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Moreno Pimentel C, Galindo García C, Ariza Estepa M, Naranjo Llamas ME, Palomar Ávila C, Castro Fernández M, Fobelo Lozano MJ. "Cap polyposis", refractory to drug treatment, including infliximab. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38873995 DOI: 10.17235/reed.2024.10297/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Cap polyposis is a rare disease characterized by the presence of inflammatory polyps with an adherent fibrin sheath ("cap"), in variable number and size, in the rectum and sigmoid. It presents with tenesmus, mucous stools and rectorrhagia. There is currently no standardized treatment, having been treated empirically with aminosalicylates, oral or rectal steroids, metronidazole, H. pylori eradication therapy and infliximab with variable results. In refractory cases, endoscopic resection of polyps may be used and surgery may even be necessary. We present the case of a 36-year-old patient diagnosed in our center with cap polyposis, refractory to both pharmacological and endoscopic treatment, and therefore treatment with infliximab was decided out of indication. The case we present is the fourth case of cap polyposis treated with infliximab available in the current literature and highlights the difficulty of achieving a clinical response with pharmacological treatment, including biologic drugs such as infliximab.
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Lu Y, Huang L, Lou X, Chen C, Sun J. Clinical, endoscopic, pathological characteristics and management of cap polyposis: experience from a Tertiary Hospital in China. Front Pharmacol 2024; 15:1391367. [PMID: 38783946 PMCID: PMC11111883 DOI: 10.3389/fphar.2024.1391367] [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: 02/25/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Background and aims Cap polyposis (CP) is a rare kind of benign disease, and the majority of previously published relevant articles involve a small number of patients. Hence, we summarized our experience to contribute additional data, hoping to raise awareness of this disease. Methods From 1 January 2017 to 1 November 2021, consecutive patients diagnosed with CP were retrospectively reviewed. Their medical histories, and laboratory, imaging, endoscopic, and pathology results were analyzed. We made telephone calls to the patients and searched for the information in our electronic medical records to obtain the follow-up results. Results Forty-one patients were chosen for analysis. The median age of the patients was 20 years old, and 90.24% (37 patients) of the patients were male. The majority of the patients presented with hematochezia. The rectum was the most commonly affected site, and the Helicobacter pylori infection rate was high. There were multiple and combined treatments for these patients. These treatments can be divided into 3 main categories: medical therapy, endotherapy and surgery. Medical therapy helped to diminish the size of but the polyps were difficult to resolve; however, the patients' symptoms could be diminished. Twenty-three patients underwent surgical resection, and 12 patients received endotherapy. We further compared the two methods of polyp resection. Both endotherapy and surgery were safe, and the recurrence risk was not significantly different between the two kinds of therapy (p = 0.321). Conclusion The clinical improvement of medical treatments was not satisfactory, and endotherapy or surgical resection could remove the polyposis and provide temporary relief, but the recurrence rates were high.
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Affiliation(s)
- Yi Lu
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lingyu Huang
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoying Lou
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chunyu Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiachen Sun
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Cap Polyposis: An Elusive Diagnosis in a Pediatric Patient Successfully Managed With Endoscopic Treatment. ACG Case Rep J 2022; 9:e00918. [PMID: 36699631 PMCID: PMC9742084 DOI: 10.14309/crj.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/31/2022] [Indexed: 01/27/2023] Open
Abstract
Cap polyposis is a rare condition of the rectum or sigmoid colon manifested by inflammatory polyps covered by a thick layer of fibrinopurulent mucus. This condition typically presents as mucoid diarrhea and rectal bleeding, and patients are often prescribed antibiotics (such as those for Helicobacter pylori), steroids, infliximab, or aminosalicylates. Surgical management is an option for unresponsive disease, but endoscopic management has been rarely reported. For cases of cap polyposis in which conservative medical management fails, wide-field endoscopic mucosal resection is a viable option.
