Case Of Polyposis Research Articles

Sudden-Onset Polyposis in Pediatric Patients With Ulcerative Colitis.

To the Editors: Inflammatory polyps may develop in 10% to 20% patients with inflammatory bowel disease (IBD).1 However, such patients are mostly adults, and polyps rarely develop in children. Filiform polyps are extremely rare in children with ulcerative colitis (UC).2 Herein, we present a case of sudden-onset filiform polyposis during UC treatment in an 11-year-old girl. Low-grade dysplasia was histopathologically confirmed in another single polyp; therefore, this case underlines the importance of evaluating the heterogeneity of inflammatory polyps in pediatric patients with UC and follow-up of such patients. A 9-year-old girl presented with severe anemia and hematochezia. Her blood test findings were as follows: white blood cell count, 12 620/μL (eosinophils, 10.3%); hemoglobin, 6.4 g/dL. Her QuantiFERON-TB test result was negative; furthermore, she tested negative for cytomegalovirus, herpes simplex virus, fluorescent antinuclear antibody, Clostridium difficile, and antineutrophil cytoplasmic antibodies. Her immunoglobulin E level was 260.5 IU/mL (reference range, <158 IU/mL). Moreover, her fecal calprotectin concentration was over 6000 mg/kg. Colonoscopy showed a severe UC flare-up throughout the colon. She was initially treated with corticosteroids, azathioprine, and 5-aminosalicylic acid; however, there was no symptom improvement. After 4 months, infliximab (5 mg/kg) was administered; however, diarrhea and hematochezia persisted. Her fecal calprotectin concentration was 2000 to 5000 mg/kg. Infliximab trough level and anti-infliximab antibody were 0.1 μg/mL and 25.3 ng/mL, respectively. Therefore, infliximab was discontinued, and intermittent steroid treatment was continued with cyclosporine as the main drug. Although there was no acute exacerbation of UC, complete remission could not be achieved. Colonoscopy performed 15 months later yielded findings similar to those obtained in the previous one. After 18 months, polyps that had not been seen before suddenly appeared in the form of filiform polyposis in the transverse colon (Figure 1A). Biopsy findings revealed inflammatory polyposis (Figure 1B). A single polyp (sized approximately 3 cm) was observed in the sigmoid colon (Figure 1C); histopathological examination showed low-grade dysplasia (Figure 1D). The patient underwent diagnostic exome sequencing; APC gene mutation or other IBD- or immune deficiency–related mutations were not detected. Tumor marker levels and positron emission tomography computed tomography findings indicated no evidence of malignancy in other organs.

Colonic ganglioneuromatous polyposis in a 6-year-old girl – A case report and review of literature

Ganglioneuroma of the gastrointestinal tract is a rare mesenchymal tumor of neural origin, especially in childhood. They are categorized into three different morphological subtypes, namely, polypoid ganglioneuroma, ganglioneuromatous polyposis (GP), and diffuse ganglioneuromatosis. Patients with ganglioneuromas have different presentations depending on the location, extent, and size of the lesion. We report here a case of colonic ganglioneuromatous polyposis, presenting as abdominal pain and chronic constipation in a 6‑year‑old girl. Although GP cases are reported in adult age group, cases in pediatric age group are rare. Only a few cases are reported in the literature of GP in the pediatric age group. Although rare, this disorder must be taken into consideration in the differential diagnosis in every patient with symptoms such as abdominal pain, constipation, and lower intestinal bleeding, to avoid a delayed diagnosis.

