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alkhuzaie A, jameel W, sultan N, aldosari M. Filiform polyposis presenting with rapid growth and severe anemia case report. Int J Surg Case Rep 2022; 100:107771. [DOI: 10.1016/j.ijscr.2022.107771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/29/2022] [Accepted: 10/29/2022] [Indexed: 11/05/2022] Open
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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.
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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
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Slack JC, Redston M, Goldsmith JD, Bousvaros B, Levy Zitomersky N. Giant Filiform Polyposis of the Colon in a 6-Year Old Male With Ulcerative Colitis. J Pediatr Gastroenterol Nutr 2022; 75:e30. [PMID: 35641897 DOI: 10.1097/mpg.0000000000003471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Jonathan C Slack
- Department of Pathology Boston Children's Hospital/Harvard Medical School, Boston, MA
| | - Mark Redston
- Department of Pathology Boston Children's Hospital/Harvard Medical School, Boston, MA
| | - Jeffrey D Goldsmith
- Department of Pathology Boston Children's Hospital/Harvard Medical School, Boston, MA
| | - Bousvaros Bousvaros
- the Department of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital/Harvard Medical School, Boston, MA
| | - Naamah Levy Zitomersky
- the Department of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital/Harvard Medical School, Boston, MA
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Shi JL, Lv YH, Huang J, Huang X, Liu Y. Patients with inflammatory bowel disease and post-inflammatory polyps have an increased risk of colorectal neoplasia: A meta-analysis. World J Clin Cases 2022; 10:966-984. [PMID: 35127910 PMCID: PMC8790459 DOI: 10.12998/wjcc.v10.i3.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/05/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Longstanding intestinal inflammation increases the risk of colorectal neoplasia in patients with inflammatory bowel disease (IBD). Accurately predicting the risk of colorectal neoplasia in the early stage is still challenging. Therefore, identifying visible warning markers of colorectal neoplasia in IBD patients is the focus of the current research. Post-inflammatory polyps (PIPs) are visible markers of severe inflammation under endoscopy. To date, there is controversy regarding the necessity of strengthened surveillance strategies for IBD patients with PIPs.
AIM To determine whether IBD patients with PIPs carryan increased risk of colorectal neoplasia.
METHODS Researchers searched the following databases up to July 31, 2021: MEDLINE (PubMed), MEDLINE (Ovid), EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wan-Fang Data, China Science and Technology Journal Database and Chinese BioMedical Literature Database. Cohort and case-control studies that compared the risk of colorectal neoplasia between IBD patients with or without PIPs and published in English or Chinese were included. Methodological quality was assessed using the Risk of Bias in Nonrandomized Studies-of Interventions assessment tool. The outcomes of interest were the rates of various grades of colorectal neoplasia. The pooled risk ratio (RR) and 95% confidence interval (95%CI) were calculated using the random-effects model. Begg’s test and Egger’s test were used to calculate the publication bias. Sensitivity and subgroup analyses were performed to verify the robustness of the results. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess the overall quality of evidence supporting the outcomes of interest.
RESULTS Nine studies involving 5424 IBD patients (1944 with PIPs vs 3480 without PIPs) were included. The overall bias in each included study ranged from moderate to serious. Compared with nonconcurrent PIPs, patients with PIPs had a higher risk of colorectal neoplasia (RR = 1.74, 95%CI: 1.35-2.24, P < 0.001, I2 = 81.4%; aHR = 1.31, 95%CI: 1.01-1.70, P = 0.04, I2 = 26.2%; aOR = 2.62, 95%CI: 1.77-3.88, P < 0.001, I2 = 0%), advanced colorectal neoplasia (RR = 2.07, 95%CI: 1.49-2.87, P < 0.001, I2 = 77.4%; aHR = 1.63, 95%CI: 1.05-2.53, P = 0.03, I2 = 10.1%) and colorectal cancer (RR = 1.93, 95%CI: 1.32-2.82, P = 0.001, I2 = 83.0%). Publication bias was not observed in Begg’s test or Egger’s test. Sensitivity and subgroup analyses showed that the results are robust. The overall quality of evidence was assessed as moderate to low.
