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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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Liu L, Lu T, Su Y. Gastrointestinal: A case of cap polyposis in children with an excellent therapeutic outcome. J Gastroenterol Hepatol 2024; 39:785-786. [PMID: 38224678 DOI: 10.1111/jgh.16458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/11/2023] [Indexed: 01/17/2024]
Affiliation(s)
- L Liu
- Department of Gastroenterology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - T Lu
- Department of Proctology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Y Su
- Department of Proctology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 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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Emami A, Shokri Shirvani J, Hosseini A, Hamidi SH. Solitary rectal ulcer transformation to cap polyposis in a 15-year-old child. BMC Gastroenterol 2022; 22:104. [PMID: 35255826 PMCID: PMC8900421 DOI: 10.1186/s12876-022-02122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cap polyposis (CP) is a benign, non-malignant inflammatory disease that affects the rectum. It usually occurs during the 5th decade of life, but children could also be affected. Its specific pathology is unknown. Due to the clinical, endoscopic, and histologic similarities with other disorders such as inflammatory bowel disease, a thorough histologic evaluation is critical to avoid unnecessary interventions. This study presents a 15-year-old child with a previously reported case of solitary rectal ulcer (SRU) that developed into CP determined by colonoscopy and histologic findings. CASE PRESENTATION A 15-year-old boy who was previously diagnosed with SRU presented to our office with rectal bleeding, mucoid discharge, and abdominal pain. Additional colonoscopy evaluation revealed multiple polyposes varying in size and shape limited to the rectum. Histologic examination revealed a characteristic cap of granulation tissue covering tortuous nondysplastic crypts in the inflamed stroma, indicating that SRU had transformed into CP. Based on the assessments, we planned to perform endoscopic mucosal resection of the lesions in multiple sessions. CONCLUSIONS Despite the rarity of CP, the transformation from SRU may be one of its etiologies. Thus, thorough serial histologic evaluation is critical in children with rectal bleeding to avoid unnecessary or harmful interventions.
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Affiliation(s)
- Abdolreza Emami
- Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Javad Shokri Shirvani
- Department of Internal Medicine, School of Medicine, Babol University of Medical Sciences, GanjAfrooz Street, 47176-47745, Babol, Mazandaran, Islamic Republic of Iran.
| | - Akramasadat Hosseini
- Department of Pathology, School of Medicine, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Seyed Hossein Hamidi
- Department of Anesthesiology, School of Medicine, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
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BRAF Mutation Is Associated with Hyperplastic Polyp-Associated Gastric Cancer. Int J Mol Sci 2021; 22:ijms222312724. [PMID: 34884530 PMCID: PMC8657452 DOI: 10.3390/ijms222312724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022] Open
Abstract
Gastric hyperplastic polyps (GHP) are frequently found to be benign polyps and have been considered to have a low carcinogenic potential. The characteristics of the hyperplastic polyp-associated gastric cancer (HPAGC) remain unclear. Therefore, we analyzed samples from 102 GHP patients and identified 20 low-grade atypical GHPs (19.6%), 7 high-grade atypical GHPs (6.9%), and 5 intramucosal cancer samples (4.9%). GHP atypia was more common in the elderly and increased with increasing polyp size. In particular, polyps larger than 1 cm were associated with a higher grade and cancer. Furthermore, mucus production decreased with increasing atypia. Although no correlation was found between atypia and Helicobacter pylori infection or intestinal metaplasia, enhanced proliferative ability (Ki-67) did correlate with atypia, as did nuclear 8-hydroxy-2'-deoxyguanosine levels. Interestingly, 4-hydroxynonenal levels in granulation tissue and the area ratio of granulation tissue within polyps also correlated with GHP atypia. In five cases of HPAGC, three cases exhibited caudal type homeobox transcription factor (CDX2)-positive cells and a mixed mucin phenotype, which is considered to be related to H. pylori infection. By contrast, two cases were CDX2 negative, with a gastric mucin phenotype, and H. pylori infection was not observed in the tumor or the surrounding mucosa. In these cases, a v-raf murine sarcoma viral oncogene homolog B1 (BRAF) mutation (V600E) was detected. All cancer samples showed high stemness and p53 protein accumulation, but no KRAS mutations. The molecular and phenotypic characteristics of the cases characterized by BRAF mutations may represent a novel subtype of HPAGC, reflecting a conserved pathway to oncogenesis that does not involve H. pylori infection. These findings are worthy of further investigation in a large-scale study with a substantial cohort of HPAGC patients to establish their clinical significance.
