croatia
| | - Davor Tomas
- School of Medicine, University of Zagreb, Zagreb, Croatia.,"Ljudevit Jurak" Department of Pathology, Clinical Hospital Center "Sestre Milosrdnice," University of Zagreb, Zagreb, Croatia
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia.,School of Medicine, University J.J. Strossmayer, Osijek, Croatia
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Aggarwal A, Lang A, Krigman HR, Dehner LP. Vascular Malformation and CAP Polyposis: A New Insight into Pathophysiology or Fortuitous Association? Fetal Pediatr Pathol 2022; 41:670-676. [PMID: 33872119 DOI: 10.1080/15513815.2021.1913537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION CAP polyposis is a benign colorectal process presenting with multiple colorectal polyps with a "CAP" of inflammatory granulation tissue whose etiology has remained largely unknown. CASE A 24-year-old male presented with a long-standing history of repeated multiple sessile colonic polyps over a period of 17 years. RESULTS The numerous polyps showed consistent histologic features of superficial erosion with a surface "CAP" of granulation tissue with minimal submucosa to evaluate over this period. A left hemicolectomy disclosed an extensive vascular malformation. CONCLUSION The underlying vascular malformation may have an etiologic correlation to the overlying CAP polyps in this patient. Future cases may benefit from an evaluation of the underlying submucosa for the presence of possible vascular malformation likely to be missed on superficial polypectomy.
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Affiliation(s)
- Ashna Aggarwal
- Department of Pathology and Immunology, Barnes-Jewish Hospital/St. Louis Children's Hospital, Washington University in St. Louis, School of Medicine, St. Louis, MO, USA
| | - Adam Lang
- Department of Pathology, Blessing Health System, Quincy, IL, USA
| | - Hannah R Krigman
- Department of Pathology and Immunology, Barnes-Jewish Hospital/St. Louis Children's Hospital, Washington University in St. Louis, School of Medicine, St. Louis, MO, USA
| | - Louis P Dehner
- Department of Pathology and Immunology, Barnes-Jewish Hospital/St. Louis Children's Hospital, Washington University in St. Louis, School of Medicine, St. Louis, MO, USA
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Emami A, Shokri Shirvani J, Hosseini A, Hamidi SH. Solitary rectal ulcer transformation to cap polyposis in a 15-year-old child. BMC Gastroenterol 2022; 22:104. [PMID: 35255826 PMCID: PMC8900421 DOI: 10.1186/s12876-022-02122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cap polyposis (CP) is a benign, non-malignant inflammatory disease that affects the rectum. It usually occurs during the 5th decade of life, but children could also be affected. Its specific pathology is unknown. Due to the clinical, endoscopic, and histologic similarities with other disorders such as inflammatory bowel disease, a thorough histologic evaluation is critical to avoid unnecessary interventions. This study presents a 15-year-old child with a previously reported case of solitary rectal ulcer (SRU) that developed into CP determined by colonoscopy and histologic findings. CASE PRESENTATION A 15-year-old boy who was previously diagnosed with SRU presented to our office with rectal bleeding, mucoid discharge, and abdominal pain. Additional colonoscopy evaluation revealed multiple polyposes varying in size and shape limited to the rectum. Histologic examination revealed a characteristic cap of granulation tissue covering tortuous nondysplastic crypts in the inflamed stroma, indicating that SRU had transformed into CP. Based on the assessments, we planned to perform endoscopic mucosal resection of the lesions in multiple sessions. CONCLUSIONS Despite the rarity of CP, the transformation from SRU may be one of its etiologies. Thus, thorough serial histologic evaluation is critical in children with rectal bleeding to avoid unnecessary or harmful interventions.
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Affiliation(s)
- Abdolreza Emami
- Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Javad Shokri Shirvani
- Department of Internal Medicine, School of Medicine, Babol University of Medical Sciences, GanjAfrooz Street, 47176-47745, Babol, Mazandaran, Islamic Republic of Iran.
| | - Akramasadat Hosseini
- Department of Pathology, School of Medicine, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Seyed Hossein Hamidi
- Department of Anesthesiology, School of Medicine, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
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Cap polyposis of the colon: A report of 2 cases with unique clinical presentations but similar histopathologic findings. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Brunner M, Agaimy A, Atreya R, Grützmann R, Matzel KE. Cap polyposis in children: case report and literature review. Int J Colorectal Dis 2019; 34:363-368. [PMID: 30426196 DOI: 10.1007/s00384-018-3192-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Cap polyposis is a benign disease of the colon, characterized by inflammatory polyps with a "cap" of inflammatory granulation tissue. Its prevalence is very low, especially in children. METHODS AND RESULTS A 16-year-old girl presented with frequent bowel movements with mucous discharge and bloody stool, leading to the initial suspicion of chronic inflammatory bowel disease. Results of further investigation by endoscopy and histological examination were consistent with a diagnosis of cap polyposis. Treatment with systemic steroids resulted in symptom improvement. CONCLUSION A review of the literature shows that cap polyposis can occur at any age, including childhood, with a slight predilection for the male gender. Rectal bleeding and rectal polyps are consistent features in all reported cases. Other typical symptoms include constipation, diarrhea, and abdominal pain. Symptoms may be very similar to those of chronic inflammatory bowel disease, the most important differential diagnosis. The cause of cap polyposis is still unclear, and specific therapy has not as yet been established. Conservative therapeutic measures should be preferred, especially in children.
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Affiliation(s)
- Maximilian Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Abbas Agaimy
- Department of Pathology, Friedrich-Alexander University Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Raja Atreya
- Department of Medicine 1, Friedrich-Alexander University Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Robert Grützmann
- Department of General and Visceral Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Klaus E Matzel
- Department of General and Visceral Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
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