AXIN2-Associated Adenomatous Colorectal Polyposis

Abstract Introduction Most cases of colorectal cancer (CRC) occur sporadically; however, ∼ 3% to 6% of all CRCs are related to inherited syndromes, such as Lynch syndrome and familial adenomatous polyposis (FAP). The adenomatous polyposis coli (APC) and mutY DNA glycosylase (MUTYH) germline mutations are the main genetic causes related to colorectal polyposis. Nevertheless, in many cases mutations in these genes have not been identified. The aim of the present case report is to describe a rare case of genetic colorectal polyposis associated with the axis inhibition protein 2 (AXIN2) gene. Case Report The first colonoscopy screening of a 61-year-old male patient with no known family history of CRC revealed ∼ 50 colorectal polyps. A histological evaluation of the resected polyps showed low-grade tubular adenomas. Germline genetic testing through a multigene panel for cancer predisposition syndromes revealed a pathogenic variant in the AXIN2 gene. In addition to colorectal polyposis, the patient had mild features of ectodermal dysplasia: hypodontia, scant body hair, and onychodystrophy. Discussion The AXIN2 gene acts as a negative regulator of the Wnt/β -catenin signaling pathway, which participates in development processes and cellular homeostasis. Further studies are needed to support the surveillance recommendations for carriers of the AXIN2 pathogenic variant.

Outcome of 82 cases of nasal polyposis undergoing functional endoscopic sinus surgery

The aim of this paper is to study 82 cases of nasal polyposis undergoing functional endoscopic sinus surgery (FESS). Our study comprised of 82 patients presenting with the symptoms of nasal polyposis (38 male patient, 44 female patients). All managed with FESS. Parameters assessed were NOSE score and nasal endoscopy score pre- operatively which was compared with post- operative score at 6 months and 12 months. We found pre-operative NOSE score was \(65.2\pm 5.7,\) at 6 months was \(28.4\pm 4.1\) and at 12 months post-operatively was \(24.2\pm 3.6.\) We found pre-operative nasal endoscopic score was 6.02, 6 months score was 3.1 and 12 months score was 2.5. We conclude that the patients nasal endoscopy score and NOSE symptom score was improved after treatment. Functional endoscopic sinus surgery is treatment of choice in patients with chronic rhinosinusitis with nasal polyps.

Highlights in the advances of chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a complex upper airway inflammatory disease with a broad spectrum of clinical variants. As our understanding of the disease pathophysiology evolves, so too does our philosophy towards the approach and management of CRS. Endotyping is gaining favour over phenotype-based classifications, owing to its potential in prognosticating disease severity and delivering precision treatment. Endotyping is especially useful in challenging CRS with nasal polyposis cases, for whom novel treatment options such as biologicals are now available. The latest European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS2020) reflects these changes with updated rhinosinusitis classifications and new integrated care pathways. With the coronavirus disease 2019 (COVID-19) pandemic, physicians and rhinologists have to balance the responsibility of managing their patients' upper airway while adequately protecting themselves from droplet and aerosol transmission. This review summarises the key updates from EPOS2020, endotype-based classification and biomarkers. The role of biologicals in CRS and the lessons we can draw from their use in severe asthma will be examined. Finally, the principles of CRS management during COVID-19 will also be discussed.

Bilateral Schneiderian (sinonasal) papilloma: An uncommon rare entity

Sinonasal papilloma is a benign surface mucosal neoplasm with variable growth pattern and cytological features. It is a rare benign tumor with tendency to recur and also malignant transformation. The most common sites of inverting papillomata are lateral nasal wall and middle meatus and are usually unilateral. Rarely Bilateral disease can occur, which may be due to direct extension of the tumour, but can also occur as two distinct lesions. The etiology still remains unclear, eventhough the morphology and clinical behavior of this lesion has been well described. Here we report a case of recurrent bilateral nasal polyposis, histologically diagnosed as Inverted sinonasal papilloma, which is a rare entity.