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Prolapsing mucosal polyp: A form of colonic polyp not to be forgotten. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2018.06.013] [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: 11/21/2022] Open
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Monreal-Robles R, González-González JA, Benavides-Salgado DE, Maldonado-Garza HJ. Prolapsing mucosal polyp: A form of colonic polyp not to be forgotten. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2019; 84:407-409. [PMID: 30971359 DOI: 10.1016/j.rgmx.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/29/2018] [Accepted: 06/14/2018] [Indexed: 11/25/2022]
Affiliation(s)
- R Monreal-Robles
- Servicio de Gastroenterología y Endoscopia Digestiva, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - J A González-González
- Servicio de Gastroenterología y Endoscopia Digestiva, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - D E Benavides-Salgado
- Servicio de Gastroenterología y Endoscopia Digestiva, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
| | - H J Maldonado-Garza
- Servicio de Gastroenterología y Endoscopia Digestiva, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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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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Exploring the role and diversity of mucins in health and disease with special insight into non-communicable diseases. Glycoconj J 2015; 32:575-613. [PMID: 26239922 DOI: 10.1007/s10719-015-9606-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/18/2015] [Indexed: 12/11/2022]
Abstract
Mucins are major glycoprotein components of the mucus that coats the surfaces of cells lining the respiratory, digestive, gastrointestinal and urogenital tracts. They function to protect epithelial cells from infection, dehydration and physical or chemical injury, as well as to aid the passage of materials through a tract i.e., lubrication. They are also implicated in the pathogenesis of benign and malignant diseases of secretory epithelial cells. In Human there are two types of mucins, membrane-bound and secreted that are originated from mucous producing goblet cells localized in the epithelial cell layer or in mucous producing glands and encoded by MUC gene. Mucins belong to a heterogeneous family of high molecular weight proteins composed of a long peptidic chain with a large number of tandem repeats that form the so-called mucin domain. The molecular weight is generally high, ranging between 0.2 and 10 million Dalton and all mucins contain one or more domains which are highly glycosylated. The size and number of repeats vary between mucins and the genetic polymorphism represents number of repeats (VNTR polymorphisms), which means the size of individual mucins can differ substantially between individuals which can be used as markers. In human it is only MUC1 and MUC7 that have mucin domains with less than 40% serine and threonine which in turn could reduce number of PTS domains. Mucins can be considered as powerful two-edged sword, as its normal function protects from unwanted substances and organisms at an arm's length while, malfunction of mucus may be an important factor in human diseases. In this review we have unearthed the current status of different mucin proteins in understanding its role and function in various non-communicable diseases in human with special reference to its organ specific locations. The findings described in this review may be of direct relevance to the major research area in biomedicine with reference to mucin and mucin associated diseases.
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Kim ES, Jeen YT, Kim JY. A patient experiencing bloody diarrhea and tenesmus for three weeks. Intest Res 2015; 13:180-1. [PMID: 25932005 PMCID: PMC4414762 DOI: 10.5217/ir.2015.13.2.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/23/2015] [Indexed: 11/07/2022] Open
Affiliation(s)
- Eun Sun Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Joo Young Kim
- Department of Pathology, Korea University College of Medicine, Seoul, Korea
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Amarapurkar AD, Amarapurkar D, Nichat P. Unusual polyposis in ulcerative colitis. Ann Gastroenterol 2014; 27:187. [PMID: 24733565 PMCID: PMC3982644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 12/13/2013] [Indexed: 11/24/2022] Open
Affiliation(s)
- Anjali Deepak Amarapurkar
- SRL and Dr Avinash Phadke Laboratory (Anjali Deepak Amarapurkar, Prachi Nichat),
Correspondence to: Deepak Amarapurkar, Department of Gastroenterology and Hepatology, Bombay Hospital and Medical Research Centre, Mumbai, India, e-mail:
| | - Deepak Amarapurkar
- Department of Gastroenterology and Hepatology, Bombay Hospital and Medical Research Centre (Deepak Anarapurkar), Mumbai, India India
| | - Prachi Nichat
- SRL and Dr Avinash Phadke Laboratory (Anjali Deepak Amarapurkar, Prachi Nichat)
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Arana R, Fléjou JF, Parc Y, El-Murr N, Cosnes J, Svrcek M. Cap polyposis and colitis cystica profunda: a rare association. Histopathology 2013; 64:604-7. [PMID: 24118052 DOI: 10.1111/his.12292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Riad Arana
- AP-HP, Hôpitaux Universitaires Est Parisien, Hôpital Saint-Antoine, Service d'Anatomie et Cytologie Pathologiques, Paris, France; Université Pierre et Marie Curie-Paris 6, Paris, France
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Abstract
Inflammatory cap polyposis (ICP) is a rare nonneoplastic polyposis of the colon of unknown etiology that can be confused with prolapse-induced polyps and hyperplastic polyposis. We contribute a case of ICP from a 59-year-old woman who was affected by severe constipation and hematochezia. Numerous sessile and semipedunculated polyps were found in the colon, all with cap of whitish fibrin. Histology revealed erosion of the surface, superficial dilated crypts filled with mucoid inflammatory exudate, and minimal crypt serration, all findings typical of ICP. Only the largest polyps had smooth muscle in the mucosa. Ki-67 showed modest expansion and irregular distribution of the crypts proliferative areas. Low-degree positivity for p16, similar to that of hyperplastic polyps, was found. CK20 was expressed as in normal mucosa. Distinguishing between ICP and other polyposis is important because of difference in management.
