Colon tumor - Inflammatory polyp of colon

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Colon tumor

Polyps

Inflammatory polyp of colon

Reviewers: Jela Bandovic, M.D. (see Reviewers page)
Revised: 21 May 2012, last major update May 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Inflamed regenerating mucosa surrounded by ulcerated tissue; also granulation tissue overlying epithelium
● Associated with Crohn’s disease or ulcerative colitis; also amebiasis, schistosomiasis, ulcer and anastomotic sites
● Usually asymptomatic but may cause obstruction or hemorrhage
● Benign; no increased risk of dysplasia compared to surrounding mucosa, although patients with inflammatory polyposis, due to ulcerative colitis, have an increased risk of dysplasia, usually in flat lesions

Case reports
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● 33 year old women with fused inflammatory polyps simulating carcinoma (Am J Gastroenterol 1980;73:441)
● With ischemia (Am Surg 1993;59:315)
● With schistosomiasis (J Clin Gastroenterol 1983;5:169)

Treatment
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● Treat underlying inflammatory condition

Clinical images
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Inflammatory polyps in ulcerative colitis

Gross description
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● Smooth hyperemic or hypervascular appearance; variable surface erosion

Gross images
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Inflammatory pseudopolyps in ulcerative colitis

Micro description
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● Inflamed lamina propria and distorted colonic epithelium (branched, tortuous, elongated or cystic crypts)
● May have surface erosion, congestion / hemorrhage or crypt abscesses
● May have bizarre stromal changes in reactive fibroblasts resembling sarcoma in a fibroblastic or granulation tissue stroma, particularly underneath areas of ulceration
● No / few mitotic figures, no atypical mitotic figures and often zonation

Micro images
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Ulcerative colitis

Annotated images

Bizarre stromal cells

Positive stains
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● Vimentin

Negative stains
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● S100, cytokeratin and CMV

Differential diagnosis
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● Pyogenic granuloma: lobular arrangement of capillaries within edematous stroma (Ann Diagn Pathol 2005;9:106)

Giant inflammatory polyp / polyposis of colon

General
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● Inflammation and polyps at least 1.5 cm
● Also called filiform polyposis if have long finger-like projections
● Uncommon, benign
● Usually associated with inflammatory bowel disease
● May be diffuse (Arch Pathol Lab Med 2004;128:1286)
● May cause obstruction (J Gastroenterol 2005;40:536, Intern Med 1996;35:24) or intussusception (Inflamm Bowel Dis 2004;10:41)

Case reports
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● 40 year old man with rectal bleeding (Case of the Week #147)
● 45 year old man with remission after topical budesonide (Anticancer Res 2005;25:2961)
● 49 year old man with Crohn’s disease (Pathol Int 2002;52:318)
● 60 year old woman and 64 year old man with no history of colonic disease (Gastroenterol Clin Biol 2006;30:913, Neth J Surg 1987;39:95)
● Two boys with cystic fibrosis and Crohn’s disease (Pediatr Dev Pathol 2006;9:25)

Treatment
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● Usually surgery (Z Gastroenterol 2000;38:845), since cannot clinically distinguish dysplastic and inflammatory polyps

Gross images
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Associated with protein losing enteropathy

Various images

Case of the Week #147

Micro images
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Case of the Week #147

Electron microscopy description
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● Fibroblasts, myofibroblasts, mast cells and lymphocytes, collagen fibers, capillaries, venules and hypertrophic autonomous nerve plexuses
● Also remnants of original epithelium and smooth muscle cells (Dis Colon Rectum 1990;33:773)

Additional references
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● Am J Surg Pathol 1986;10:420

Inflammatory polyp of colon secondary to mucosal prolapse

General
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● Includes inflammatory cap polyposis and diverticular polyp (Am J Surg Pathol 1991;15:871)
● Usually rectosigmoid
● Associated with chronic straining
● Median age 20 years in one study; associated with rectal bleeding and mucous diarrhea (Dis Colon Rectum 2004;47:1208)
● Represented 1/3 of inflammatory polyps in children in one study (Arkh Patol 2003;65:29)
● Expresses different mucins than normal colon (Gut 1998;42:135)

Case reports
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● 76 year old Japanese woman with polyps throughout colon (Gut 2005;54:1342)
● Associated with protein losing enteropathy (Am J Gastroenterol 2000;95:2095)

Treatment
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● Polypectomy; patients with multiple polyps or other pathology may require resection
● Infliximab (Gastroenterology 2004;126:1868), and Helicobacter treatment may be useful (Helicobacter 2004;9:651)

Gross description
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● Sessile polyp covered by cap of fibrinopurulent exudate

Micro description
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● Crypts are elongated, tortuous and distended with goblet cell hypertrophy and serrated tubules
● Eroded surface with fibrinopurulent inflammatory cap overlying acute and chronically inflamed stroma with fibromuscular obliteration of lamina propria and proliferation of muscularis mucosa

Micro images
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Staining for non-sulfated mucins

Figure 3

Electron microsopy images
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Thick superficial layer of mucus

Additional references
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● Am J Gastroenterol 2002;97:370, Histopathology 1993;23:63

End of Colon tumor > Polyps > Inflammatory polyp of colon

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