CONCLUSION IBD patients with PIPs may have an increased incidence of colorectal neoplasia.
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Affiliation(s)
- Jia-ling Shi
- Department of Geriatrics and Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Ye-hong Lv
- Department of Geriatrics and Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Jun Huang
- Department of Geriatrics and Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Xue Huang
- Department of Geriatrics and Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Ying Liu
- Department of Geriatrics and Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
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Goyal S, Sakhuja P, Gupta K, Saluja S. Red carpet of filiform polyposis! Postgrad Med J 2021; 98:309. [PMID: 33563710 DOI: 10.1136/postgradmedj-2020-139245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Surbhi Goyal
- Pathology, GB Pant Hospital, New Delhi, Delhi, India
| | - Puja Sakhuja
- Pathology, GB Pant Hospital, New Delhi, Delhi, India
| | - Kanishk Gupta
- Pathology, GB Pant Hospital, New Delhi, Delhi, India
| | - Sundeep Saluja
- Gastrointestinal Surgery, GB Pant Hospital, New Delhi, Delhi, India
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Katerji R, Huber AR. Giant Inflammatory Polyps in Diverticular Disease Mimicking a Colonic Mass: A Potential Malignant Masquerader. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923242. [PMID: 32595204 PMCID: PMC7347030 DOI: 10.12659/ajcr.923242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inflammatory pseudopolyps (IPPs) are a common manifestation in inflammatory bowel disease (IBD) with more cases reported with ulcerative colitis than Crohn's disease. IPPs can grow to form large polyps which are called giant inflammatory polyps (GIPs). These polyps may cause an obstruction and form a mass-like lesion and surgical resection may be warranted. CASE REPORT A 65-year-old male without a previous history of IBD presented with abdominal discomfort, poor appetite, constipation, weight loss, and hematochezia. Due to the high suspicion of malignancy, a computed tomography (CT) scan was performed and showed a fixed lesion in the mid sigmoid colon highly concerning for a primary colon carcinoma, with scattered diverticula, and associated with elevated carcinoembryonic antigen (CEA). Colonoscopy was done but the scope could not be passed due to obstruction. Sigmoidectomy was performed which showed a huge noninvasive lesion, which looked like pseudopolypoid serpiginous mass as giant inflammatory polyp, with scattered diverticula. On microscopic examination, pathology showed a villous polyp with numerous inflammatory cells, without any dysplasia or carcinoma. CONCLUSIONS GIPs are rarely reported without a history of IBD. Diagnosis of GIPs can be very challenging, and surgery is sometimes indicated for definitive diagnosis.
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Affiliation(s)
- Roula Katerji
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA
| | - Aaron R Huber
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA
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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.
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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
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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.
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Chang S, Pochapin M, Khan A. Making the Cut: An Isolated Filiform Polyp. Clin Gastroenterol Hepatol 2016; 14:e95. [PMID: 26829027 DOI: 10.1016/j.cgh.2016.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 01/22/2016] [Accepted: 01/24/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Shannon Chang
- Division of Gastroenterology, New York University, New York City, New York
| | - Mark Pochapin
- Division of Gastroenterology, New York University, New York City, New York
| | - Abraham Khan
- Division of Gastroenterology, New York University, New York City, New York
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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.
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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.
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Hokama A, Nagahama M, Kishimoto K, Fujita J. Colonic stricture with filiform polyposis in Crohn's disease. BMJ Case Rep 2014; 2014:bcr-2014-204710. [PMID: 24825561 DOI: 10.1136/bcr-2014-204710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Akira Hokama
- Department of Endoscopy, University of the Ryukyus, Nishihara, Japan
| | - Masayoshi Nagahama
- Department of Digestive and General Surgery, University of the Ryukyus, Nishihara, Japan
| | - Kazuto Kishimoto
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Nishihara, Japan
| | - Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Nishihara, Japan
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