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Affiliation(s)
| | - Bal M. Dhungel
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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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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19
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Aggarwal R, Gupta P, Chopra P, Nundy S. Rectal cap polyposis masquerading as ulcerative colitis with pseudopolyposis and presenting as chronic anemia: a case study with review of literature. Saudi J Gastroenterol 2013; 19:187-9. [PMID: 23828750 PMCID: PMC3745662 DOI: 10.4103/1319-3767.114507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Cap polyposis (CP) is an under recognized form of non-neoplastic colonic polyps, characterised by the presence of inflammatory polyps with a distinct "cap" of granulation tissue. CP is often seen masquerading as chronic inflammatory bowel disease. The most common symptoms are mucoid diarrhoea, bloody stools, abdominal pain, and tenesmus. In this case report, we present a patient who was diagnosed with CP during the investigation of unexplained chronic long standing anemia secondary to intermittent rectal bleeding. CP, although rare, should be considered in the differential diagnosis of patients presenting with intermittent rectal bleeding and mucoid diarrhoea.
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Affiliation(s)
- Riti Aggarwal
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Pallav Gupta
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India,Address for correspondence: Dr. Pallav Gupta, Department of Pathology, Sir Ganga Ram Hospital, New Delhi - 110 060, India. E-mail:
| | - Prem Chopra
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Samiran Nundy
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
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20
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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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21
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OHMI A, TSUKAMOTO A, OHNO K, UCHIDA K, NISHIMURA R, FUKUSHIMA K, TAKAHASHI M, NAKASHIMA K, FUJINO Y, TSUJIMOTO H. A Retrospective Study of Inflammatory Colorectal Polyps in Miniature Dachshunds. J Vet Med Sci 2012; 74:59-64. [DOI: 10.1292/jvms.11-0352] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Aki OHMI
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Atsushi TSUKAMOTO
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Koichi OHNO
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Kazuyuki UCHIDA
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Ryohei NISHIMURA
- Department of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Kenjiro FUKUSHIMA
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Masashi TAKAHASHI
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Ko NAKASHIMA
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Yasuhito FUJINO
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Hajime TSUJIMOTO
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo
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22
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Song L, Jhun BW, Park J, Kim D, Chang DK, Kim YH, Kim JJ, Kim JY. [A case of cap polyposis complicated with idiopathic retroperitoneal fibrosis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 58:275-9. [PMID: 22113045 DOI: 10.4166/kjg.2011.58.5.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An optimal treatment for cap polyposis has not been established. Several treatment approaches, including anti-inflammatory agents, antibiotics, immunomodulators, and endoscopic therapy have been described. Surgical resection of the affected colon and rectum may be indicated for patients with persistent disease. Repeat surgery is indicated in cases of recurrence after surgery. However, symptomatic polyposis may still recur, and spontaneous resolution of cap polyposis is possible. We report a case of recurrent cap polyposis complicated with retroperitoneal fibrosis after inadequate low anterior resection with a positive resection margin. Surgical approaches for the treatment of cap polyposis should be carefully considered before treatment.
