Small Polypoid Research Articles

Atypical localization of metastatic melanoma in the gastrointestinal tract.

Although most melanomas are diagnosed in early stages of the disease, a significant percentage show metastases from the beginning or during follow-up. The most common route is lymphatic, while hematogenous spread is less frequent. The most common site for metastases is the skin itself, although they can also occur in other organs, including the digestive tract, where the small intestine is the most frequently affected organ (2). We present the case of a 48-year-old woman with a history of superficial spreading melanoma of the cervical region, surgically treated 7 years prior and in remission, who presented with painless jaundice of 48 hours duration, without fever or other infectious focus. Upon arrival at the Emergency Department, she had a direct bilirubin of 7.9 mg/dL and a CRP of 140 mg/L. An abdominal ultrasound was performed, revealing biliary tract dilation without apparent cause, with secondary, apparently tumoral involvement of the gallbladder. During hospitalization, the study was completed with an abdominal CT scan, visualizing hyperdense lesions with a polypoid appearance in the gallbladder, in addition to the aforementioned intra- and extrahepatic biliary tract dilation. The cause was then identified as a hyperdense mass in the duodenum affecting the papilla, along with two other small hypervascular polypoid lesions in the second portion of the duodenum. With these findings, an ERCP was performed, revealing a papilla with a "pregnant" appearance, compatible with ampulloma, in addition to duodenal pseudopolyps of nonspecific appearance. The anatomopathological analysis was compatible with duodenal metastases from melanoma. Melanoma is the cancer with the highest mortality rate, and the gastrointestinal tract is a typical location for metastases, only surpassed by the skin itself and the lungs, especially the small intestine, although not the duodenum, where they are found in only 12% of cases (4). In this case, the diagnosis was complicated by the endoscopic appearance of the lesion, as the characteristic features are pigmented, blackish lesions typical of melanoma. As seen in the image, these lesions had an erythematous and pseudo-inflammatory appearance, so for diagnosis and treatment, it was essential to consider the history of the disease to perform an adequate anatomopathological diagnosis.

A Case Report of a Rare Huge Ureteral Fibroepithelial Polyp: Challenges and Clinical Management

Ureteral fibroepithelial polyps (UFPs) are rare abnormality that may cause ureteral obstruction. Herein, we report a 35- year- old woman with flank pain, dysuria, frequency and transient total gross hematuria. A mass in the right ureter was reported on imaging and in endoscopic evaluation, small polypoid mass protruding from the right ureteral orifice in the bladder, and a huge ureteral mass originating from proximal ureter was observed. A right subcostal flank incision was done, a huge polypoid mass with a segment of ureteral was excised, and end-to-end anastomosis of the ureter was done. Histopathological examination showed a UFP without malignancy.

Coronary Artery Disease and Gallbladder Inflammatory Pseudopolyps.

Axial MR image demonstrating multiple small gallbladder polypoid lesions characterized by contrast enhancement in a 78-year-old male hospitalized for acute chest pain due to coronary artery disease who showed fever and emesis during hospitalization and had signs of acute acalculous cholecystitis at computed tomography. Given the overall clinical conditions and the MR features, the inflammatory origin of the polyps was considered. The patient underwent cholecystectomy and the histological diagnosis of gallbladder inflammatory pseudopolyps was confirmed. This rare entity represents 5–10% of all gallbladder polyps, and their differentiation from benign and malignant tumors might be challenging especially in acalculous patients, thus surgery is often performed.

Polypoid lesions in the stomach and the colon: Cronkhite-Canada syndrome

An 83-year-old woman was admitted to our hospital with a 4 week history of abdominal pain, diarrhoea, and dysgeusia. During additional history taking and physical examination, she also complained of a recent worsening of cutaneous hyperpigmentation and alopecia. Laboratory data showed mild hypoalbuminaemia (3·6 g/dL [normal range 3·9–4·9]); all other parameters were within normal limits. Oesophagogastroduodenoscopy and colonoscopy were done and multiple small reddish polypoid lesions were seen mainly at the gastric antrum, ascending colon, and caecum (figure A, B).