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Aggarwal A, Lang A, Krigman HR, Dehner LP. Vascular Malformation and CAP Polyposis: A New Insight into Pathophysiology or Fortuitous Association? Fetal Pediatr Pathol 2022; 41:670-676. [PMID: 33872119 DOI: 10.1080/15513815.2021.1913537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION CAP polyposis is a benign colorectal process presenting with multiple colorectal polyps with a "CAP" of inflammatory granulation tissue whose etiology has remained largely unknown. CASE A 24-year-old male presented with a long-standing history of repeated multiple sessile colonic polyps over a period of 17 years. RESULTS The numerous polyps showed consistent histologic features of superficial erosion with a surface "CAP" of granulation tissue with minimal submucosa to evaluate over this period. A left hemicolectomy disclosed an extensive vascular malformation. CONCLUSION The underlying vascular malformation may have an etiologic correlation to the overlying CAP polyps in this patient. Future cases may benefit from an evaluation of the underlying submucosa for the presence of possible vascular malformation likely to be missed on superficial polypectomy.
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Affiliation(s)
- Ashna Aggarwal
- Department of Pathology and Immunology, Barnes-Jewish Hospital/St. Louis Children's Hospital, Washington University in St. Louis, School of Medicine, St. Louis, MO, USA
| | - Adam Lang
- Department of Pathology, Blessing Health System, Quincy, IL, USA
| | - Hannah R Krigman
- Department of Pathology and Immunology, Barnes-Jewish Hospital/St. Louis Children's Hospital, Washington University in St. Louis, School of Medicine, St. Louis, MO, USA
| | - Louis P Dehner
- Department of Pathology and Immunology, Barnes-Jewish Hospital/St. Louis Children's Hospital, Washington University in St. Louis, School of Medicine, St. Louis, MO, USA
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Minagawa T, Ikeuchi H, Kusunoki K, Kuwahara R, Horio Y, Kihara T, Hirota S, Uchino M. Cap polyposis treated with laparoscopic-assisted total proctocolectomy and ileal J-pouch anal anastomosis: a case report. Surg Case Rep 2021; 7:153. [PMID: 34185178 PMCID: PMC8241959 DOI: 10.1186/s40792-021-01214-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background Cap polyposis (CP) is extremely rare in Japan, and there is no established cure. We report a case in which CP was improved by surgical treatment. Case presentation A 48-year-old man was investigated at a local hospital because of diarrhea and bloody stools in 2018. The patient was treated with metronidazole for suspected amoebic dysentery, but his symptoms did not improve. Subsequent close examination revealed possible CP, but treatment with 5-aminosalicylic acid and a steroid enema had no effect. The patient was then referred to our hospital. The bloody stools, diarrhea, and abdominal pain worsened despite medical treatment, so laparoscopic-assisted total proctocolectomy and ileal J-pouch anal anastomosis with ileostomy were performed. CP has no known cause or established treatment, but Helicobacter pylori (HP) infection has been reported in many CP cases in Japan, and HP eradication is often successful. This patient was HP-negative and did not improve with antimicrobial treatment, but the symptoms improved after surgery. Conclusions Even after surgery, CP recurrence reportedly occurs within a short period in many cases. However, our patient has had no signs of CP recurrence during 1 year of follow-up.
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Affiliation(s)
- Tomohiro Minagawa
- Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Kurando Kusunoki
- Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Ryuichi Kuwahara
- Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Yuki Horio
- Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Takako Kihara
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Motoi Uchino
- Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
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Cap polyposis of the colon: A report of 2 cases with unique clinical presentations but similar histopathologic findings. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Brunner M, Agaimy A, Atreya R, Grützmann R, Matzel KE. Cap polyposis in children: case report and literature review. Int J Colorectal Dis 2019; 34:363-368. [PMID: 30426196 DOI: 10.1007/s00384-018-3192-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Cap polyposis is a benign disease of the colon, characterized by inflammatory polyps with a "cap" of inflammatory granulation tissue. Its prevalence is very low, especially in children. METHODS AND RESULTS A 16-year-old girl presented with frequent bowel movements with mucous discharge and bloody stool, leading to the initial suspicion of chronic inflammatory bowel disease. Results of further investigation by endoscopy and histological examination were consistent with a diagnosis of cap polyposis. Treatment with systemic steroids resulted in symptom improvement. CONCLUSION A review of the literature shows that cap polyposis can occur at any age, including childhood, with a slight predilection for the male gender. Rectal bleeding and rectal polyps are consistent features in all reported cases. Other typical symptoms include constipation, diarrhea, and abdominal pain. Symptoms may be very similar to those of chronic inflammatory bowel disease, the most important differential diagnosis. The cause of cap polyposis is still unclear, and specific therapy has not as yet been established. Conservative therapeutic measures should be preferred, especially in children.