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Affiliation(s)
- Limhwa Song
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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23
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Gallegos M, Lau C, Bradly DP, Blanco L, Keshavarzian A, Jakate SM. Cap polyposis with protein-losing enteropathy. Gastroenterol Hepatol (N Y) 2011; 7:415-420. [PMID: 21869875 PMCID: PMC3151416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
| | - Cynthia Lau
- Department of Gastroenterology Rush University Medical Center Chicago, Illinois
| | | | | | - Ali Keshavarzian
- Department of Gastroenterology Rush University Medical Center Chicago, Illinois
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24
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Hald A, Rønø B, Melander MC, Ding M, Holck S, Lund LR. MMP9 is protective against lethal inflammatory mass lesions in the mouse colon. Dis Model Mech 2010; 4:212-27. [PMID: 21123624 PMCID: PMC3046095 DOI: 10.1242/dmm.005801] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The family of matrix metalloproteinases (MMPs) is responsible for extracellular matrix degradation during physiological and pathophysiological tissue remodeling processes such as embryogenesis, tissue repair and cancer progression. Despite these important roles of MMPs, inhibition or ablation of individual members of the MMP family in animal models have been shown to have little effect. It has been speculated that this results from a functional overlap between individual MMPs and (as-yet-unclassified) functional overlaps between MMPs and other protease systems. We here present genetic data showing that concomitant ablation of MMP9 (gelatinase B) and the serine protease plasmin results in lethal inflammatory mass lesions in the colon. These lesions possessed several histological attributes that are characteristic of mucosal prolapse seen in humans, and they were found to be associated with splenomegaly, enlarged mesenteric lymph nodes, decreased thymus size and altered populations of circulating immune cells. A time-course study provided evidence that the massive lymphoid hyperplasia and reactive changes were secondary to discrete fibrinous lesions also observed in mice only deficient for plasminogen (Plg), the zymogen for plasmin. These data demonstrate a non-appreciated vital protective role for MMP9 in the absence of Plg.
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Affiliation(s)
- Andreas Hald
- Department of Cellular and Molecular Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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25
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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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26
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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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28
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Yantiss RK, Odze RD. Pitfalls in the interpretation of nonneoplastic mucosal biopsies in inflammatory bowel disease. Am J Gastroenterol 2007; 102:890-904. [PMID: 17324129 DOI: 10.1111/j.1572-0241.2007.01105.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review provides a summary of common diagnostic problems encountered by both pathologists and gastroenterologists when evaluating patients with diarrhea and in whom inflammatory bowel disease (IBD) is suspected. The two most common forms of IBD, ulcerative colitis (UC) and Crohn's disease (CD), may, in certain settings, show overlapping endoscopic and pathologic features, potentially resulting in diagnostic confusion. For instance, some cases of UC may show unusual CD-like features, such as rectal sparing, discontinuous disease, aphthous ulceration, ileal or extracolonic involvement, and granulomatous inflammation, all of which may be evident in mucosal biopsy specimens. CD may also present as a diffuse, superficial pancolitis with ileal sparing that mimics the endoscopic and histologic appearance of UC. Furthermore, other forms of colitis, such as microscopic colitis, diverticulitis, diversion colitis, and nonsteroidal anti-inflammatory drug (NSAID)-induced colonic injury may also show IBD-like changes in mucosal biopsies. The potential diagnostic pitfalls faced by physicians, as well as features that aid in the distinction among these entities, are discussed in detail in this review.