Pyloric adenomatous carcinoma of the gallbladder following laparoscopic cholecystectomy: A case report.

IntroductionAdenoma and intra-adenoma carcinoma of the gallbladder are relatively rare diseases, and the World Health Organization classification reports a frequency of 0.3% for gallbladder adenomas. Precise preoperative diagnosis of gallbladder cancer, especially in the early stages, is challenging. Herein, we report a case of pyloric adenomatous carcinoma of the gallbladder, diagnosed by laparoscopic cholecystectomy and pathology, along with a literature review. This case was reported in accordance with the SCARE 2020 Guideline (Ref).Presentation of caseA 62-year-old woman was diagnosed with a 4-mm polypoid lesion in the gallbladder during a medical examination. The patient was followed-up by ultrasonography (US) once a year and was referred to our department because of an increase in size. Carcinoembryonic antigen and carbohydrate antigen 19-9 levels were within normal limits. Abdominal ultrasonography revealed a pedunculated polypoid lesion in the body of the gallbladder measuring 8 mm. Computed tomography demonstrated that the whole tumor was enhanced in the early phase without significant lymph node enlargement. Magnetic resonance cholangiopancreatography demonstrated a type Ip polypoid lesion located in the body of the gallbladder without pancreaticobiliary junctional abnormalities. Endoscopic ultrasound detected a superficial nodular-type Ip polypoid lesion in the gallbladder body with a parenchyma-like internal echogenic pattern.DiscussionBased on these findings, the patient was diagnosed with gallbladder adenoma, and laparoscopic cholecystectomy was performed. Histopathological examination revealed the tumor was a papillary growth of atypical high columnar epithelial cells. The final diagnosis was pyloric adenoma with high-grade dysplasia and intra-adenoma carcinoma. The patient is currently undergoing outpatient follow-up without recurrence for 1 year.ConclusionEarly gallbladder carcinoma with adenoma should be considered in patients with small gallbladder polypoid lesions. Considering the surgical stress of cholecystectomy and the malignant potential of gallbladder cancer, preceding surgery would be acceptable.

Laparoscopic and endoscopic cooperative surgery for leiomyosarcoma of the stomach: a case report with a review of the literature

BackgroundLeiomyosarcoma is a rare tumor that could originate from the gastrointestinal tract, uterus, kidney, retroperitoneum, and the soft tissues of the extremities. It accounts for only 1% of all gastrointestinal mesenchymal tumors and primary leiomyosarcoma of the stomach is extremely rare. Most cases reported as leiomyosarcoma of the stomach before the development of KIT immunohistochemistry might be gastrointestinal stromal tumors (GISTs) of the stomach and only 18 cases of leiomyosarcoma of the stomach have been reported since early 2000s. We report here a patient with leiomyosarcoma of the stomach treated by laparoscopic and endoscopic cooperative surgery (LECS).Case presentationA 59-year-old man was referred to our hospital for an early gastric cancer, which was initially treated by endoscopic submucosal dissection. Six months after his initial treatment, a follow-up esophagogastroduodenoscopy revealed a small polypoid lesion at the lesser curvature of the proximal stomach, which appeared to be a hyperplastic polyp. However, one and a half years later, the lesion grew and showed more irregular surface. Biopsy at the time revealed smooth muscle cell proliferation suggestive of leiomyoma. Three years later, the lesion grew even larger and biopsy showed pleomorphic spindle cells. Immunohistochemical study showed positive staining for alpha-smooth muscle actin and desmin, but negative for c-kit and CD34. Ki-67 labeling index was nearly 60%. Based on these findings, the diagnosis of leiomyosarcoma was established. The patient subsequently underwent a partial gastrectomy by LECS. The patient is currently in good condition without recurrence or metastasis at 12 months after surgery.ConclusionsLeiomyosarcoma of the stomach is extremely rare. This is the first report of leiomyosarcoma of the stomach treated by LECS. We could also follow its appearance change through endoscopic examination for 3 years.

Distal Tubular Hyperplasia: A Proposal for a Unique Form of Renal Tubular Proliferation Distinct From Papillary Adenoma.

