Retention Polyps Research Articles

Histopathological Analysis of Gastrointestinal Polyps: A Yearlong Study at a Tertiary Care Center

This retrospective study was conducted at a tertiary care institute from January to December 2023. The study aimed to evaluate the range of histological characteristics seen in gastrointestinal polyps. By employing Hematoxylin and Eosin (H&E) stained slides, a total of 62 cases were examined in order to categorise polyps according to age, gender, location, and histological type. The results indicated that adenomatous polyps were primarily located in the large intestine, while hyperplastic polyps were more prevalent in the stomach. Additional forms that were detected include hamartomatous, juvenile, fundic gland, inflammatory fibroid, fibroepithelial, retention polyps, and a single case of familial polyposis coli. The study observed a male-to-female ratio of 0.9:1, with the highest number of cases occurring in the age bracket of 61-70. The findings emphasize the significance of differentiating between neoplastic and non-neoplastic polyps, especially because neoplastic polyps can progress through an adenoma-carcinoma sequence. Keywords: Gastrointestinal polyps, adenomatous polyp, hyperplastic polyp

S2024 Elderly Patient, Youthful Pathology: Solitary Colonic Juvenile Polyp Found in a 75-Year-Old Male

Introduction: Colonic juvenile polyps are generally found in the pediatric population. Classically, juvenile polyps (JP) are the most common polyp subtype seen in pediatric gastroenterology, accounting for approximately 80-90% of polyps in children. Generally, JP are diagnosed within the first decade of life and most common presentation is painless rectal bleeding. Other terminology used are juvenile hamartomatous polyp or retention polyps. There is no malignant potential for solitary JP and they tend to not recur. Case Description/Methods: We present a 75-year-old male with past medical history of hypertension, diabetes and hyperlipidemia referred to gastroenterology for surveillance colonoscopy due to a history of tubular adenomas. At the pre-procedure visit, the patient was well without GI complaints such as overt bleeding, change in bowel habits or unintentional weight loss. No family history of colon cancer or polyps was reported. Physical exam and vitals were normal at the time of procedure. Colonoscopy revealed a 40mm pedunculated sigmoid colon polyp which was excised using an endoloop at the stalk base followed by hot snare polypectomy ((Figure A). Three other sub-centimeter sessile polyps in the rectosigmoid area were removed by cold snare polypectomy. Histopathological examination of the large pedunculated polyp was consistent with a JP(Figure B). Other polyps were tubular adenomas. Discussion: Our current patient is the oldest reported case of isolated colonic JP. These polyps tend to have a common phenotypical appearance measuring around 10-30mm and roughly 90% of them are considered pedunculated. JP are ultimately defined by their distinctive histopathological features such as edematous lamina propria with inflammatory cells, cystically dilated glands that are bordered by cuboidal or columnar epithelium with reactive changes, and mucus filled glands. Fortunately for our patient, the presence of only a solitary colonic JP generally carries no known malignant potential. Juvenile polyposis syndrome (JPS) on the other hand is a hereditary condition characterized by the presence of hamartomatous polyps in the digestive tract and is known to have an increased risk of digestive tract malignancies. JPS is suspected when a patient has 5 or more juvenile polyps in the gastrointestinal tract or a juvenile polyp and a family history of juvenile polyps. A DNA test to check SMAD4 or BMPR1A gene is helpful.Figure 1.: (a) A 40mm polyp (Paris 0-Ip) located in the in the sigmoid colon. (b) Hamartomatous polyp has ulcerated surface with benign dilated glands.

Osseous Metaplasia in Juvenile Polyps: Report of Four Cases and Review of Literature

Background: There are occasional reports of osseous metaplasia (OM) occurring in gastrointestinal polyps. We report 4 cases occurring in juvenile retention polyps. Case reports: Four juvenile retention polyps presented with rectal bleeding. Microscopically there was osseous metaplasia in addition to the typical surface ulceration and granulation tissue appearance. Discussion/conclusion: Osseous metaplasia was only detected on histopathologic examination of the resected polyps. Although the clinical significance is not established, OM suggests that the polyps have been present for a longer period of time.