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Affiliation(s)
- Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine of the Weill Medical College of Cornell University, New York, New York, USA
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29
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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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30
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Daniel F, El Braks R, Grandjouan S, Villet R, Lechaux JP, Vuong PN, Atienza P. Recto-sigmoid polyposis revealing rectal prolapse in two young patients. Int J Colorectal Dis 2006; 21:192-4. [PMID: 15714293 DOI: 10.1007/s00384-004-0703-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2004] [Indexed: 02/04/2023]
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31
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Konishi T, Watanabe T, Takei Y, Kojima T, Nagawa H. Cap polyposis: an inflammatory disorder or a spectrum of mucosal prolapse syndrome? Gut 2005; 54:1342-3. [PMID: 16099801 PMCID: PMC1774658 DOI: 10.1136/gut.2005.073452] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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32
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33
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Chinen T, Misawa T, Yao T, Nasu T, Yoshida K, Kubo S, Toyoshima S, Sakaguchi T, Harada N. Pedunculated cap polyps preceding the development of cap polyposis: case report. Gastrointest Endosc 2005; 61:338-40. [PMID: 15729261 DOI: 10.1016/s0016-5107(04)02470-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Takatoshi Chinen
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, Japan
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34
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Akamatsu T, Nakamura N, Kawamura Y, Shinji A, Tateiwa N, Ochi Y, Katsuyama T, Kiyosawa K. Possible relationship between Helicobacter pylori infection and cap polyposis of the colon. Helicobacter 2004; 9:651-6. [PMID: 15610079 DOI: 10.1111/j.1083-4389.2004.00273.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cap polyposis is a rarely encountered disease characterized by multiple distinctive inflammatory colonic polyps located from the rectum to the distal colon. The etiology of this disease is still unknown, and no specific treatment has been established. AIM We report three cases of cap polyposis that were cured following eradication therapy for Helicobacter pylori infection. METHODS AND RESULTS Three women were referred to Shinshu University Hospital because of mucoid and/or bloody diarrhea. Laboratory data showed hypoproteinemia in all cases; markers of inflammation such as C-reactive protein were negative. Colonoscopy revealed multiple sessile polyps with mucus adherent on the apices of the mucosal folds in the rectum and/or the sigmoid colon. The intervening mucosa was normal. Microscopic examinations of biopsy specimens taken from sessile polyps revealed inflamed mucosa with elongated tortuous crypts attenuated towards the mucosal surface. A granulation tissue 'cap' was observed on the surface of the mucosa. Various treatments were unsuccessful, including administration of metronidazole or prednisolone, avoidance of straining at defecation, and surgical or endoscopic resection. All were diagnosed with H. pylori infection in the stomach. Helicobacter pylori was not detected in the biopsy specimens from the colonic inflammatory polyps by immunohistochemical study using polyclonal anti-H. pylori antibody. After successful eradication therapy the clinical symptoms improved. Disappearance of cap polyposis was confirmed by colonoscopy in all three cases. CONCLUSION We speculate that H. pylori infection might play a role in the pathogenesis of cap polyposis.
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Affiliation(s)
- Taiji Akamatsu
- Department of Endoscopy, Shinshu University Hospital, Shinshu University School of Medicine, Matsumoto, Japan.
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35
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Langhorst J, Stolte M, Dobos G, Neuhaus H. Cap polyp of the esophagus caused by cholesterol embolization. Gastrointest Endosc 2003; 57:792-5. [PMID: 12739567 DOI: 10.1067/mge.2003.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Jost Langhorst
- Department of Medicine, Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Essen, Germany
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36
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Ohkawara T, Kato M, Nakagawa S, Nakamura M, Takei M, Komatsu Y, Shimizu Y, Takeda H, Sugiyama T, Asaka M. Spontaneous resolution of cap polyposis: case report. Gastrointest Endosc 2003; 57:599-602. [PMID: 12665781 DOI: 10.1067/mge.2003.166] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Tatsuya Ohkawara
- Department of Gastroenterology and Hematology, Division of Endoscopy, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Abstract
Diverticular colitis is the term used to describe a particular pattern of active chronic inflammation in the sigmoid colon affected by diverticular disease, namely the occurrence of luminal mucosal inflammation, whether or not there is evidence of inflammation within and/or around the diverticula themselves. The pathogenesis remains uncertain but is almost certainly multifactorial. In some cases mucosal prolapse, faecal stasis and relative mucosal ischaemia have been implicated as important pathogenetic factors, whilst other cases are clearly the result of a mass effect caused by subserosal peridiverticulitis and suppuration. Symptoms and endoscopic findings are diverse. Histologically, the disease may vary from modest inflammatory changes with vascular ectasia, through classical mucosal prolapse changes, to florid active chronic inflammation, closely mimicking chronic inflammatory bowel disease, especially ulcerative colitis. Thus, accurate clinical and endoscopic correlation is vital for the attainment of the correct diagnosis. Diverticular colitis may respond well to treatment similar to that used for chronic inflammatory bowel disease, adding to the similarities of this disease, notably localised to the sigmoid colon, and ulcerative colitis. Indeed, in a few cases described in the literature, diverticular colitis may 'progress' to otherwise classical ulcerative colitis, suggesting, in some cases at least, a similar pathogenesis.