We identified an unusual pattern of renal tubular proliferation associated with chronic renal disease, found in 23 patients, diffusely (n=12), or focally (n=11). Incidence was 5% of end-stage renal disease kidneys from one institution (8/177) and 7/23 patients with acquired cystic kidney disease-associated renal cell carcinoma from another. Most (19 patients) had 1 or more neoplasms including papillary (n=9), acquired cystic kidney disease (n=8), clear cell (n=4), or clear cell papillary (n=3) renal cell carcinoma. All (20 men, 3 women) had end-stage renal disease. The predominant pattern (n=18) was the indentation of chronic inflammation into renal tubules forming small polypoid structures; however, 5 had predominantly hyperplastic epithelium with less conspicuous inflammation. In 14 patients both patterns were appreciable, whereas the remainder had only the inflammatory pattern. Immunohistochemistry was positive for cytokeratin 7, high-molecular-weight cytokeratin, PAX8, and GATA3. Staining for alpha-methylacyl-CoA racemase was negative or weak, dramatically less intense than papillary neoplasms or proximal tubules. CD3 and CD20 showed a mixture of B and T lymphocytes in the inflammatory areas. Fluorescence in situ hybridization showed no trisomy 7 or 17 or loss of Y (n=9). We describe a previously uncharacterized form of renal tubular proliferation that differs from papillary adenoma (with weak or negative alpha-methylacyl-CoA racemase, lack of trisomy 7 or 17, and sometimes diffuse distribution). On the basis of consistent staining for high-molecular-weight cytokeratin and GATA3, we propose the name distal tubular hyperplasia for this process. Future studies will be helpful to assess preneoplastic potential and etiology.

Ectomesenchymal chondromyxoid tumor of the tongue: A small polyp, a big diagnosis

Ectomesenchymal chondromyxoid tumor (ECMT) is a recently described benign tumor, with a striking predilection for the oral cavity. We present the case of a 26-year-old female complaining of a small polypoid lesion, in the right dorsal-anterior aspect of the tongue. The polypoid lesion was resected, and after histopathological analysis a diagnosis of ECMT was rendered. ECMT is a very rare tumor with only a few published cases, none of them in Colombia.

Small Bowel Polypoid Lesions: Similar But Different!

Question: A 48-year-old female patient was admitted to our endoscopy unit for resection of a large (40-mm) duodenal adenoma (nongranular type laterally spreading adenoma; Paris classification type IIa) that was found on a routine esophagogastroduodenoscopy. The patient was asymptomatic with unremarkable blood tests and stable body weight. Colorectal polyps or other pathologies were excluded in an ileocolonoscopy.

Severe rectal bleeding caused by a small polypoid lobular capillary hemangioma.

Severe rectal bleeding caused by a small polypoid lobular capillary hemangioma.

Incidental diagnosis of very small rectal neuroendocrine neoplasms: when should endoscopic submucosal dissection be performed? A single ENETS centre experience.

The management of small (≤5 mm) rectal neuroendocrine neoplasms (r-NENs), incidentally removed during colonoscopy, still remains under debate. All consecutive patients affected by r-NENs from January 2013 to December 2017 were studied. The inclusion criteria were: (1) patients having an incidental pathological diagnosis of very small (≤5 mm) polypoid r-NENs; (2) patients treated with a standard polypectomy as first-line therapy and (3) patients treated by endoscopic submucosal dissection (ESD) as salvage therapy. The primary endpoint was to identify the factors related to residual disease after a standard polypectomy. The secondary endpoint was to calculate the accuracy of endoscopic ultrasound (EUS), grading and size in predicting residual disease. Starting from a prospective database of 123 consecutive patients affected by r-NENs, only 31 met the inclusion criteria. A final pathological examination of an ESD specimen showed residual disease in 7 out of 31 patients (22.6%). A multivariate analysis showed that the size of the polyps was the only independent factor related to residual disease with an odds ratio of 8.7 ± 7.5 (P = 0.013) for each millimetre. The accuracy of EUS, grading and tumour size (3.1 mm cut-off point) and area under the curves were 0.661 ± 0.111, 0.631 ± 0.109 and 0.821 ± 0.109, respectively. When the r-NEN polyp was larger than 3 mm, ESD was indicated. Unlike the size of the tumour, grading and EUS features did not accurately predict residual disease.

