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Prolapsing mucosal polyps: an underrecognized form of colonic polyp--a clinicopathological study of 15 cases
D A Tendler1, S Aboudola, J F Zacks
1Division of Gastroenterogy, Duke University Medical Center, Durham, North Carolina 7710, USA.
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."
Insights
Prolapsing mucosal polyps in the sigmoid colon, often linked to diverticular disease, present with bleeding and pain. These polyps share histological traits with other gastrointestinal prolapse conditions.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Gastrointestinal Pathology
Background:
- Mucosal prolapse is a recognized phenomenon across the gastrointestinal tract.
- Various conditions manifest as prolapsing intestinal mucosa, affecting different segments of the GI tract.
Purpose of the Study:
- To describe the clinical, endoscopic, and histological features of 15 patients with polypoid masses in the sigmoid colon exhibiting mucosal prolapse.
- To determine if these sigmoid colon polyps are histologically similar to other known mucosal prolapse conditions.
Main Methods:
- Retrospective identification of 15 patients with colon polyps showing endoscopic and histological signs of mucosal prolapse.
- Review of patient records for clinical presentation, endoscopic findings, and histological examination.
Main Results:
- Twelve patients experienced nonspecific symptoms like intestinal bleeding and abdominal pain; three were asymptomatic.
- Polyps were located in the sigmoid colon, frequently associated with diverticular disease, and more common in men.
- Endoscopic findings revealed well-circumscribed, hyperemic masses distinct from surrounding mucosa. Histology showed crypt abnormalities, fibromuscular obliteration, and thickened muscularis mucosa.
Conclusions:
- Prolapsing mucosal polyps of the colon exhibit histological similarities to other GI mucosal prolapse conditions.
- These findings support classifying these sigmoid polyps as part of a broader "mucosal prolapse syndrome."
- This designation helps unify the understanding of diverse prolapsing mucosal lesions in the GI tract.