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Ma Y, Zhang K, Cao Y. Colonic muco-submucosal elongated polyp misdiagnosed as an inverted colonic diverticulum. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2025; 117:108. [PMID: 38205692 DOI: 10.17235/reed.2024.10153/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Colonic muco-submucosal elongated polyp 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. Endoscopic magnification of the mucosal surface showed a uniform honeycomb pattern of regular colonic muco-submucosal elongated polyp vessels, with soft and deformable "folds" and "gyrus" at the top. The exact pathogenesis of CMSEP is still unclear.
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Affiliation(s)
- Yimin Ma
- Gastroenterology, Gaochun People's Hospital of Nanjing, China
| | - Kangwei Zhang
- Gastroenterology, Gaochun People's Hospital of Nanjing, China
| | - Youhong Cao
- Gastrotenterology, Gaochun People's Hospital of Nanjing, China
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Taniguchi A, Endo I, Nishiyama T, Watanabe N, Yoshida O, Asano H, Kubo M, Udaka T. Multiple enteric muco-submucosal elongated polyps causing intussusception. Clin J Gastroenterol 2024; 17:41-45. [PMID: 37976018 DOI: 10.1007/s12328-023-01888-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
A 20-year-old woman presented to our hospital with abdominal pain. Abdominal computed tomography revealed multiple masses in the upper jejunum, which were suspected as lipomas. Partial resection of the small intestine, including the masses, was performed on the same day due to intussusception secondary to the masses. Pathological examination revealed that the masses consisted of mucosa and edematous submucosa with multiple dilated blood vessels and lymphatic ducts without muscularis propria. The masses were diagnosed as multiple muco-submucosal elongated polyps (MSEP), a type of non-neoplastic polyp. MSEP was originally named colonic MSEP, but with the development of endoscopic techniques and imaging tests, similar polyps have been reported to occur not only in the colon but also in the entire intestinal tract. In this case, multiple MSEPs in the upper jejunum caused intussusception. As reported cases of multiple lesions causing intussusception are few, our case may help to clarify the pathogenesis of this disease.
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Affiliation(s)
- Atsuki Taniguchi
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan.
| | - Izuru Endo
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
| | - Takeyoshi Nishiyama
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
| | - Nobuyuki Watanabe
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
| | - Osamu Yoshida
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
| | - Hiroaki Asano
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
| | - Masatoshi Kubo
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
| | - Tetsunobu Udaka
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
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Kikuchi R, Emoto S, Nozawa H, Sasaki K, Murono K, Abe S, Sonoda H, Shinozaki-Ushiku A, Ishihara S. Jejunal intussusception and perforation due to enteric muco-submucosal elongated polyp: a case report and literature review. Surg Case Rep 2023; 9:4. [PMID: 36627469 PMCID: PMC9832183 DOI: 10.1186/s40792-022-01584-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND A muco-submucosal elongated polyp is a non-neoplastic growth composed of mucosa and submucosa. Although muco-submucosal elongated polyps are commonly reported in the large intestine, they are rare in the small intestine, in which they are called enteric muco-submucosal elongated polyps. We herein present a case of jejunal intussusception and perforation due to an enteric muco-submucosal elongated polyp. CASE PRESENTATION A 46-year-old woman presented with abdominal pain and vomiting. Computed tomography revealed jejunal intussusception, which was reduced via a nasointestinal ileus tube. Oral double-balloon endoscopy showed an elongated polyp in the proximal jejunum. The patient refused surgical resection and thus, the polyp was monitored. Six months later, the patient was readmitted with the recurrence of jejunal intussusception and underwent emergency surgery. Intraoperative findings revealed an intussuscepted bowel with an elongated polyp and multiple perforations in the proximal jejunum. We resected approximately 90 cm of the bowel, including the intussuscepted segment and perforated sites. The pedunculated polyp, which was 60 mm in length, was located on the oral side of the resected specimen. Histopathologically, the polyp was covered by normal mucosa and the submucosa consisted of edematous loose connective tissue. The histopathological diagnosis confirmed an enteric muco-submucosal elongated polyp. CONCLUSIONS Symptomatic patients with enteric muco-submucosal elongated polyps may be at risk of complications, as observed in the present case, and need to undergo timely resection.