Mucosal Schwann cell hamartomas do occur the gastric mucosa \u2013 report of two cases mimicking fundic gland polyps

Mucosal Schwann cell hamartomas (MSCHs) are recently characterized benign spindle cell lesions of the colon and rectum. There is only one report of MSCHs in the stomach (antrum). Herein, we present the first reports of MSCHs occurring in the fundic mucosa as lesions that endoscopically mimicked a typical fundic gland polyp. Case 1. A 56-year-old woman sought medical attention due to epigastric pain. A small polypoid lesion in the fundic mucosa was removed with an endoscopic impression of a fundic gland polyp. Case 2. A 66-year-old man sought medical attention due to epigastric pain. The patient underwent antral and corporal biopsies that showed mild non-active gastritis without Helicobacter pylori infection. Small polypoid lesions in the fundic mucosa were seen; one was removed with an endoscopic impression of the fundic gland polyp. At the microscope, both lesions were entirely intramucosal, ill-defined spindle cell aggregations, suggesting a fascicular growth pattern. Both lesions were strongly and diffusely positive for S100. Awareness of this lesion is relevant to avoid the diagnosis of other benign spindle cell lesions that are associated with familial syndromes.

Endometrial cancer after radiation therapy for cervical carcinoma: A radiological approach

Clinical and pathological aspects of endometrial cancers that develop after radiation therapy for cervical carcinoma have been studied for years but their imaging features have not yet been described.To determine these features, we performed a retrospective study that included all patients of our institution that were diagnosed with an endometrial cancer after being submitted to radiation therapy for cervical cancer and that performed computed tomography (CT) or magnetic resonance (MR) imaging at the time of the diagnosis, in a period of 11 years.We found 13 patients meeting these inclusion criteria. A wide range of morphologies were observed: single solid tumors (46%); single mixed tumors (15%); large heterogeneous multifocal tumors (15%) and multifocal small polypoid tumors (15%). Large tumors were frequent at presentation, with 65% of the lesions measuring more than 5 cm (mean, 7.4 cm; range, 1.2–14.9 cm). Hematometra was a striking feature that was present in 85% of the cases, with a mean volume of 318 mL and was associated in 91% of the cases with cervical stenosis, a known complication of pelvic radiotherapy that could justify a delay in symptoms presentation. Post-radiotherapy changes and hematometra limited the utility of MR imaging in local staging. Distant metastases could be promptly diagnosed with CT or MR imaging and were observed in 42% of the patients.These rare heterogeneous tumors should be considered after radiotherapy for cervical carcinoma, especially when hematometra is observed. Aggressive histological presentations and delayed symptoms due to cervical stenosis are responsible for an unfavorable prognosis.

A Rare Cause of Whole Gastrointestinal Duct Edema and Multiple Small Intestinal Polypoid Ulcers

A Rare Cause of Whole Gastrointestinal Duct Edema and Multiple Small Intestinal Polypoid Ulcers