Polipose gástrica: relato de caso e revisão da literatura

Pólipos gastrointestinais são elevações da mucosa circundante do sistema digestório, encontradas frequentemente em exames endoscópicos de rotina. A grande maioria é achado acidental e alguns pólipos podem indicar doença ou síndrome associada. Este artigo tem como objetivo apresentar um caso de polipose gástrica manifestada como Síndrome de Peütz-Jeghers em uma paciente de 25 anos, do sexo feminino, com história de dor abdominal em região epigástrica há 12 dias da admissão hospitalar, que evoluiu com vômitos e hematêmese 3 dias antes do internamento. A paciente realizou endoscopia digestiva alta (EDA), que evidenciou múltiplas lesões polipoides, regulares e de superfície lisa. Tomografia computadorizada (TC) do abdômen visualizou volumosa lesão vegetante coraliforme, de 16,3 x 10,2 x 5,4cm. Optou-se por realizar uma gastrectomia total com reconstrução em Y-de-Roux. O tempo total da cirurgia foi de 150min e ocorreu sem complicações. Paciente evoluiu com boas condições clínicas, sem intercorrências e recebeu alta hospitalar no 9º dia de pós-operatório (DPO). Estudo histopatológico da peça cirúrgica (estômago) evidenciou múltiplos pólipos gástricos de padrão predominante hamartomatoso, com transformação adenomatosa focal, margens cirúrgicas livres, sugerindo síndrome de Peütz-Jeghers. Nossa paciente não demonstrou hiperpigmentação mucocutânea, corroborando o fato de que a hiperpigmentação não é condição “sine qua non” para a síndrome de Peütz-Jeghers.

Clinical study on the correlation between radiological and intra operative findings in cases of sino nasal polyposis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Sino nasal polyposis is a common condition often encountered by the otolaryngologists. Though plain radiographs are valuable in the pre-operative evaluation, the CT scan plays a major role in identifying the extent of disease and the anatomic variations accurately for the surgeon. This study evaluates the value of pre-operative CT scans by correlating the scan findings with intra-operative surgical findings.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Total 50 adult patients who attended the ENT department from November 2018 to October 2020 with Sino nasal polyposis were selected for the study. All were subjected to CT scan and underwent Functional Endoscopic Sinus Surgery. The intra-operative findings were compared with the CT scan findings. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study, the pre-operative CT scan showed single sinus involvement in 20% and multiple sinus involvement in 80% of cases. Mucosal abnormality was reported in 86% and normal in 14% of cases. Osteomeatal obstruction was reported in 44% and normal in 56% of cases. Various anatomical abnormalities were noted in 100% of cases. There was a perfect positive co relation between CT scan findings and intra operative findings with regards to Osteomeatal occlusion and anatomical or mucosal abnormalities. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The study done to assess the correlation between pre-operative CT scan findings and intra-operative findings of Sino nasal polyposis cases has shown a perfect positive correlation between the findings. Pre-operative CT scan is an invaluable tool for the surgeon for accurate diagnosis and treatment planning. &lt;/p&gt;

Outcome of 82 cases of nasal polyposis undergoing functional endoscopic sinus surgery

Aim: To study 82 cases of nasal polyposis undergoing functional endoscopic sinus surgery (FESS). Methodology: Our study comprised of 82 patients presenting with the symptoms of nasal polyposis (38 male patient, 44 female patients). All managed with FESS. Parameters assessed were NOSE score and nasal endoscopy score pre- operatively which was compared with post- operative score at 6 months and 12 months. Results: We found pre- operative NOSE score was 65.2±5.7, at 6 months was 28.4±4.1 and at 12 months post- operatively was 24.2±3.6. We found pre- operative nasal endoscopic score was 6.02, 6 months score was 3.1 and 12 months score was 2.5. Conclusion: Patients nasal endoscopy score and NOSE symptom score was improved after treatment. Functional endoscopic sinus surgery is treatment of choice in patients with chronic rhinosinusitis with nasal polyps.

A clinicopathological study on fungal infection in nasal polyposis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Nasal polyposis is a multifactorial disease. Despite the presence of numerous theories proposed towards the aetiology of nasal polyp, inflammation is the main causative factor. Fungi can impair the local immune system and bring about an inflammatory response causing polyp formation. The aim and objective of the research was to know the prevalence of fungal infection in nasal polyposis and to assess the microbiological and pathological features of fungi in nasal polyposis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 100 patients operated for nasal polyposis were included in the study excluding immune-compromised patients. All the nasal polyposis cases were subjected to clinical examination, diagnostic nasal endoscopy and medical treatment before undergoing surgical treatment. Polyps removed were subjected to histopathological examination (HPE) and potassium hydroxide (KOH) wet mount examination under microscope. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of the 100 patients studied 66 patients (66%) were in the age group between 31 to 60 years. 85 patients had bilateral polyps, in which fungal element was isolated in 11 patients and among 15 patients with antrochoanal polyp 1 patient had fungal isolates. Of the 17 patients who had previous history of surgery, fungi were isolated in 4 patients and the rest were from patient who got operated for the first time. 3 out of the 8 patients, who had recurrence, were positive for fungal infection.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Fungi are found to be more prevalent in nasal polyps and fungi can be considered as one of the main causative factor for formation of nasal polyposis and its recurrence after surgery. Anti-fungal agents could be a helping hand in the management of nasal polyposis to prevent its recurrence.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Hepatocellular Carcinoma in the Adolescent With Classical Familial Adenomatous Polyposis: Clinical Case

