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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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Kasuga S, Anzai H, Makise N, Sonoda H, Nagai Y, Abe S, Yokoyama Y, Ozawa T, Emoto S, Murono K, Sasaki K, Kawai K, Nozawa H, Ushiku T, Ishihara S. Giant filiform polyposis with high-grade dysplasia: A case report and review of the literature. Ann Med Surg (Lond) 2022; 82:104433. [PMID: 36268352 PMCID: PMC9577439 DOI: 10.1016/j.amsu.2022.104433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- So Kasuga
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
- Corresponding author. Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hiroyuki Anzai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Naohiro Makise
- Department of Pathology, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Yuzo Nagai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Shinya Abe
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Yokoyama
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Ozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, The University of Tokyo, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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Affiliation(s)
- Soon Chul Kim
- Department of Pediatrics, Jeonbuk National University Medical School and Hospital, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
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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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Karaskova E, Veghova-Velganova M, Geryk M. Giant post-inflammatory polyposis in a child with ulcerative colitis: A case report. Int J Surg Case Rep 2020; 77:249-251. [PMID: 33189004 PMCID: PMC7672246 DOI: 10.1016/j.ijscr.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 10/26/2022] Open
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Complete Regression of Giant Inflammatory Polyp after Treatment with Adalimumab. Case Rep Gastrointest Med 2019; 2019:5347637. [PMID: 30984431 PMCID: PMC6431470 DOI: 10.1155/2019/5347637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/13/2019] [Indexed: 12/22/2022] Open
Abstract
Giant inflammatory polyps (GIPs) are a rare complication of IBD resulting from chronic regenerative and healing processes leading to a polypoid formation on inflamed mucosa. We reported a case of GIP in a patient with long standing left-sided ulcerative colitis (UC); a well circumscribed sessile GIP was found during a colonoscopy for colorectal cancer screening on a normal colonic mucosa in the cecum. After a severe flare of the left-sided colitis and due to partial response to steroids patient was treated with adalimumab; new colonoscopy after 6 months shows complete disappearance of the GIP previously described. It is the first case report of GIP in normal macroscopic mucosa with complete disappearance after biologic treatment.
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Abstract
Background: Filiform polyposis is a rare benign condition referred to as inflammatory polyposis, or pseudopolyposis that is usually found in association with Crohn’s disease, ulcerative colitis or granulomatous colitis which is formed by non-specific mucosal and submucosal reactions to previous severe inflammation. It is characterized by multiple finger-like projections most commonly in the transverse and descending colon. Case Report: A 15-year-old girl with a history of ulcerative colitis was admitted to the pediatric emergency department with abdominal pain attacks for the past 2 weeks. Abdominal ultrasound and magnetic resonance enterography revealed mucosal thickening in the transverse and descending colon. Colonoscopy revealed small filiform polyps throughout the colon. Histopathological examination revealed inflammatory polyps associated with ulcerative colitis. Conclusion: Non-neoplastic filiform polyps can be detected even in children with ulcerative colitis with long-term remissions.
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Affiliation(s)
- Nafiye Urgancı
- Clinic of Pediatric Gastroenterology, İstanbul Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Derya Kalyoncu
- Clinic of Pediatrics, İstanbul Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey,Clinic of Pediatrics, İstanbul İstinye State Hospital, İstanbul, Turkey
| | - Canan Tanık
- Department of Patology, University of Health Sciences, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
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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.
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Lusilla A, de Tomás J. Leptomeningeal carcinomatosis in a young patient with obstructive colorectal signet- ring cell adenocarcinoma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:535. [PMID: 28530107 DOI: 10.17235/reed.2017.4602/2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present the case report of a twenty-five-year-old Moroccan male patient who suffered from leptomeningeal carcinomatosis related to a signet-ring cell carcinoma of the rectum. He presented to the emergency department with abdominal pain, constipation, weight loss and rectal bleeding. The rectal examination showed a rectal tumor and a CT scan revealed a large bowel obstruction due to rectal diffuse thickening. An emergency transverse colostomy was performed, with a rectal biopsy and a cytological sample collection. The pathology analysis showed a signet-ring cell carcinoma from the rectum. The staging evaluation was completed and neoadjuvant chemotherapy and radiotherapy were offered to the patient. Two months later, he developed neurological signs of leptomeningeal involvement which was confirmed by a lumbar puncture. Then, the patient received systemic and intrathecal chemotherapy but later died. This case shows the tendency of colorectal signet-ring cell carcinomas to cause leptomeningeal metastasis, even in young patients.
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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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