Colonic Muco-submucosal Elongated Polyp Research Articles

A case of colonic muco-submucosal elongated polyp (CMSEP) misdiagnosed as a inverted colonic diverticulum (ICD).

CMSEP is a large intestine polyp with a long and broad stalk and a "worm-like" appearance which is covered by normal mucosa. The submucosal layer consists of edematous and fibrotic interstitium, adipose tissue, dilated blood vessels, and lymphatic follicles[1]. Endoscopic magnification of the mucosal surface showed a uniform honeycomb pattern of regular blood vessels, with soft and deformable "folds" and "gyrus" at the top. The exact pathogenesis of CMSEP is still unclear.

Polypectomy of a colonic mucosubmucosal elongated polyp

Polypectomy of a colonic mucosubmucosal elongated polyp

Two Cases of Leiomyoma in the Colon Masquerading as Other Types of Colonic Pedunculated Polyps

We describe two cases of leiomyoma in the colon that were diagnosed histologically after endoscopic resection. The first case was a 79-year-old Japanese woman who presented with a pedunculated polyp of 14 mm length at the splenic flexure. Preoperative diagnosis suggested a colonic mucosubmucosal elongated polyp. The second case was a 29-year-old Japanese woman who presented with a pedunculated polyp of 40 mm length at the hepatic flexure and had an ulcer on top of the polyp. Preoperative diagnosis suggested an inflammatory fibroid polyp. A pathological diagnosis of colonic leiomyoma was made after endoscopic resection in both cases. Both tumors were confirmed to originate, not from the proper muscle layer, but from the muscularis mucosae. These cases underscore that although colonic involvement is infrequent, leiomyomas can display pedunculated morphology in the colon rather than the typical gross appearance of gastrointestinal submucosal tumors seen with sessile morphology.

Colonic mucosubmucosal elongated polyp:a clinicopathologic analysis

Colonic mucosubmucosal elongated polyp:a clinicopathologic analysis

A Case of Giant Colonic Muco-submucosal Elongated Polyps Associated with Intussusception.

Colonic muco-submucosal elongated polyp (CMSEP), a newly categorized non-neoplastic colorectal polyp, is a pedunculated and elongated polyp composed of normal mucosal and submucosal layers without any proper muscle layer. We herein report a giant variant of CMSEP associated with intussusception in the rectosigmoid colon, with a review of the literature. A 48-year-old woman underwent a laparoscopic low anterior resection due to multiple large submucosal polypoid masses associated with intussusception. Grossly, the colonic masses were multiple pedunculated polyps with a long stalk and branches ranging in size from a few millimeters to 14.0 cm in length. Microscopically, there was no evidence of hyperplasia, atypia, or active inflammation in the mucosa. The submucosal layers were composed of edematous and fibrotic stroma with fat tissue, dilated vessels, and lymphoid follicles.

Colonic mucosubmucosal elongated polyp: report of a series of 14 cases and review of the literature.

Most colorectal polyps can be reliably assigned to one of the known polyp categories, but a subset of polyps named colonic mucosubmucosal elongated polyps (CMSEPs) do not fall into any of these categories. First described in the Japanese literature, CMSEPs seem to be under-recognized in the Western literature. The aims of this study were to describe the clinicopathological features of 14 CMSEPs, discuss potential pathogenetic mechanisms, and increase awareness of this entity among pathologists. Fourteen pedunculated colorectal polyps that met the histopathological criteria for CMSEP (as described by Matake et al. and Alizart et al.) were assessed (12 males and two females; mean age 59.7 years). Five polyps were located in the sigmoid colon, four in the rectum, two in the descending colon, and three in the colon not otherwise specified. Nine of 14 polyps were discovered incidentally: two of nine on routine screening colonoscopy, two of nine on surveillance colonoscopy for inflammatory bowel disease (IBD), and five of nine upon surgical intervention for carcinoma or IBD. None coexisted with diverticular disease. The polyps were long and slender, varied from 5 to 30 mm in length (mean 15.9 mm), and showed a normal-looking colonic mucosal layer and underlying loose submucosa with thick-walled and congested blood vessels and lymphatics. CMSEPs show subtle but distinctive pathological features, and occur in normal and diseased colons. Pathologists need to be aware of this entity, to avoid confusion with other more commonly encountered colorectal polyps. With increasing colon cancer screening programmes and surveillance colonoscopy, it is likely that CMSEPs will be encountered more often.