Background. Hepatocellular carcinoma is rare disease in pediatrics, it affects mostly male adolescents aged 10–15 years. There are only 10 described cases of hepatocellular carcinoma and familial adenomatous polyposis combination.Clinical Case Description. Patient G., 16 years, visited the pediatrician with complaints on low fever episodes and abdominal pain. The abdominal ultrasound was performed. Non-homogeneous mass was revealed in the left lobe of the liver. Contrast X-ray computer tomography has revealed large pathological mass in the left lobe of the liver (atypical haemangioma? adenoma?). Adenoma phenotype was established in obtained needle biopsy material. The child has undergone the resection of the left lobe of the liver with plastic reconstruction of the left hepatic vein entry. Histological examination of the surgical specimen has confirmed the presence of hepatocellular carcinoma. Peripheral blood α-fetoprotein levels remained within normal range throughout the follow-up. In past medical history: classical familial adenomatous polyposis in the mother (diagnosis has been established 3 years before the clinical events in the child). The genetic testing of APC gene (Adenomatous Poliposis Coli) was performed after detection of the tumor in the child’s liver. The pathological allele similar to that previously found in the mother has been identified. Conclusion. Timely diagnosis of familial adenomatous polyposis, risk awareness on combined course of polyposis with various malignant tumors, as well as monitoring of health condition of the child are necessary to diagnose hepatocellular carcinoma on its early stages.

Revision endoscopic sinus surgery for bilateral nasal polyposis

Background Nasal polyps have an incidence of 4% in all of the population. Apart from the surgery performed, some patients will present with recurrence. Recurrence ranged from 4 to 60% in? nasal polyps (NP), with a median of 20%, across all studies reviewed over a maximum of 2 years. Objective The aim? was to review cases of recurrent bilateral nasal polyposis in terms of the incidence of local factors contributing to recurrence. Patients and methods This prospective study included 50 adult patients (males and females) experiencing recurrent BNP after previous functional endoscopic sinus surgery. The patients were recruited from the outpatient clinic, Otorhinolaryngology Department, Kobry El-Kobba Military Hospital. The mean age of primary disease was 39 years. There were significant differences between endoscopic and computed tomography (CT) findings according to the presence of different local factors contributing to recurrence of NP, in the form of lateralized middle turbinate, residual infected air cells, scarred frontal recess, middle meatal antrostomy stenosis, retained uncinate process, and retained agar nasi cells. The detection rate of endoscopy was higher than the CT scan. Results The most frequent finding was lateralized middle turbinate (74.0%) followed by residual infected air cells and scarred frontal recess (60.0% for each). Middle meatal antrostomy stenosis was found in 40.0% of cases. Retained agar nasi cells was found in 48.0% of cells, whereas retained uncinate process was found in only 36.0% of cases. Conclusion There were significant differences between endoscopic and CT findings according to the presence of different local factors contributing to recurrence of NP, in the form of lateralized middle turbinate, residual infected air cells, scarred frontal recess, middle meatal antrostomy stenosis, retained uncinate process, and retained agar nasi cells. The detection rate of endoscopy was higher than the CT scan.

Filiform polyposis with sigmoid colon adenocarcinoma: a case report

BackgroundFiliform 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 presentationA 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.ConclusionsThis 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.