Colonic Amyloidoma: A Rarely Encountered Finding

Amyloidosis is a systemic disease characterized by the extracellular deposition of abnormal protein fibrils throughout the body that disrupts normal tissue architecture and function. It can present in many different forms, but the most common form that affects the gastrointestinal tract (GIT) is amyloid light-chain (AL) amyloidosis. Although amyloid deposition in the GIT is not uncommon, less than 50% will develop GI symptoms including GI dysmotility, malabsorptive diarrhea, spontaneous hemorrhage, and pseudo-obstruction. Early diagnosis of AL amyloidosis is essential because most cases are diagnosed late and associated with a poor prognosis. If left untreated it can carry median 1-year mortality rate of approximately 50%. Identifying the classic findings of AL amyloidosis during endoscopy should prompt further evaluation for disease. Our patient is a 54-year-old man with a past medical history significant for AL amyloidosis diagnosed on renal biopsy, who presented with worsening hematochezia. He also reported recurrent abdominal pain, a 60-pound weight loss, chronic diarrhea, and recurrent syncope for the last 4 months. Hemoglobin was 8.4 g/dL on admission. Colonoscopy revealed multiple large and small hemorrhagic polypoid lesions. The largest lesion filled approximately 75% of the colon. Multiple blood clots were also identified, but no active bleeding was seen during endoscopy. Endoscopic biopsies were not pursued given significant bleeding risk and prior diagnosis of AL amyloidosis. AL amyloid deposition within the vascular walls of the GIT increases vessel fragility and can result in hemorrhage beneath the lamina propria, forming submucosal hematomas. During endoscopy, submucosal hematomas appear purple and have a polypoid appearance with a shelf-like base. Other common findings during endoscopy include: mucosal ulcerations, intestinal erosions, yellowish plaque-like infiltrative lesions, and thickened mucosal folds. Rarely, as evident in our case, patients may have tumor-forming deposits of amyloid called amyloidomas, which can be wrongly diagnosed as a primary or metastatic GI malignancy. Given the poor prognosis associated with AL amyloidosis, recognizing common endoscopic findings should prompt the endoscopist to maintain a high index of suspicion and diagnose amyloidosis to improve overall prognosis.Figure: Endoscopy Findings.

A Rectal Tonsil Like No Other

Rectal tonsil is a rare condition. Its etiology is unknown, but it is comprised of a reactive proliferation of lymphoid tissue. Here we present a case of large, bleeding rectal tonsil. A 33-year-old healthy female presented with a 3-year history of intermittent rectal bleeding. Initial colonoscopy revealed irregular granular-appearing rectal mucosa, which was partially circumferential and extended 10 cm from the anal verge. Biopsy showed atypical lymphoid infiltrate positive for CD-20 and bcl-2, concerning for low-grade B-cell non-Hodgkin lymphoma. Endoscopic ultrasound showed mild, diffuse wall thickening of the mucosal/submucosal layer. Biopsies confirmed reactive lymphoid hyperplasia with flow cytometry negative for clonal population. She continued to have rectal bleeding at 6-month follow-up. Repeat colonoscopy showed a circumferential area of severely granular mucosa from the dentate line to 5 cm from the anal verge. Biopsies again revealed reactive lymphoid hyperplasia with negative flow cytometry and FISH. Currently, the patient continues to be monitored with close follow-up. The rectal tonsil is a rare finding. The most common presentation is rectal bleeding. Our case is the largest lesion presented in the literature as majority of the lesions reported consisted of discrete small (< 6mm) polypoid lesions or nodules. Previous studies reported complete resection of these small discrete lesions and show no recurrence or lymphoma transformation. However, the follow up for these studies is brief. Rectal tonsil should be distinguished from MALT lymphoma and other lymphoid diseases with malignant potential. Our patient is unique as the lesion was large and circumferential; therefore the patient elected to remain under close surveillance. It is important to continue to surveillance of these patients to understand long-term outcomes.Figure: Colonoscopy: Rectal tonsil.Figure: Colonoscopy: Rectal tonsil (retroflexion).

Brunner’s gland cyst: a clinicopathological study of 25 cases highlighting an underappreciated lesion

Brunner's gland cysts are rare, benign lesions of the duodenum usually seen as incidental, polypoid or cystic lesions of the duodenum. We present a series of 25 cases of Brunner's gland cyst, the largest case series to date. All the cases were identified during endoscopic assessment for unrelated causes. The mean age of the patients was 66.2 years and the sex ratio was approximately equal. Most were detected as a small (3-10 mm) polypoid lesion in the second part of the duodenum, away from the ampulla. Most of the cysts were unilocular and all were lined by undulating, cytologically bland cuboidal to columnar cells with clear cytoplasm and small, basal nuclei. No mitotic activity or proliferative activity was seen. No recurrence was noted, despite incomplete removal in many cases. We agree with the hypothesis that Brunner's gland cysts are likely to be caused by local obstruction to the draining duct of Brunner's glands.