Clinicopathological characteristic analysis of three cases of colonic muco-submucosal elongated polyp

Objective To explore the clinicopathological features,diagnosis and differential diagnosis of colonic muco-submucosal elongated polyp (CMSEP).Methods The clinical manifestations,endoscopic and histological features of three cases of CMSEP were analyzed.The literature was reviewed with regard to the diagnostic criteria and differential diagnosis.Results Three patients were male,and aged 25,45 and 75 years old.Two polyps were at transverse colon and one at rectum.Under colonoscope,all three cases showed the long pedunculated polyps.The surfaces of two polyps were smooth and the colors were similar to colonic mucosa while one polyp appeared mucosal erosion and congestion on the top.Under optical microscope,three cases had similar lesions.The axis of the lesions was expanded submucosa and the surface was the layer of colonic mucosa.The expanded and thick walled blood vessels were seen paralleled to the long axis in the submucosa of the axis of lesions.One polyp with mucosal erosion on the top presented with adenocarcinomal changes.Conclusions CMSEP is a kind of specific polypoid lesion,with characteristic colonoscopic and pathological features.Most are benign changes,however malignant changes occur in a few cases.In histology,CMSEP should be identified with mucosal prolapse syndrome associated inflammatory polyp. Key words: Intestinal mucosa; Colonic polyps; Colonoscopy; Pathology, clinical; Dignosis,differential; Colonic muco-submucosal elongated polyp

Colonic muco-submucosal elongated polyp (CMSEP) の1例

Colonic muco-submucosal elongated polyp (CMSEP) の1例

A Case of Nonpolypoid Cancer Arising from Colonic Muco-submucosal Elongated Polyp

A colonic muco-submucosal elongated polyp (CMSEP) was identified at colonoscopy in a 53-year-old male patient with lower gastrointestinal bleeding. Non-polypoid depressed type of early cancer was noted at the tip of the colonic polyp. The CMSEP is very rare and incidentally found in most cases. Moreover, its association with colonic neoplasia is extremely rare. To our knowledge, this is the second case report of CMSEP associated with a cancerous transformation.

Colonic Mucosubmucosal Elongated Polyp

Colonic mucosubmucosal elongated polyp (CMSEP) is a distinctive non-neoplastic colorectal polyp characterized by pedunculated, elongated shape and is composed mainly of expanded submucosa with a normal mucosal lining. Only a small number of these polyps have been reported, exclusively from Japan. We report the clinicopathologic characteristics of 13 CMSEPs occurring in 11 patients, mostly from European ancestry. Ten of these polyps were resected during colonoscopy, and 3 were diagnosed in a patient who underwent sigmoid resection for diverticular disease. Among patients who had undergone a colonoscopy, 4 had altered bowel habit, and 1 suffered from abdominal discomfort; the other 5 patients had routine screening colonoscopy. Eight polyps were located in the sigmoid colon, 3 in the right colon, 1 in the rectosigmoid junction, and 1 in the descending colon. Polyp size ranged from 10 to 150 mm. Histologically, CMSEPs were characterized by unremarkable large bowel mucosa and submucosal stalk containing dilated thick-walled veins running parallel to the long axis of the polyp. Mucosal inflammation or fibromuscular proliferation characteristic of mucosal prolapse was absent. The pathogenesis of CMSEP may involve mechanical traction of the mucosa and the superficial submucosa during peristalsis in a fragile area of the colon. Despite the occasional large size, CMSEP is a benign lesion seldom leading to clinical complications.

Small Muco-Submucosal Elongated Polyp of the Sigmoid Colon

A 79-year-old man visited our hospital for a positive fecal occult blood test. Colonoscopy revealed a pedunculated polyp, of about 7 mm in diameter, in the sigmoid colon (Picture 1A). A short stalk and innominate grooves were enhanced by indigocarmine (Picture 1B). The lesion seemed to be covered by normal mucosa, and we speculated that this polyp might be a colonic muco-submucosal elongated polyp (CMSEP) or a pedunculated leiomyomatous polyp (PLP). Endoscopic polypectomy was performed. The lesion consisted of edematous loose connective tissue. The resected specimen demonstrated dilatation of blood vessels and lymphatics in the submucosal layer (Picture 2). This polyp was diagnosed as a CMSEP. The incidence of CMSEP was only 0.39% in one endoscopic polypectomy series (1). CMSEPs should be distinguished from other submucosal lesions such as PLPs, lipoma and lymphangioma (1). The endoscopic findings of CMSEP in the present case resembled those of a PLP (2).