Biallelic germline nonsense variant of MLH3 underlies polyposis predisposition

PurposeSome 10% of familial adenomatous polyposis (FAP) and 80% of attenuated polyposis (AFAP) cases remain molecularly unexplained. We scrutinized such cases by exome-wide and targeted methods to search for novel susceptibility genes. MethodsExome sequencing was conducted on 40 unexplained (mainly sporadic) cases with FAP or AFAP from Finland. The DNA mismatch repair (MMR) gene MLH3 (MutL Homolog 3) was pinpointed and prompted a subsequent screen of ~1000 Swedish patients referred to clinical panel sequencing for colon tumor susceptibility. ResultsThree homozygous carriers of a truncating variant in MLH3, c.3563C>G, p.Ser1188Ter, were identified among the index cases from the Finnish series. An additional biallelic carrier of the same variant was present in the Swedish series. All four patients shared a 0.8-Mb core haplotype around MLH3, suggesting a founder variant. Colorectal polyps from variant carriers showed no instability at mono-, di-, tri-, or tetranucleotide repeats, in agreement with previous findings of a minor role of MLH3 in MMR. Multiple loci were affected by loss of heterozygosity, suggesting chromosomal instability. ConclusionOur results show that a biallelic nonsense variant of MLH3 underlies a novel syndrome with susceptibility to classical or attenuated adenomatous polyposis and possibly extracolonic tumors, including breast cancer.

Utility of Mesalazine in Familial Adenomatous Polyposis: Clinical Report of Reduction of Polyp Size in Patients with Ulcerative Colitis, and Safety Examination in Familial Adenomatous Polyposis Patients

Mesalazine is the gold standard drug for treatment of ulcerative colitis (UC). Here, we describe 4 cases of familial adenomatous polyposis (FAP) patients with UC that showed reduction of intestinal polyp diameter by mesalazine treatment. Of note, the effects of mesalazine on the development of intestinal polyps in FAP patients have not been reported, and we further investigated whether the short-term use of high-dose mesalazine (4 g/day) has harmful effects on FAP patients or not. The authors found that the treatment showed slightly adverse events in FAP patients. However, mesalazine tended to reduce the number of colon polyps in male subjects with FAP. This report provides basic information for planning a double-blind, randomized, clinical trial that aims to show mesalazine’s potential to suppress intestinal polyp development in FAP.

Intussusception reveals MUTYH-associated polyposis syndrome and colorectal cancer: a case report

BackgroundWe are reporting a rare case of MUTYH-associated polyposis, a colorectal cancer hereditary syndrome, diagnosticated after an intussusception. Colorectal cancer is an important cause of cancer related mortality that can be manifested by an intussusception, a rare occurrence in adults and almost always related to tumors. Approximately 5% of colorectal cancers can be attributed to syndromes known to cause hereditary colorectal cancer, such as MUTYH-associated polyposis, autosomal genetic syndrome associated with this disease.Case presentationWe present the case of a 44 years old male, that sought medical consultation with a complaint of abdominal discomfort, that after five days changed its characteristics. The patient was sent to the emergency department were a CT-scan revealed intestinal sub-occlusion by ileocolic invagination. Right colectomy was carried out. The anatomic-pathological examination revealed a moderately differentiated mucinous adenocarcinoma and multiples sessile polyps, which led to the suspicion of a genetic syndrome. In the genetics analysis two mutations were observed in the MUTYH gene, and MUTYH-associated polyposis was diagnosticated.ConclusionThis case demonstrates the importance of meticulous analysis of the patient examinations results to identify possible discrete alterations that can lead to improved understanding of disease.

Assess the outcome of pre and postoperative bacterial culture in sinonasal polyposis cases under FESS