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Affiliation(s)
- L Ludeman
- Department of Histopathology, Gloucestershire Royal Hospital, Gloucester, United Kingdom
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38
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Abstract
Diverticular disease is common in the elderly Western population and its complications are frequent clinical presentations. Despite this, the pathogenesis of the condition remains relatively poorly understood. Several theories have been developed, the most acceptable suggesting elastosis of the taeniae coli as the primary event, causing shortening of the sigmoid colon, with relative mucosal excess and subsequent mucosal herniations. A Western-type diet is implicated in the increased uptake of proline from the gut, leading to elastosis of the sigmoid colon. For pathologists, in clinical practice, the disease is most commonly seen in sigmoid colonic resection specimens, usually performed for complications of the disease. It is now realised that mucosal biopsies of the luminal mucosa, in the sigmoid colon affected by diverticular disease, can produce perplexing pathological changes. In particular diverticular colitis can mimic both ulcerative colitis and Crohn's disease: care should be taken when diagnosing chronic inflammatory bowel disease on a background of diverticular disease. For pathologists, diverticular disease remains something of an enigma: although common, its pathogenesis remains ill-defined and its complications can provide diagnostic difficulties, which require precise clinical and radiological correlation.
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Affiliation(s)
- Linmarie Ludeman
- Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
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39
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Shimizu K, Koga H, Iida M, Yao T, Hirakawa K, Hoshika K, Mikami Y, Haruma K. Does metronidazole cure cap polyposis by its antiinflammatory actions instead of by its antibiotic action? A case study. Dig Dis Sci 2002; 47:1465-1468. [PMID: 12141801 DOI: 10.1023/a:1015890329492] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Kayoko Shimizu
- Department of Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan
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40
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Shimizu K, Koga H, Iida M, Yao T, Hirakawa K, Hoshika K, Mikami Y, Haruma K. Does metronidazole cure cap polyposis by its antiinflammatory actions instead of by its antibiotic action? A case study. Dig Dis Sci 2002; 47:1465-1468. [PMID: 12141801 DOI: 10.1023/a: 1015890329492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Kayoko Shimizu
- Department of Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan
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41
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Tendler DA, Aboudola S, Zacks JF, O'Brien MJ, Kelly CP. Prolapsing mucosal polyps: an underrecognized form of colonic polyp--a clinicopathological study of 15 cases. Am J Gastroenterol 2002; 97:370-6. [PMID: 11866275 DOI: 10.1111/j.1572-0241.2002.05472.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Prolapsing intestinal mucosa occurs in many forms throughout the GI tract. We describe 15 patients with polypoid masses in the sigmoid colon and histological features of mucosal prolapse. METHODS Fifteen patients with colon polyps demonstrating endoscopic and histological features of mucosal prolapse were retrospectively identified from our database. RESULTS Twelve patients presented with signs and symptoms that were nonspecific, but consistent with mucosal prolapse, such as occult or gross intestinal bleeding and lower abdominal pain. Three patients were asymptomatic. The polyps occurred in the sigmoid colon, usually in association with diverticular disease, and appeared more often in men. Endoscopically, the polyps appeared to be well-circumscribed, hyperemic masses that contrasted sharply with normal-appearing adjacent mucosa. Histological features include glandular crypt abnormalities, fibromuscular obliteration of the lamina propria, and thickened and splayed muscularis mucosa. CONCLUSIONS Prolapsing mucosal polyps of the colon are histologically similar to other mucosal prolapsing conditions in the GI tract, such as the solitary rectal ulcer syndrome, inflammatory cloacogenic polyps, inflammatory "cap" polyps, and gastric antral vascular ectasia, and should therefore be designated as part of the "mucosal prolapse syndrome."