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Affiliation(s)
- Ryosuke Kikuchi
- grid.412708.80000 0004 1764 7572Department of Surgical Oncology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655 Japan
| | - Shigenobu Emoto
- grid.412708.80000 0004 1764 7572Department of Surgical Oncology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655 Japan
| | - Hiroaki Nozawa
- grid.412708.80000 0004 1764 7572Department of Surgical Oncology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655 Japan
| | - Kazuhito Sasaki
- grid.412708.80000 0004 1764 7572Department of Surgical Oncology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655 Japan
| | - Koji Murono
- grid.412708.80000 0004 1764 7572Department of Surgical Oncology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655 Japan
| | - Shinya Abe
- grid.412708.80000 0004 1764 7572Department of Surgical Oncology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655 Japan
| | - Hirofumi Sonoda
- grid.412708.80000 0004 1764 7572Department of Surgical Oncology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655 Japan
| | - Aya Shinozaki-Ushiku
- grid.412708.80000 0004 1764 7572Department of Pathology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655 Japan
| | - Soichiro Ishihara
- grid.412708.80000 0004 1764 7572Department of Surgical Oncology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655 Japan
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Okamura T, Oyama S, Matsumoto K, Saijo Y, Fujimoto H, Arakura N, Igarashi T, Usuda S, Mishima S, Kiyosawa K. A case of giant enteric muco-submucosal elongated polyp detected by melena. Clin J Gastroenterol 2020; 13:1121-1124. [PMID: 32720222 DOI: 10.1007/s12328-020-01193-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
A 78-year-old woman was admitted for examination and treatment of melena. Although upper and lower gastrointestinal endoscopy and abdominal computed tomography showed no bleeding lesions, oral double-balloon endoscopy revealed a long, slender polyp covered with normal mucosa and accompanied with erosions in the proximal jejunum. Surgical resection was successful. Histopathologically, the polyp was 125 mm in length and composed of edematous mucosa with dilated blood vessels. The growth was diagnosed as a rare enteric muco-submucosal elongated polyp. Her melena improved postoperatively.
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Affiliation(s)
- Takuma Okamura
- Department of Gastroenterology, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, 390-8510, Japan.
| | - Sumika Oyama
- Department of Gastroenterology, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, 390-8510, Japan
| | - Ko Matsumoto
- Department of Gastroenterology, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, 390-8510, Japan
| | - Yuya Saijo
- Department of Gastroenterology, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, 390-8510, Japan
| | - Hitomi Fujimoto
- Department of Gastroenterology, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, 390-8510, Japan
| | - Norikazu Arakura
- Department of Gastroenterology, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, 390-8510, Japan
| | - Tohru Igarashi
- Department of Gastroenterology, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, 390-8510, Japan
| | - Seiichi Usuda
- Department of Gastroenterology, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, 390-8510, Japan
| | - Shuji Mishima
- Department of Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Kendo Kiyosawa
- Department of Gastroenterology, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, 390-8510, Japan
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Colonic Mucosubmucosal Elongated Polyp in the Sigmoid Colon on Surveillance Colonoscopy. ACG Case Rep J 2019; 6:e00110. [PMID: 31616775 PMCID: PMC6722346 DOI: 10.14309/crj.0000000000000110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/03/2019] [Indexed: 11/17/2022] Open
Abstract
Colonic mucosubmucosal elongated polyp (CMSEP) is a newly designated colorectal polyp. It has unique endoscopic features of a worm- or drumstick-shaped appearance. Histologically, it is composed of normal colonic mucosa and expanded submucosa with a prominent vascular component and no significant inflammation. CMSEP is usually detected incidentally on screening colonoscopy or colonoscopy for other causes. Differential diagnoses that need to be considered include mucosal prolapse syndrome, filiform polyposis, hamartomatous polyp, colon leiomyoma, inverted diverticulum, and residual stalk of a pedunculated adenoma. We present a case of CMSEP on surveillance colonoscopy and literature review.