Primary malignant melanoma of the gallbladder: report of a case

Introduction: It is controversial if the gallbladder involvement of the malignant melanoma is primary or secondary. It may be difficult to distinguish between primary and metastatic disease. Case: A 77-year-old man was referred to our department for treatment of a round mass of the gallbladder.On September 2012, he was incidentally diagnosed with melanoma of stomach by endoscopy during health screening. Further examinations were done to determine the primary origin but there was no other focus on the evaluation. Ultrasound revealed small polypoid lesion of the gallbladder wall. Positron emission tomography (PET) detected hypermetabolic lesion in the gallbladder. The surgery was recommended for those lesions but the patient was refused. On February 2014, repeated ultrasound was performed. A round mass was detected in the gallbladder. On endoscopy, the melanoma of stomach was not identified. Other abnormal lesions were not checked at Computed tomography (CT). The patient underwent radical cholecystectomy. The specimen was opened and a polypoid mass of dark-brownish color was revealed. Microscopically, melanin pigment accumulation within the cystoplasm of the tumor cells was noted. It was extended from mucosa to the subserosa and junctional activity was shown on histologic examaniation. The patient recovered uneventfully, and to date there has been no evidence of metastatic spread or recurrence of disease 19 months after surgery was performed. Conclusions: Primary melanoma of the gallbladder is rare disease. It is often difficult to distinguish from metastatic disease. Although the prognosis of these patients is poor, an aggressive surgical treatment can improve survival in selected patients.