Polypectomy of a colonic muco-submucosal elongated polyp

Polypectomy of a colonic muco-submucosal elongated polyp

Colonic muco-submucosal elongated polyp: diagnosis with endoscopic ultrasound

Colonic muco-submucosal elongated polyp is a new clinical entity first reported in 1998. The purpose of this report is to determine the value of endoscopic ultrasound in the diagnosis of this condition. We reviewed the endosonographic and histological findings of seven colonic muco-submucosal elongated polyps that were removed completely by endoscopic resection or surgery. The lesions appeared as pedunculated submucosal tumours, measuring 1-4 cm in maximal diameter. Endosonographically, all lesions consisted of mucosal and submucosal layers, and microcystic components were found in the submucosal layer. There were no echogenic masses or muscularis propria within the polyps. These endosonographic features corresponded to histological findings of this type of polyp which was covered with normal mucosa and composed of submucosal layer alone. The submucosal layer consisted of oedematous, loose, connective tissue and/or fibrous tissue, accompanied by dilated blood vessels and lymphatics. Endoscopic ultrasound enabled differentiation of colonic muco-submucosal elongated polyp from other submucosal lesions.

Colonic muco-submucosal elongated polyp

Colonic muco-submucosal elongated polyp

A case of non-tumorous stalagmite-shaped colonic polyp indicating histological findings like mucosal polyp or colonic muco-submucosal elongated polyp

A case of non-tumorous stalagmite-shaped colonic polyp indicating histological findings like mucosal polyp or colonic muco-submucosal elongated polyp

Elongated non-neoplastic duodenal polyp: Endoscopic features

According to a well-established and widely accepted classification of intestinal tumors, protruding lesions of the duodenum are divided histopathologically into two categories: neoplastic and non-neoplastic.1 The latter category includes inflammatory, hamartomatous, and hyperplastic polyps. In the duodenum, however, there are polypoid lesions that cannot be specifically classified as any of these non-neoplastic types. These indeterminate lesions have been referred to as “unclassified polyps.” Three patients with duodenal polyps that were of the unclassified type were encountered. The polyps had markedly similar and uniform morphologic and histopathologic features.

Ｃｏｌｏｎｉｃ Ｍｕｃｏ‐Ｓｕｂｍｕｃｏｓａｌ Ｅｌｏｎｇａｔｅｄ Ｐｏｌｙｐ（ＣＭＳＥＰ）の１例 本邦報告例の検討

大腸ポリープの分類不能とされるものの中で,共通の特徴がみられたpolypに対してcolonic mucosubmucosal elongated polyp(CMSEP)という概念が近年提唱されている.われわれは,本概念に相当すると思われる症例を経験したので報告する.症例は,58歳の女性で,血便を主訴とし来院した.注腸検査で上行結腸に細長いポリープを認め,大腸内視鏡的ポリープ切除術を行ったところ,切除されたポリープは65×10×10mmであった.病理学的検討で,表面は正常な大腸粘膜に覆われ,粘膜下に拡張したリンパ管と血管の増殖からなるポリープで,CMSEPの特徴に一致した.現在までに自験例を含めて,27例,29個のCMSEPが報告されており,これらを検討し報告した.CMSEPという新しい概念は,大腸ポリープに対するひとつの分類として確立されるべきと考える.

Long pedunculated colonic polyp composed of mucosa and submucosa: proposal of a new entity, colonic muco-submucosal elongated polyp.

We encountered 15 patients with colonic polyps showing histologic features that did not belong to any of the known categories. All polyps were elongated and drumstick-shaped, with lengths of 12 to 160 (mean, 29 mm) mm. Histologically, the polyps were covered with normal mucosa and consisted of edematous, loose, fibrous, connective tissues and dense, fibrous submucosal layers, often showing dilation of blood vessels and lymphatics. Although the mechanism of generation of such polyps remains unknown, their elongation may be caused by intestinal motion. Because this kind of polyp has not been described previously outside Japan, we here introduce a new type of polyp, which we have proposed calling the colonic muco-submucosal elongated polyp.