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Affiliation(s)
- Maximilian Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Abbas Agaimy
- Department of Pathology, Friedrich-Alexander University Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Raja Atreya
- Department of Medicine 1, Friedrich-Alexander University Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Robert Grützmann
- Department of General and Visceral Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Klaus E Matzel
- Department of General and Visceral Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
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Polypectomy for Recurrent Inflammatory Cap Polyposis Combined with Argon Plasma Coagulation. ACG Case Rep J 2018; 5:e35. [PMID: 29774225 PMCID: PMC5948317 DOI: 10.14309/crj.2018.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/22/2018] [Indexed: 01/15/2023] Open
Abstract
A 15-year-old adolescent boy presented with chronic constipation, difficulty in defecation, and episodic bloody stools. A rectal mass lesion was digitally palpated. Colonoscopy showed a large circumferential polypoid lesion of the mid-rectum. Snare polypectomy was performed, and histopathology confirmed a diagnosis of benign inflammatory cap polyposis. At 3-month follow-up, sigmoidoscopy showed multiple recurrences of polyps at the site of the previous rectal polypectomy, which were removed by combined hot snare polypectomy and argon plasma coagulation. At 1-year follow-up, the patient was symptom-free and had no more episodes of bloody stool. Follow-up sigmoidoscopy showed a post-polypectomy rectal mucosal scar without recurrent polypoid lesions.
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Kim SC, Kang MJ, Jeong YJ, Hwang PH. A Case of Cap Polyposis with Epidermal Nevus in an Infant. J Korean Med Sci 2017; 32:880-884. [PMID: 28378565 PMCID: PMC5383624 DOI: 10.3346/jkms.2017.32.5.880] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/25/2016] [Indexed: 12/31/2022] Open
Abstract
Cap polyposis is extremely rare in children. We report a case of an 11-month-old male infant who visited our hospital because of rectal prolapse and small amount of hematochezia lasting several days. He also had an epidermal nevus in the sacral area. Colonoscopy showed erythematous, multilobulated, circumferential, polypoid lesions with mucoid discharge from the rectum. He was diagnosed with cap polyposis by endoscopy and histologic examination. He was treated with surgical resection, and was closely followed up. In the relevant literature, there is no report of cap polyposis in an infant. We report the first case of cap polyposis in the youngest infant.
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Affiliation(s)
- Soon Chul Kim
- Department of Pediatrics, Chonbuk National University Medical School, Chonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Myoung Jae Kang
- Department of Pathology, Chonbuk National University Medical School, Chonbuk National University Hospital, Jeonju, Korea
| | - Yeon Jun Jeong
- Division of Pediatric Surgery, Chonbuk National University Medical School, Chonbuk National University Hospital, Jeonju, Korea
| | - Pyoung Han Hwang
- Department of Pediatrics, Chonbuk National University Medical School, Chonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea.
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Li JH, Leong MY, Phua KB, Low Y, Kader A, Logarajah V, Ong LY, Chua JHY, Ong C. Cap polyposis: A rare cause of rectal bleeding in children. World J Gastroenterol 2013; 19:4185-4191. [PMID: 23864782 PMCID: PMC3710421 DOI: 10.3748/wjg.v19.i26.4185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/22/2013] [Accepted: 05/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinicopathological features and treatment outcomes of cap polyposis in the pediatric population.
METHODS: All pediatric patients with histologically proven diagnosis of cap polyposis were identified from our endoscopy and histology database over a 12 year period from 2000-2012 at our tertiary pediatric center, KK Women’s and Children’s Hospital in Singapore. The case records of these patients were retrospectively reviewed. The demographics, clinical course, laboratory results, endoscopic and histopathological features, treatments, and outcomes were analyzed. The study protocol was approved by the hospital institutional review board. The histological slides were reviewed by a pediatric histopathologist to confirm the diagnosis of cap polyposis.
RESULTS: Eleven patients were diagnosed with cap polyposis. The median patient age was 13 years (range 5-17 years); the sample included 7 males and 4 females. All of the patients presented with bloody stools. Seven patients (63%) had constipation, while 4 patients (36%) had diarrhea. All of the patients underwent colonoscopy and polypectomies (excluding 1 patient who refused polypectomy). The macroscopic findings were of polypoid lesions covered by fibrinopurulent exudates with normal intervening mucosa. The rectum was the most common involvement site (n = 9, 82%), followed by the rectosigmoid colon (n = 3, 18%). Five (45%) patients had fewer than 5 polyps, and 6 patients (65%) had multiple polyps. Histological examination of these polyps showed surface ulcerations with a cap of fibrin inflammatory exudate. Four (80%) patients with fewer than 5 polyps had complete resolution of symptoms following the polypectomy. One patient who did not consent to the polypectomy had resolution of symptoms after being treated with sulphasalazine. All 6 patients with multiple polyps experienced recurrence of bloody stools on follow-up (mean = 28 mo).