Histopathology of Polyps and Cancer of Colorectum: A ten years study from a tertiary care center

Introduction and objectives: Polyps and colorectal cancer have overlapping clinical presentation and may be difficult to diagnose on clinical grounds alone and close clinicopathological correlation is required for correct diagnosis and management. This study was aimed to see the spectrum of polyps and cancer in colorectum, see the percentage of colorectal cancer in younger individuals, see association between histologic grade and pathologic stage at presentation and compare site of tumor and pathologic stage at presentation in younger and older age group.
 Methods: This study was carried out on 138 consecutive cases of polyps and malignant lesions of colorectum during a time period of 10 years from January 2011 to December 2020.
 Results: Age of the patients ranged from 2 – 90 years with mean 45.1 years and a male female ratio 2:1. There were 58 (42.0%) cases of polyps and 80 (58.0%) cases of malignancies. 37 (46.3%) malignancy cases were seen in individuals ≤ 50 years of age. Most common site of involvement was rectum in 80 (58.0%) cases. Most common non-neoplastic polyp was retention polyp comprising 25 (67.6%) and most common neoplastic polyp was adenoma comprising of 18 (85.7%) cases. Most common malignancy was adenocarcinoma comprising 75 (93.8%) cases.
 Conclusion: Significant number of malignancies is seen in younger individuals stressing the need for suspicion and surveillance in this age group. Histologic grade is an important prognostic parameter and there is no difference in site of tumor and stage at presentation between younger and older age group.

Colonoscopy and Microscopy: Two sides of the coin- Our experience at Tertiary Care Centre in Central India

Introduction: The colonoscopy along with mucosal biopsy interpretation forms a prime diagnostic tool in work of patients with lesional diversity of colorectal region. The study was conduted to evaluate the histomorphological spectrum of colorectal lesions on colonoscopic biopsies and correlate the microscopy (histomorphology) with colonoscopic diagnosis offered. Materials and Methods: The material consisted of 168 colonoscopic biopsies which were submitted to the Department of Pathology, Govt. Medical College & Superspeciality Hospital, Nagpur during the period of Jan 2014 –Dec 2016. The histopathological classification of these lesions was based on WHO. Statistical analysis was done by Open Epi Info software. Result: Out of 168 colonoscopicbiopsies, 116 were non-neoplastic and 52 were neoplastic. A higher frequency of colonic diseases occur in males with male: female ratio -1.4:1 and the age range was between 2yrs to 92 yrs. Among the non-neoplastic lesions, ulcerative colitis was most common diagnosis, with frequent age group involved was 41- 50 yrs. Uncommon but interesting lesions like amoebic colitis (2 cases), pseudo membranous colitis(1 case), Melanosis coli (1 case) & congestive colopathy (1 case) were also found. Hyper plastic polyp & retention polyps were most common in non-neoplastic category while villous adenoma with dysplasia’s was most common in neoplastic polyps. Among the neoplastic lesions, conventional adenocarcinoma was the commonest subtype with rectum as the most common site. Conclusion: Colonoscopy & Microscopy are the two sides of the coin which can be used effectively together not only in diagnosis &treatment of colorectal lesions but alsosurveillance of inflammatory bowel disease. As 48% of overall malignant lesions occurred in less than 50yrs of age, due importance should be given to colonoscopic screening to detect early colorectal neoplasm. Keywords: Colonoscopy, Colorectal carcinoma, Dysplasia, Microscopy (histomrphology), Ulc

The Spectrum of colonic lesions: A Clinico-pathological study of colonic biopsies

