S2223 Rare Colonic Vascular Ectasia Disguised as a Polyp

Abstract

Introduction: Vascular ectasia in the gastrointestinal (GI) tract is commonly seen as dilated and congested submucosal blood vessels, which appear as characteristic red flat lesions on endoscopy. In the colon, they can be found incidentally and are estimated to be responsible for 2-30% of lower GI bleeds. Polypoid appearing vascular ectasia lesions are exceedingly rare. We report an asymptomatic case of colonic polypoidal vascular ectasia. Case Description/Methods: A 62-year-old asymptomatic man with a history of diabetes mellitus II and hypertension and no family history of GI malignancy presented for his index screening colonoscopy. A 7cm pedunculated polyp was seen in the sigmoid colon (Figure 1a), with mucosa appearing identical to the surrounding mucosa. It was removed with hot snare polypectomy, and the polypectomy site was clipped with two hemoclips. The rest of the colonoscopy was unremarkable. Pathology demonstrated colonic mucosa with mild hyperplastic changes and submucosal vascular ectasia, as evidenced by markedly dilated and congested submucosal vessel that extended the length of the entire polyp with clusters of smaller congested capillaries spreading into the overlying mucosa, as shown in the 20x (Figure 1b) and corresponding high power 400x (Figure 1c) histopathological images. Pathology was negative for dysplasia. Discussion: Polypoid appearing colonic vascular ectasia lesions are infrequent, and literature review shows only 15 lesions matching the description in our case. In addition, these lesions are typically located in the cecum or ascending colon, accounting for 54-81.9% of colonic vascular ectasia. Classically, angiodysplasia of the colon is associated with aortic stenosis, chronic renal failure, and in patients with Von Willebrand disease. In our patient, the patient was asymptomatic, and the lesion was incidentally identified during a screening colonoscopy. The lesion was a large pedunculated polyp located in the sigmoid colon, unlike most colonic vascular ectasias that appear in the right/proximal colon. Since the lesion is benign and not an adenoma of the colon, the colon cancer surveillance interval was determined to be 10 years. This report is pertinent for endoscopists who may encounter abnormal polypoid masses on colonoscopy. Keeping vascular ectasia on the differential diagnosis will aid in both intra-procedure decision-making and post-procedure follow-up.Figure 1.: A. CT Chest with Pneumomediastinum B. Upper Endoscopy With Erythematous Posterior Oropharynx and an Extrinsic, Longitudinal Bulge in the Proximal Esophagus C. Intraoperative Photograph During Thoracotomy.