Unusual Esophageal Mass as a Cause of Dysphagia

Question: A 73-year-old man with underlying alcoholic liver cirrhosis presented with a 1-month history of dysphagia. Upper endoscopy performed by his primary physician showed a polypoid lesion with a stricture in the middle esophagus; thus, he was referred for management. The patient has a 25 pack-year smoking history. Physical examination and laboratory testing revealed no remarkable abnormalities. Repeat endoscopy showed a small polypoid lesion but the endoscope could not be inserted due to severe stricture. Ultrathin endoscopy (GIF-XP260N; Olympus Optical Co., Ltd, Tokyo, Japan) revealed a 1.0-cm polypoid lesion with normal appearing mucosa in the esophagus, 27 cm from the incisors (Figure A). A biopsy from the lesion revealed proliferated and dysregulated epithelia throughout the mucosal layer, which was consistent with squamous intraepithelial neoplasm. Computed tomography scan showed only short segmental thickening of the middle esophageal wall. Because the patient declined surgery, we performed endoscopic resection (Figure B); however, remnant tumor under the small polypoid lesion could not be approached endoscopically (Figure C). Pathologically, the lobulating mass had proliferation of the capillaries with inflammatory cell infiltration and edematous stroma below the normal stratified squamous epithelium (Figure D). There was also disorganized squamous epithelium in the area surrounding spindle-shaped lymphovascular endothelia (Figure E). What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Pyogenic granuloma (PG), a polypoid capillary hemangioma, is a benign lesion arising from blood vessels of the skin or the oral and nasal mucosa.1Kusakabe A. Kato H. Hayashi K. et al.Pyogenic granuloma of the stomach successfully treated by endoscopic resection after transarterial embolization of the feeding artery.J Gastroenterol. 2005; 40: 530-535Crossref PubMed Scopus (25) Google Scholar In contrast with classic capillary hemangiomas, PG is composed of numerous newly formed capillaries of variable sizes arranged in a distinctive lobular pattern with or without ulceration on the surface. PGs are usually diagnosed in children and young adults and are rarely found in the alimentary tract. To date, only 42 cases of PGs in the alimentary tract have been reported, with 23 cases located in the esophagus.2Seoung H.G. Kim G.H. Song G.A. et al.Esophageal pyogenic granuloma: endosonographic findings and endoscopic treatments.Clin Endosc. 2013; 46: 81-84Crossref PubMed Scopus (6) Google Scholar No case of malignant transformation has been reported. To our knowledge, this is the first described case of PG associated with esophageal squamous cell carcinoma. Although the precise etiology is unknown, suggested etiologic factors include mechanical trauma, infection, chemical irritation, pregnancy, and hormonal mechanisms that induce reactive inflammatory and abnormal vascular responses.2Seoung H.G. Kim G.H. Song G.A. et al.Esophageal pyogenic granuloma: endosonographic findings and endoscopic treatments.Clin Endosc. 2013; 46: 81-84Crossref PubMed Scopus (6) Google Scholar Previously, a case of PG was reported originating in Barrett’s epithelium.3Craig R.M. Carlson S. Nordbrock H.A. et al.Pyogenic granuloma in Barrett's esophagus mimicking esophageal carcinoma.Gastroenterology. 1995; 108: 1894-1896Abstract Full Text PDF PubMed Scopus (26) Google Scholar In this case, the patient was treated with repeated dilations because of stricture formation caused by severe esophagitis, suggesting that it had been caused by trauma. However, the pathogenesis of co-occurring PG and squamous cell carcinoma is unclear in our case. Endoscopically, PG is seen as a protruding tumor or, sometimes, a pedunculated mass, with its color ranging from dark red to friable sanguine, reflecting the blood-rich nature of the lesion.1Kusakabe A. Kato H. Hayashi K. et al.Pyogenic granuloma of the stomach successfully treated by endoscopic resection after transarterial embolization of the feeding artery.J Gastroenterol. 2005; 40: 530-535Crossref PubMed Scopus (25) Google Scholar Although small polypoid lesions can be removed endoscopically, surgical excision is required in patients with large or deep lesions, or lesions that mimic malignant transformation.1Kusakabe A. Kato H. Hayashi K. et al.Pyogenic granuloma of the stomach successfully treated by endoscopic resection after transarterial embolization of the feeding artery.J Gastroenterol. 2005; 40: 530-535Crossref PubMed Scopus (25) Google Scholar Symptoms of esophageal PG include dysphagia, retrosternal pain, weight loss, and bleeding. PG should be differentially diagnosed from inflammatory polyps, benign and malignant vascular malformations, and angiomatous variants of Kaposi sarcoma.1Kusakabe A. Kato H. Hayashi K. et al.Pyogenic granuloma of the stomach successfully treated by endoscopic resection after transarterial embolization of the feeding artery.J Gastroenterol. 2005; 40: 530-535Crossref PubMed Scopus (25) Google Scholar Surgical resection would have been the best treatment choice in our case; however, the patient declined operative intervention. Instead, he received regional radiation of 55.8 Gy; an alternative treatment would have been photodynamic therapy. After radiation treatment, complete remission was achieved and the stricture improved (Figure F). Follow-up esophagogastroduodenoscopy at 3 and 6 months showed no evidence of recurrence.

Clinical Outcomes of Endoscopic Removal in Patients with Colorectal Polypoid Leiomyomas.

Although polypoid leiomyomas in the colon and rectum are rare, they are increasingly detected during colonoscopy. The aim of this study was to evaluate the efficacy and clinical outcomes of endoscopic removal for colorectal polypoid leiomyoma. Data were retrospectively collected from 22 patients with polypoid leiomyoma arising from the muscularis mucosae in the colon and rectum who underwent endoscopic removal at single referral gastrointestinal endoscopy unit. Colonoscopic findings, endoscopic removal, success rates, complication rates (bleeding or perforation), pathologic characteristics, and recurrence rates were investigated. Most polypoid leiomyomas were small asymptomatic lesions less than 1 cm. The tumors were located predominantly in the left colon. Ten leiomyomas were removed using cold biopsy forceps, and 12 were resected by conventional polypectomy or endoscopic mucosal resection. All tumors arose from or involved the muscularis mucosa. There were no complications, such as bleeding or perforation. No local remnant lesions were found in 19 patients who underwent at least one follow-up colonoscopy. This case series represent cases of small colorectal polypoid leiomyoma that were safely removed endoscopically. An awareness of their endoscopic and clinic-pathological characteristics may provide safe treatment strategy for colonic leiomyomatous tumors of similar size in capable hands.