Background: The colon is a seat for various diseases which include both non neoplastic and neoplastic conditions, with some of the inflammatory diseases being premalignant. The endoscopic evaluation of the large bowel has helped in not only direct visualisation of these lesions but also in taking a biopsy for histopathological diagnosis which also helps in the further assessment and treatment of the patient. Colonoscopy is also considered gold standard for cancer surveillance, which is the third prevalent cancer in men and women.23Thus colonoscopic biopsy is an important tool in the diagnosis of large bowel diseases. Objectives: To study the spectrum of lesions of colon in conjunction with clinical data and to evaluate the histomorphology of colonoscopic biopsies. Materials and Methods: All colonoscopic biopsies received in Department of Pathology, of a tertiary health care centre during a three year study period ,i.e from August 2012 to August 2014, were subjected to histopathological study and data analysed. Results: A total of 159 colonoscopic biopsies were studied. Out of them, 68 (42.8%) were non neoplastic, 23 (14.4%) were benign lesions and 68 (42.8%) were malignant lesions. Among the 68 Non neoplastic lesions, 32 cases were non-specific colitis, 11 cases ulcerative colitis, 5 cases juvenile polyps, 5 cases hyperplastic polyps, 4 cases SRUS, 3 cases granulomatous inflammation,3 cases retention polyp, 2 cases Crohn’s disease and one case each of acute inflammation, inflammatory polyp and endometriosis. Out of the 23 benign cases, 18were tubular adenomas (78.3%); 3 were villous adenomas (13%); 1 case of tubulovillous adenoma (4.3%) and 1 case of Benign spindle cell lesion (4.3%).Out of 68 malignant lesions, 24 cases(35.3%) were Well differentiated Adenocarcinoma, 25 cases (36.8%) were Moderately differentiated Adenocarcinoma, 9 cases (13.2%) were Poorly differentiated, 8 cases (11.8%) were Mucin secreting Adenocarcinoma an

Colonic Polyps in the “Esophagus”

Purpose: Esophageal atresia is a condition in which the proximal and distal portions of the esophagus do not communicate. Etiologies of these anomalies are still largely unknown; however, vascular insufficiency, genetic factors, vitamin deficiencies, drug and alcohol exposure, viral, chemical, and physical events have all been linked to embryologic developmental aberrancy. Our patient is a 32 y.o. male with esophageal and duodenal atresia corrected by gastrojejunal anastomosis and colonic interposition as an infant. He presented with nausea, melena, hematemesis, and a syncopal episode. His medical history was remarkable for dysphagia and recurrent pneumonias. On admission, UGI and SBS revealed colonic interposition with segments of the jejunum anastomosed to the stomach, proximal duodenum, and biliary system. Gastric varices, an ulcer in the fundus, and inflammatory changes in the duodenal bulb were suspected. Upper endoscopy however, revealed a non-bleeding 1.5 cm neo-esophageal /gastric ulcer at the anastomosis site, and a 1 cm sessile polyp in the proximal neo-esophageal transposed colon. This was removed via snare cautery polypectomy and was later histologically confirmed as a juvenile retention polyp. Multiple studies of patients with interposition report post-operative complications such as motility problems, gastroesophageal reflux, and respiratory complications.7 The endoscopic findings and history of recurrent pneumonia in our patient confirm these findings. Cases of adenomatous polyps and adenocarcinoma in transposed colonic segments to correct esophageal atresia have also been reported. This illustrates the need and re-emphasizes the importance of colon cancer screening wherever colonic tissue is found. 1. Deurloo et al, “Esophageal function after correction of esophageal atresia: follow-up after more than 18 years.” Eur J Gastroenterol Hepatol. 2005; 17(1): A27.[figure1][figure2]FigureFigure

A Case of Colitis Cystica Profunda Mixed with Juvenile Retention Polyp in a 7-month-old Infant

A Case of Colitis Cystica Profunda Mixed with Juvenile Retention Polyp in a 7-month-old Infant

Poliposis múltiple juvenil no familiar: Caso clínico

We report a 15 years old girl presenting with severe hematochezia with secondary anemia and hemodynamic decompensation, rectal prolapse and spontaneous anal elimination of polyps. She had no family history of polyposis and a search for the disease in her close relatives was negative. A complete diagnostic work up did not find polyps in other segments of the digestive tract. Colonoscopy showed more than 200 polyps between the cecum and the rectum. Pathological analysis confirmed the presence of retention polyps with adenomatous areas and mild atypia. The patient was subjected to a proctocolectomy with ileal pouch and sphincteric preservation, using a mechanical suture. Postoperative evolution was uneventful and after 24 months of follow up, the patient is asymptomatic, with two stool movements per day and without incontinence.

Colonic inflammation found at diagnosis of juvenile retention polyps in pediatric patients.