CONCLUSION: Cap polyposis is a rare and under-recognised cause of rectal bleeding in children. Our study has characterized the disease phenotype and treatment outcomes in a pediatric cohort.
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Kini GP, Murray I, Champion-Young J, Lau M, Katta V, Thorn M, Schultz MP. Cap polyposis mistaken for Crohn's disease: case report and review of literature. J Crohns Colitis 2013; 7:e108-11. [PMID: 22766527 DOI: 10.1016/j.crohns.2012.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 01/03/2023]
Abstract
We report the case of a 19-year old male who presented with collapse and hypoglycemia associated with two weeks of frequent hard stools, abdominal pain relieved by defecation, postprandial vomiting and significant weight loss. Radiologically and endoscopically a diagnosis of Crohn's colitis was made and the patient was treated with steroids and immunosuppression. Following several hospital admissions treatment had to be escalated to include anti-TNF-α agents. Despite maximum therapy the patient continued to deteriorate symptomatically and biochemically with severe hypoalbuminemia and persistent anemia and a total colectomy was performed. Intra-operative finding was that of an inflamed large intestine and pseudo-polyposis but histology was reported as cap polyposis. The specimen was compared with the biopsies obtained from the earlier colonoscopies and it was felt that the previous samples were taken from areas of severely inflamed polypoid mucosa with histology mimicking colitis in inflammatory bowel disease.
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Affiliation(s)
- Geogry P Kini
- Gastroenterology Department, Dunedin Hospital, Dunedin, New Zealand.
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Mason M, Faizi SA, Fischer E, Rajput A. Inflammatory cap polyposis in a 42-year-old male. Int J Surg Case Rep 2013; 4:351-3. [PMID: 23416507 DOI: 10.1016/j.ijscr.2012.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 12/12/2012] [Accepted: 12/29/2012] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Inflammatory cap polyposis (CP) is an uncommon, non-malignant condition whose pathogenesis is poorly understood. Initial presentation of CP may mimic other gastrointestinal conditions like inflammatory bowel disease, pseudomembranous colitis, irritable bowel syndrome, and colon cancer. PRESENTATION OF CASE A 42-year-old male presented with symptoms of constipation, abdominal pain and weight loss, which were suggestive of a malignancy. DISCUSSION Since the symptoms of CP resemble closely those of other gastrointestinal diseases, particularly colon cancer, making the initial diagnosis can be challenging and it is often delayed. The mainstay of initial treatment is conservative, however symptomatic and complicated cases require prompt surgical intervention with close clinical follow-up. CONCLUSION We chose to report this case because it represents a rare and unique disease process that may masquerade as a colon cancer. It is important for surgeons to be aware of this non-malignant condition since inadequate surgery usually results in recurrence.
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Affiliation(s)
- Meredith Mason
- University of New Mexico School of Medicine, Albuquerque, NM, United States
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Papaconstantinou I, Karakatsanis A, Benia X, Polymeneas G, Kostopoulou E. Solitary rectal cap polyp: Case report and review of the literature. World J Gastrointest Surg 2012; 4:157-62. [PMID: 22816031 PMCID: PMC3400045 DOI: 10.4240/wjgs.v4.i6.157] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 12/23/2011] [Accepted: 12/28/2011] [Indexed: 02/06/2023] Open
Abstract
Rectal bleeding combined with the presence of a rectal mass has been traditionally associated with the presence of malignant disease. Cap polyposis is a relatively young and still undefined rare entity which mainly involves the rectosigmoid. It is characterized by the presence of inflammatory polyps. In this case report, we present a patient who was diagnosed with a solitary cap polyp of the rectum during the investigation of a bleeding rectal mass. The patient’s age and the absence of family history were not in favor of malignancy, despite the strong initial clinical impression. After confirmation of the diagnosis, the patient underwent a snare excision and remains asymptomatic. Cap polyposis, although rare, should be suspected and, when diagnosed, should be treated according to location, number of polyps and severity of symptoms.
