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• W2111849969 abstract "Question: A 39-year-old Hispanic man with a 7-year history of intermittent left lower quadrant abdominal pain and hematochezia. He is otherwise healthy. On several computed tomography (CT) scans, there were diffuse colonic diverticula. During acute attacks, inflammatory changes were noted within the pelvis adjacent to a large, inflamed, sigmoid diverticulum. These finings were consistent with acute sigmoid diverticulitis. He was treated with antibiotics. During colonoscopy, there was significant sigmoid luminal narrowing with near circumferential erythematous and bluish mucosa (Figure A and Video Clip) at 35 cm from the anal verge. This discolored mucosal segment was actually the base of several elongated and pedunculated polyps (Figure B). The pedicles of these polyps were hyperemic and adenomatous tissue was not observed. One of these pedunculated polyps was removed through snare polypectomy uneventfully. What is the diagnosis?See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.Answer to the Clinical Challenges and Images in GI Question: Image 1: Prolapsing Mucosal Polyps of the ColonThis patient has prolapsing mucosal polyps (PMP) of the colon. Histologically, there are surface erosions with fibrin/inflammatory exudates, fibromuscular proliferation in lamina propria with mucosal architectural distortion (encircling some crypts showing hyperplastic or villiform appearance with minimum inflammation and reactive epithelial atypia; Figure C). The muscularis mucosae is thickened and mucosal blood vessels are telangiectatic. The current understanding is that the PMP of the colon are histologically similar to other mucosal prolapsing conditions in the gastrointestinal (GI) tract, such as the solitary rectal ulcer syndrome, inflammatory cloacogenic polyps (in the anus), inflammatory cap polyps, and gastric antral vascular ectasia, and should therefore be designated as part of the mucosal prolapse syndrome.1Chetty R. Bhathal P.S. Slavin J.L. Prolapse-induced inflammatory polyps of the colorectum and anal transitional zone.Histopathology. 1993; 23: 63-67Crossref PubMed Scopus (52) Google Scholar, 2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar, 3Cheung D.Y. Kim J.I. Park Y.B. et al.Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction.Intern Med. 2007; 46: 1701-1704Crossref PubMed Scopus (2) Google Scholar In our case, we hypothesize that on one hand these PMP with their associated luminal narrowing caused his recurrent diverticulitis and left lower quadrant abdominal pain. On the other hand, recurrent diverticulitis and intermittent obstruction might have exacerbated these PMP and mucosal venous congestion.View Large Image Figure ViewerDownload Hi-res image Download (PPT)PMP of the colon usually occurs in the sigmoid colon and is associated with diverticulosis.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar, 3Cheung D.Y. Kim J.I. Park Y.B. et al.Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction.Intern Med. 2007; 46: 1701-1704Crossref PubMed Scopus (2) Google Scholar There is a male predominance of this condition. These patients present with occult or gross lower GI bleeding and lower abdominal pain.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar On endoscopy, the polyps appear well-circumscribed and hyperemic, either broad based or pedunculated in larger polyps.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar, 3Cheung D.Y. Kim J.I. Park Y.B. et al.Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction.Intern Med. 2007; 46: 1701-1704Crossref PubMed Scopus (2) Google Scholar The polyps can be multiple or solitary and their sizes vary.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar In some cases, the large polyps can encompass the colon wall circumferentially as in our patient. Adenomatous tissue is not present. The treatment options for symptomatic PMP of the colon include conservative management, endoscopic polypectomy if feasible, and surgical resection of the involved colon in cases of very large polyps, circumferential, and obstructive lesions.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar, 3Cheung D.Y. Kim J.I. Park Y.B. et al.Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction.Intern Med. 2007; 46: 1701-1704Crossref PubMed Scopus (2) Google Scholar Our patient underwent sigmoid colectomy. Surgical pathology confirmed multiple PMP and the largest polyp at 1.8 cm × 1.8 cm × 4.0 cm in size. Question: A 39-year-old Hispanic man with a 7-year history of intermittent left lower quadrant abdominal pain and hematochezia. He is otherwise healthy. On several computed tomography (CT) scans, there were diffuse colonic diverticula. During acute attacks, inflammatory changes were noted within the pelvis adjacent to a large, inflamed, sigmoid diverticulum. These finings were consistent with acute sigmoid diverticulitis. He was treated with antibiotics. During colonoscopy, there was significant sigmoid luminal narrowing with near circumferential erythematous and bluish mucosa (Figure A and Video Clip) at 35 cm from the anal verge. This discolored mucosal segment was actually the base of several elongated and pedunculated polyps (Figure B). The pedicles of these polyps were hyperemic and adenomatous tissue was not observed. One of these pedunculated polyps was removed through snare polypectomy uneventfully. What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Answer to the Clinical Challenges and Images in GI Question: Image 1: Prolapsing Mucosal Polyps of the ColonThis patient has prolapsing mucosal polyps (PMP) of the colon. Histologically, there are surface erosions with fibrin/inflammatory exudates, fibromuscular proliferation in lamina propria with mucosal architectural distortion (encircling some crypts showing hyperplastic or villiform appearance with minimum inflammation and reactive epithelial atypia; Figure C). The muscularis mucosae is thickened and mucosal blood vessels are telangiectatic. The current understanding is that the PMP of the colon are histologically similar to other mucosal prolapsing conditions in the gastrointestinal (GI) tract, such as the solitary rectal ulcer syndrome, inflammatory cloacogenic polyps (in the anus), inflammatory cap polyps, and gastric antral vascular ectasia, and should therefore be designated as part of the mucosal prolapse syndrome.1Chetty R. Bhathal P.S. Slavin J.L. Prolapse-induced inflammatory polyps of the colorectum and anal transitional zone.Histopathology. 