The finding of colonic inflammation concurrently with a juvenile retention polyp (JRP) may have prognostic value. However, the significance of abnormal mucosal histology with JRP has not been evaluated. We evaluated the significance of mucosal histology at the time of JRP removal with respect to future development of inflammatory bowel disease (IBD) and polyp recurrence. The medical records of patients who had an endoscopic polypectomy performed at the Children's Hospital of Philadelphia (CHOP) from 1/1/87 through 4/30/98 were retrospectively reviewed. JRP was histologically identified in 96 patients. A total of 54 patients had colonic mucosal biopsies: 30 (55.6%) had normal histology and 24 (44.4%) had colitis. Of the 24 patients with colitis, 14 patients (58.3%) had inflammation at the polyp site. Twelve of these patients had additional inflammation elsewhere in the colon. Nine (37.5%) had inflammation elsewhere in the colon; however, biopsies around the polyp site were not obtained. One patient with inflammation did not have the location of the polyp documented. Four patients (16.7%) had IBD at the time of polypectomy; two were diagnosed prior and two coincident with JRP. None have subsequently been diagnosed with IBD. There was no difference in polyp recurrence between those with or without inflammation (16.7% [4/24] vs 10.0% [3/30]). The mean follow-up period was 72.4 months (range, 5-142 months). In our experience, histological mucosal inflammation is a common finding with JRP. This inflammation may be a precursor for the development of JRP but has no predictive value for polyp recurrence. This colitis does not seem to be associated with IBD.

Colonic inflammation found at diagnosis of juvenile retention polyps in pediatric patients

OBJECTIVE: The finding of colonic inflammation concurrently with a juvenile retention polyp (JRP) may have prognostic value. However, the significance of abnormal mucosal histology with JRP has not been evaluated. We evaluated the significance of mucosal histology at the time of JRP removal with respect to future development of inflammatory bowel disease (IBD) and polyp recurrence. METHODS: The medical records of patients who had an endoscopic polypectomy performed at the Children’s Hospital of Philadelphia (CHOP) from 1/1/87 through 4/30/98 were retrospectively reviewed. RESULTS: JRP was histologically identified in 96 patients. A total of 54 patients had colonic mucosal biopsies: 30 (55.6%) had normal histology and 24 (44.4%) had colitis. Of the 24 patients with colitis, 14 patients (58.3%) had inflammation at the polyp site. Twelve of these patients had additional inflammation elsewhere in the colon. Nine (37.5%) had inflammation elsewhere in the colon; however, biopsies around the polyp site were not obtained. One patient with inflammation did not have the location of the polyp documented. Four patients (16.7%) had IBD at the time of polypectomy; two were diagnosed prior and two coincident with JRP. None have subsequently been diagnosed with IBD. There was no difference in polyp recurrence between those with or without inflammation (16.7% [4/24] vs 10.0% [3/30]). The mean follow-up period was 72.4 months (range, 5–142 months). CONCLUSIONS: In our experience, histological mucosal inflammation is a common finding with JRP. This inflammation may be a precursor for the development of JRP but has no predictive value for polyp recurrence. This colitis does not seem to be associated with IBD.

Relationship Between Colitis and Juvenile Retention Polyps in Pediatric Patients

Relationship Between Colitis and Juvenile Retention Polyps in Pediatric Patients

Pseudomalignant ulcerative change of the gastrointestinal tract

The occurrence of pseudomalignant ulcerative change in seven specimens from the colon and rectum of six patients is described. In all cases, there was surface ulceration of a polypoid lesion which contained granulation tissue and acute and chronic inflammation. There was an underlying inflammatory pseudopolyp in four lesions, a juvenile polyp in one lesion, an adenomatous polyp in one lesion, and a benign retention polyp in one lesion. Within the stroma of all cases were numerous atypical cells that mimicked a malignant neoplasm. The atypical cells expressed vimentin in immunohistochemical studies; no expression of keratins, leukocyte common antigen, factor VIII, Ulex europaeus, carcinoembryonic antigen, actin, or desmin was found. Recognition of this lesion is important, as confusion with carcinoma, lymphoma, sarcoma, or a viral infection may easily occur.