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Sinonasal polyposis is multifactorial condition characterised by mucous membrane lesions in nose and paranasal sinuses. Pre and post-operative management of cases undergoing functional endoscopic sinus surgery (FESS) give ideal surgical outcome. This study designed to assess pre and postoperative bacterial profile in sinonasal polyposis cases undergoing Functional endoscopic sinus surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total 100 cases ready for endonasal endoscopic surgery with chief complaints of sinonasal polyposis were recruited for the study. Pre and post-operative nasal swabs were collected from lateral wall, floor and area over the polyps. Sensitivity test was performed by using commonly available antibiotics i.e. ceftriaxone, erythromycin, ampicillin, gentamycin, ciprofloxacin, cephalexin, doxycycline and co-trimoxazole. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Pre-operative bacterial culture showed growth of &lt;em&gt;Staphylococcus &lt;/em&gt;coagulase negative&lt;em&gt; &lt;/em&gt;(CONS) in 32% cases, &lt;em&gt;Staphylococcus aureus&lt;/em&gt; in 24%. Post-operative bacteria culture showed&lt;em&gt; Staphylococcus &lt;/em&gt;coagulase negative&lt;em&gt; &lt;/em&gt;(CONS) in 22% cases, &lt;em&gt;Staphylococcus aureus&lt;/em&gt; in 22% cases. &lt;em&gt;Staphylococcus &lt;/em&gt;coagulase negative (CONS) and &lt;em&gt;Staphylococcus aureus&lt;/em&gt; had resistance to Ampicillin and Gentamycin.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;em&gt;Staphylococcus &lt;/em&gt;coagulase negative (CONS) and &lt;em&gt;Staphylococcus aureus are &lt;/em&gt;isolated commonly in pre and post-operative bacteria culture. Ampicillin, gentamicin, cefotaxime and ceftriaxone are primary choice for intravenous antibiotics in current clinical practice and in al surgical procedures including endoscopic sinus procedures.&lt;/p&gt;

SINONASAL POLYPOSIS;

Objectives: Practice to see the sphenoid sinuses for the presence of fungus to get the objective of complete removal of sinonasal polypi and its recurrence. Study Design: Retrospective observational study. Place and Duration: Department of ENT and Head and Neck surgery Al-Tibri Medical College Hospital, Isra University Karachi Campus from June 2016 to December 2017. Method: 60 cases of sinonasal polyposis with no co-morbidity like hypertension, diabetes etc, underwent FESS, 32 were male, 28 were female, age range from 18 year to 60 year. In 24 patients we found fungus in sphenoid sinus after removing polyps from other areas. Result: We found in 40% of cases in sphenoid sinuses with pure sionasal polypi. Conclusion: There is always possibility of finding fungus in hidden areas of sphenoid sinus when we are dealing sinonasal undergoing FESS.

A Case of Familial Adenomatous Polyposis that Developed Primary Carcinoma of the Appendix

A Case of Familial Adenomatous Polyposis that Developed Primary Carcinoma of the Appendix

REFRACTORY NASAL POLYPOSIS TREATED WITH OMALIZUMAB IN A CHILD

Introduction Current treatment of inflammatory nasal polyposis consists of nasal/oral glucocorticoid therapy and surgical management if unresponsive to pharmacotherapy. The etiology is often multifactorial and requires combination management with both pharmacotherapy and surgery. We present a case of refractory nasal polyposis in a child treated with omalizumab, preventing the need for repeat surgical intervention. Case Description A 12-year old male with history of severe asthma, allergic rhinitis and allergic fungal sinusitis requiring functional endoscopic sinus surgery, developed worsening nasal polyposis despite maximal medical therapy. Physical and endoscopic exam revealed left sided nasal polyps, bilateral inferior turbinate hypertrophy, vocal cord nodules and hoarse voice. FeNO was uptrending, ranging from 98-175 ppb over the past year. Management included allergen immunotherapy, oral leukotriene-receptor antagonist, high-dose inhaled corticosteroid/long-acting beta agonist, oral antihistamine, intranasal antihistamines, high-dose intranasal steroid rinses, and oral steroids. His asthma was well controlled. Repeat surgical intervention was anticipated. Given his rising FeNO levels despite oral steroids, omalizumab was initiated in an attempt to decrease his nasal inflammatory process. Significant symptomatic improvement was noted after two omalizumab injections and his FeNO decreased to 65 ppb, the lowest value in the previous 3 years. Six months later, his FeNO has declined further to 29 ppb. Endoscopic exam showed polyp regression. This has prevented need for nasal surgery with continued use. Discussion Off-label use of omalizumab for atopic nasal polyposis should be considered in patients nonresponsive to traditional pharmacotherapies.