1993; 23: 63-67Crossref PubMed Scopus (52) Google Scholar, 2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar, 3Cheung D.Y. Kim J.I. Park Y.B. et al.Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction.Intern Med. 2007; 46: 1701-1704Crossref PubMed Scopus (2) Google Scholar In our case, we hypothesize that on one hand these PMP with their associated luminal narrowing caused his recurrent diverticulitis and left lower quadrant abdominal pain. On the other hand, recurrent diverticulitis and intermittent obstruction might have exacerbated these PMP and mucosal venous congestion.PMP of the colon usually occurs in the sigmoid colon and is associated with diverticulosis.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar, 3Cheung D.Y. Kim J.I. Park Y.B. et al.Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction.Intern Med. 2007; 46: 1701-1704Crossref PubMed Scopus (2) Google Scholar There is a male predominance of this condition. These patients present with occult or gross lower GI bleeding and lower abdominal pain.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar On endoscopy, the polyps appear well-circumscribed and hyperemic, either broad based or pedunculated in larger polyps.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar, 3Cheung D.Y. Kim J.I. Park Y.B. et al.Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction.Intern Med. 2007; 46: 1701-1704Crossref PubMed Scopus (2) Google Scholar The polyps can be multiple or solitary and their sizes vary.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar In some cases, the large polyps can encompass the colon wall circumferentially as in our patient. Adenomatous tissue is not present. The treatment options for symptomatic PMP of the colon include conservative management, endoscopic polypectomy if feasible, and surgical resection of the involved colon in cases of very large polyps, circumferential, and obstructive lesions.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar, 3Cheung D.Y. Kim J.I. Park Y.B. et al.Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction.Intern Med. 2007; 46: 1701-1704Crossref PubMed Scopus (2) Google Scholar Our patient underwent sigmoid colectomy. Surgical pathology confirmed multiple PMP and the largest polyp at 1.8 cm × 1.8 cm × 4.0 cm in size. This patient has prolapsing mucosal polyps (PMP) of the colon. Histologically, there are surface erosions with fibrin/inflammatory exudates, fibromuscular proliferation in lamina propria with mucosal architectural distortion (encircling some crypts showing hyperplastic or villiform appearance with minimum inflammation and reactive epithelial atypia; Figure C). The muscularis mucosae is thickened and mucosal blood vessels are telangiectatic. The current understanding is that the PMP of the colon are histologically similar to other mucosal prolapsing conditions in the gastrointestinal (GI) tract, such as the solitary rectal ulcer syndrome, inflammatory cloacogenic polyps (in the anus), inflammatory cap polyps, and gastric antral vascular ectasia, and should therefore be designated as part of the mucosal prolapse syndrome.1Chetty R. Bhathal P.S. Slavin J.L. Prolapse-induced inflammatory polyps of the colorectum and anal transitional zone.Histopathology. 1993; 23: 63-67Crossref PubMed Scopus (52) Google Scholar, 2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar, 3Cheung D.Y. Kim J.I. Park Y.B. et al.Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction.Intern Med. 2007; 46: 1701-1704Crossref PubMed Scopus (2) Google Scholar In our case, we hypothesize that on one hand these PMP with their associated luminal narrowing caused his recurrent diverticulitis and left lower quadrant abdominal pain. On the other hand, recurrent diverticulitis and intermittent obstruction might have exacerbated these PMP and mucosal venous congestion. PMP of the colon usually occurs in the sigmoid colon and is associated with diverticulosis.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar, 3Cheung D.Y. Kim J.I. Park Y.B. et al.Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction.Intern Med. 2007; 46: 1701-1704Crossref PubMed Scopus (2) Google Scholar There is a male predominance of this condition. These patients present with occult or gross lower GI bleeding and lower abdominal pain.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar On endoscopy, the polyps appear well-circumscribed and hyperemic, either broad based or pedunculated in larger polyps.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar, 3Cheung D.Y. Kim J.I. Park Y.B. et al.Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction.Intern Med. 2007; 46: 1701-1704Crossref PubMed Scopus (2) Google Scholar The polyps can be multiple or solitary and their sizes vary.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar In some cases, the large polyps can encompass the colon wall circumferentially as in our patient. Adenomatous tissue is not present. The treatment options for symptomatic PMP of the colon include conservative management, endoscopic polypectomy if feasible, and surgical resection of the involved colon in cases of very large polyps, circumferential, and obstructive lesions.2Tendler D.A. Aboudola S. Zacks J.F. et al.Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases.Am J Gastroenterol. 2002; 97: 370-376PubMed Google Scholar, 3Cheung D.Y. Kim J.I. Park Y.B. et al.Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction.Intern Med. 2007; 46: 1701-1704Crossref PubMed Scopus (2) Google Scholar Our patient underwent sigmoid colectomy. Surgical pathology confirmed multiple PMP and the largest polyp at 1.8 cm × 1.8 cm × 4.0 cm in size." @default.
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• W2111849969 title "Unusual Colon Polyps" @default.
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