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Affiliation(s)
- Ioannis Papaconstantinou
- Ioannis Papaconstantinou, Andreas Karakatsanis, Xanthi Benia, George Polymeneas, Second Department of Surgical, Aretaieion Hospital, University of Athens, Faculty of Medicine, 76 Vas Sophias Av, 11528 Athens, Greece
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Takeshima F, Senoo T, Matsushima K, Akazawa Y, Yamaguchi N, Shiozawa K, Ohnita K, Ichikawa T, Isomoto H, Nakao K. Successful management of cap polyposis with eradication of Helicobacter pylori relapsing 15 years after remission on steroid therapy. Intern Med 2012; 51:435-9. [PMID: 22333383 DOI: 10.2169/internalmedicine.51.6376] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A 37-year-old woman was evaluated at our hospital for a treatment-resistant proctosigmoiditis. Fifteen years previously, ulcerative colitis was suspected and she was cured by steroid therapy. Colonoscopy revealed multiple sessile polyps covered with white exudate from the rectum to the sigmoid colon. Histopathological examination revealed a mucosal surface cover of granulation tissue. Based on these findings, cap polyposis was diagnosed. She underwent Helicobacter pylori eradication therapy, and at 1 month after therapy, her symptoms had improved. We present a case of cap polyposis relapsing 15 years after remission with steroid therapy, and that was improved by H. pylori eradication therapy.
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Affiliation(s)
- Fuminao Takeshima
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Japan.
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Chang HS, Yang SK, Kim MJ, Ye BD, Byeon JS, Myung SJ, Kim JH. Long-term outcome of cap polyposis, with special reference to the effects of steroid therapy. Gastrointest Endosc 2012; 75:211-6. [PMID: 22078102 DOI: 10.1016/j.gie.2011.08.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 08/13/2011] [Indexed: 02/06/2023]
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Kim ES, Jeen YT, Keum B, Seo YS, Chun HJ, Um SH, Kim CD, Ryu HS. Remission of cap polyposis maintained for more than three years after infliximab treatment. Gut Liver 2009; 3:325-8. [PMID: 20431770 PMCID: PMC2852720 DOI: 10.5009/gnl.2009.3.4.325] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 06/19/2009] [Indexed: 12/19/2022] Open
Abstract
Cap polyposis is a rare disorder with characteristic endoscopic and histological features; its etiology is still unknown, and no specific treatment has been established. We report a case of cap polyposis that improved remarkably after infliximab infusion and had no recurrence for 3 years.
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Affiliation(s)
- Eun Sun Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Nakagawa Y, Nagai T, Okawara H, Nakashima H, Tasaki T, Soma W, Hisamatsu A, Watada M, Murakami K, Fujioka T. Cap polyposis (CP) which relapsed after remission by avoiding straining at defecation, and was cured by Helicobacter pylori eradication therapy. Intern Med 2009; 48:2009-13. [PMID: 19952483 DOI: 10.2169/internalmedicine.48.2547] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 52-year-old woman was diagnosed with cap polyposis (CP) with characteristic clinical, endoscopic, and histological features. By avoiding straining at defecation, her symptoms improved temporarily, however recrudesced. She was diagnosed with Helicobacter pylori (H. pylori) infection, and received eradication therapy successfully. After this eradication therapy, her symptoms and colonoscopic findings recovered completely. Only two reports in the English language literature have discussed the relationship between CP and eradication therapy for H. pylori, all patients achieved complete recovery. We recommend H. pylori testing for all cases of CP and H. pylori eradication therapy if necessary.
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Geboes K, De Hertogh G, Van Caillie MA, Van Eyken P. Non-adenomatous colorectal polyposis syndromes. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.cdip.2007.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Mucosal prolapse solitary rectal ulcer syndrome is a condition which has frequently confused both pathologists and surgeons alike. Despite its recognition in the nineteenth century, it continues to be a diagnostic challenge. The significance of correctly diagnosing this condition is that it avoids the morbidity and mortality associated with major surgery or the side-effects of long-term medical treatment. This review considers the histological features of mucosal prolapse and how it may mimic other pathological conditions.
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Affiliation(s)
- B Singh
- Nuffield Department of Surgery, John Radcliffe Hospital, Oxford, UK
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