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Affiliation(s)
| | - Dora M Lam-Himlin
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona, USA
| | - David E Fleischer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA
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Familial Occurrence of Enteric Muco-Submucosal Elongated Polyp. ACG Case Rep J 2016. [DOI: 10.14309/02075970-201607000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kim JH, Lee SY, Jang JH, Han HY, Kang DW. A Case of Giant Colonic Muco-submucosal Elongated Polyps Associated with Intussusception. J Pathol Transl Med 2016; 50:474-478. [PMID: 27214574 PMCID: PMC5122725 DOI: 10.4132/jptm.2016.04.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 04/03/2016] [Accepted: 04/27/2016] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Joo Heon Kim
- Department of Pathology, Eulji University Hospital, Daejeon, Korea
| | - Seung Yun Lee
- Department of Pathology, Eulji University Hospital, Daejeon, Korea
| | - Je Ho Jang
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Hyun Young Han
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
| | - Dong Wook Kang
- Department of Pathology, Eulji University Hospital, Daejeon, Korea
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Ali RH, Mohammad NM, Serra S, Chetty R. Colonic mucosubmucosal elongated polyp: report of a series of 14 cases and review of the literature. Histopathology 2016; 69:592-9. [PMID: 26990356 DOI: 10.1111/his.12969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/12/2016] [Indexed: 11/27/2022]
Abstract
AIMS 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. METHODS AND RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Rola H Ali
- Department of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait.
| | | | - Stefano Serra
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Runjan Chetty
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
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Abstract
We report 2 cases of enteric muco-submucosal elongated polyps (EMSEPs) that presented with gastrointestinal bleeding. The 2 patients are siblings. They both had a history of percutaneous coronary intervention for coronary artery disease and were on dual antiplatelet therapy. They underwent endoscopic resection of the polyps, which displayed identical endoscopic and histological features compatible with EMSEP. This is the first report of familial occurrence of EMSEP, suggesting possible genetic involvement. It is also important to note that the use of antiplatelet agents appears to be a predisposing factor for gastrointestinal bleeding from EMSEP.
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Terris B. [Digestive tumors and pseudotumors that rarely get discussed. Case 3: colonic mucosal/submucosal elongated polyp]. Ann Pathol 2013; 33:259-62. [PMID: 23954120 DOI: 10.1016/j.annpat.2013.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Benoît Terris
- Université Paris-Descartes, hôpital Cochin, Paris cedex 14, France.
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Filiform polyps and filiform polyp–like lesions are common in defunctioned or diverted colorectum resection specimens. Ann Diagn Pathol 2013; 17:341-4. [DOI: 10.1016/j.anndiagpath.2013.04.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 04/07/2013] [Indexed: 11/20/2022]
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Tan CL, Tan SH, So JBY, Petersson F. Muco-submucosal elongated polyps of the gastrointestinal tract: A case series and a review of the literature. World J Gastroenterol 2013; 19:1845-1849. [PMID: 23555175 PMCID: PMC3607763 DOI: 10.3748/wjg.v19.i11.1845] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 01/08/2013] [Accepted: 01/24/2013] [Indexed: 02/06/2023] Open
Abstract
We present three cases of gastrointestinal muco-submucosal elongated polyps, two located in the duodenum and one in the descending colon. All three cases had a characteristic, “worm-like” endoscopic appearance and were lined by unremarkable mucosa. The vascular component was located in the submucosa and was composed of a mixture of variably dilated blood vessels (capillaries and veins) and lymphatics. The duodenal polyps displayed lipomatous metaplasia of the submucosal stroma. The dual vascular phenotype of the vascular component was confirmed by immunohistochemistry with D2-40 and CD31.
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