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Affiliation(s)
- D A Tendler
- Division of Gastroenterogy, Duke University Medical Center, Durham, North Carolina 7710, USA
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42
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Sadamoto Y, Jimi S, Harada N, Sakai K, Minoda S, Kohno S, Nawata H. Asymptomatic cap polyposis from the sigmoid colon to the cecum. Gastrointest Endosc 2001; 54:654-6. [PMID: 11677493 DOI: 10.1067/mge.2001.118135] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Y Sadamoto
- Department of Gastroenterology, Hara-Sanshin General Hospital, Fukuoka, Japan
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43
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Isomoto H, Urata M, Nakagoe T, Sawai T, Nomoto T, Oda H, Nomura N, Takeshima F, Mizuta Y, Murase K, Shimada S, Murata I, Kohno S. Proximal extension of cap polyposis confirmed by colonoscopy. Gastrointest Endosc 2001; 54:388-91. [PMID: 11522989 DOI: 10.1067/mge.2001.116888] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- H Isomoto
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
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44
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Kajihara H, Uno Y, Ying H, Tanaka M, Munakata A. Features of cap polyposis by magnifying colonoscopy. Gastrointest Endosc 2000; 52:775-8. [PMID: 11115917 DOI: 10.1067/mge.2000.109874] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- H Kajihara
- First Departments of Internal Medicine and the Second Department of Pathology, Hirosaki University, Aomori, Japan
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45
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Oriuchi T, Kinouchi Y, Kimura M, Hiwatashi N, Hayakawa T, Watanabe H, Yamada S, Nishihira T, Ohtsuki S, Toyota T. Successful treatment of cap polyposis by avoidance of intraluminal trauma: clues to pathogenesis. Am J Gastroenterol 2000; 95:2095-8. [PMID: 10950064 DOI: 10.1111/j.1572-0241.2000.02277.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
"Cap polyposis" is a rarely-encountered condition in which distinctive inflammatory polyps are located from the rectum to the distal descending colon. Microscopically, the polyps consist of elongated, tortuous, and distended crypts covered by a "cap" of inflammatory granulation tissue. Although the pathogenesis is unknown, mucosal prolapse has been postulated to be an important etiological factor, given certain clinical and histological similarities. We describe two cases of cap polyposis with protein-losing enteropathy. One was treated successfully by avoidance of straining at defecation. Another resolved after double-barreled transverse colostomy. Both successful treatments support a causal link of polyposis to prolapse.
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Affiliation(s)
- T Oriuchi
- Third Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan
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Shiomi S, Moriyama Y, Oshitani N, Matsumoto T, Kuroki T, Kawabe J, Ochi H, Okuyama C. A case of cap polyposis investigated by scintigraphy with human serum albumin labeled with Tc-99m DTPA. Clin Nucl Med 1998; 23:521-3. [PMID: 9712385 DOI: 10.1097/00003072-199808000-00006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cap polyposis is a rare intestinal disease that can be difficult to differentiate from inflammatory bowel disease. When cap polyposis is suspected, it is important to confirm protein loss. A 54-year-old woman who had been treated for ulcerative colitis for 7 years had severe hypoproteinemia. Scintigraphy with Tc-99m-labeled DTPA complexed with human serum albumin showed protein loss from the descending colon. Left hemicolectomy and sigmoid colectomy were performed. Cap polyposis was diagnosed on the basis of histologic findings from an operative specimen. The patient's diarrhea resolved after surgery and her hypoproteinemia improved. Scintigraphy with this label gave information helpful in the diagnosis of cap polyposis.
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Affiliation(s)
- S Shiomi
- Third Department of Internal Medicine, Osaka City University Medical School, Osaka, Japan
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47
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48
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49
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Abstract
A case of a patient who developed a polypoid area of mucosal prolapse three and a half years after having an ileoanal pouch for ulcerative colitis is presented. This seems to be the first published report. This new manifestation of mucosal prolapse in a pelvic ileal reservoir underlines that the pouch as a neorectum is subject to disorders familiar in the rectum.
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Affiliation(s)
- J M Blazeby
- University Department of Surgery, Bristol Royal Infirmary
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50
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Géhénot M, Colombel JF, Wolschies E, Quandalle P, Gower P, Lecomte-Houcke M, Van Kruiningen H, Cortot A. Cap polyposis occurring in the postoperative course of pelvic surgery. Gut 1994; 35:1670-2. [PMID: 7828996 PMCID: PMC1375635 DOI: 10.1136/gut.35.11.1670] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The case is reported of a 42 year old woman who presented with the characteristic clinical, sigmoidoscopic, and histological features of cap polyposis occurring in the postoperative course of pelvic surgery. Pathogenesis of cap polyposis is unknown. In this patient, abnormal colonic motility was not a likely aetiological factor as suggested in previous cases. Despite some arguments favouring an infectious origin or participation, no specific viral or bacterial agent was identified. Cap polyposis remains a poorly recognised condition, which may be confused with inflammatory bowel disease.
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Affiliation(s)
- M Géhénot
- Clinique des maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHRU Lille, France
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