Diseases of the colon and rectum in Bolivia

A review of the surgical and autopsy records from two general hospitals in La Paz, Bolivia, discloses an incidence of colon and rectal disease, excluding hemorrhoids, of 0.6 per cent (138 of 22,361 surgical cases) and 2.5 per cent (16 of 640 consecutive autopsies). Acquired megacolon complicated by volvulus represented more than half of all cases in the surgical series. Ulcerative colitis, diverticular disease, and neoplastic polyps represented less than 10 per cent of the cases of colonic diseasce. Only ten cases of carcinoma of the colon were seen, whereas five cases of granulomatous colitis or ileocolitis were detected in the same surgical material. Among sixty-four lesions of the rectum, so-called retention polyps accounted for 54.5 per cent of the cases, with carcinoma next in frequency (25 percent), and the remainder being different varieties of inflammatory conditions. In the autopsy material almost half of the cases were infectious conditions, followed by congenital malformations and complicated acquired megacolon. No case of diverticular disease of the colon or neoplastic polyps was seen, and there was only one case of cancer of the large bowel. Because of the high incidence of acquired megacolon and the low incidence of cancer, ulcerative colitis, adenomatous polyps, and diverticular disease of the colon, possible etiopathogenic factors of these conditions are discussed in comparison with their incidence in other developed and developing countries of the world.

Polyps of the colon and rectum in Cali, Colombia.

AbstractA systematic search for polyps was carried out in 1,499 autopsy specimens of large intestine from Cali, Colombia, a low‐incidence area for colo‐rectal carcinoma. No cases of carcinoma were found in the series studied. The prevalence of each of the main types of polyps, namely adenomatous, hyperplastic and retention, is described. Retention polyps tend to disappear with age. Hyperplastic polyps appear around the 4th decade of life, are often multiple, are mostly found in the sigmoid and rectum and their prevalence does not increase appreciably with age; these findings are interpreted as added evidence against an association between hyperplastic polyps and carcinoma of the colon and rectum. Adenomatous polyps increase in prevalence with age and are more often multiple and in males tend to be concentrated in the sigmoid; tentative comparisons of Cali data with findings from countries at high risk for colo‐rectal cancer suggest a statistical association between prevalence of adenomas and incidence of carcinoma of the colon and an even stronger association between colon cancer and atypical cellular changes in adenomas. It is suggested that populations at high risk to colon cancer are probably characterized by an increased prevalence of adenomatous polyps, particularly in the sigmoid colon of males, and display a larger proportion of multiple polyps and atypical cellular changes.

“Juvenile” retention polyps of the colon and rectum

This report analyzes a total of 124 “juvenile” retention polyps of the colon and rectum in 50 patients, 8 of whom were adults. Twenty-four percent of the patients had more than one polyp, but late recurrences were seen only in 2 patients with diffuse multiple polyposis. The development of carcinoma in a juvenile retention polyp is not recorded, either in the present series or in the literature. Unlike the adenomatous polyp, the juvenile retention polyp does not appear to be of neoplastic origin; it may represent a hamartomatous or inflammatory process.

Polyps in the large bowel in children

The presentation of large bowel polyps in children is discussed and a classification is presented. The retention polyp which is usually single and in the rectum, accounted for 85% of a series of 194 polyps. The types of polyps which are neoplastic, hamartomatous, inflammatory and lymphoid, are discussed. The method of double contrast enema used is described.

Adenocarcinoma, adenomas and polyps of the colon. Histochemical study.

Acid and alkaline phosphatases, esterase, ATPase and succinic dehydrogenase were studied in colonic lesions. Inflammatory and retention polyps showed normal enzymatic activities. Adenocarcinoma, villous adenoma, adenomatous and hyperplastic polyps demonstrated loss of acid phosphatase, esterase and ATPase. Succinic dehydrogenase was irregularly distributed and showed diminished activity with focal intense reaction in adenocarcinoma, while demonstrating uniform diminution in villous adenoma and atypical areas in adenomatous polyps and hyperplastic polyps. Adenomatous polyps showed intense succinct dehydrogenase activity. Alkaline phosphatase could not be demonstrated in the tissues examined. The lesions were classified according to histochemical patterns. Inflammatory and retention polyps were grouped together. Adenomatous polyps constituted a separate group. Adenocarcinoma formed another division. Villous adenoma, atypical areas in adenomatous polyps and hyperplastic polyps were classified together. Thus the hyperplastic polyp does not appear to be related to either the adenomatous, inflammatory or retention varieties. The significance of the enzymatic similarities of hyperplastic polyps and the potentially invasive colonic lesions must be investigated further.