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Malignant risk in juvenile polyposis coli: increasing documentation in the pediatric age group
K F Heiss1, D Schaffner, R R Ricketts
1Department of General Surgery and Pathology, Egleston Children's Hospital, Atlanta, GA.
Insights
Juvenile polyps, once thought benign, may show adenomatous changes. Aggressive evaluation and treatment are recommended for multiple juvenile polyps to detect potential malignancy.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
Background:
- Juvenile polyps traditionally viewed as benign and self-limiting.
- Previous understanding: solitary, rectosigmoid, no malignant potential.
Observation:
- Increased colonoscopy use reveals adenomatous changes in juvenile polyps.
- Reported 3 pediatric cases with juvenile and adenomatous polyps.
- Patients presented with rectal bleeding.
Findings:
- Two of three pediatric patients showed atypia, one severe.
- All patients treated with endorectal pull-through.
- Histological evaluation confirmed adenomatous changes.
Implications:
- Reconsideration of juvenile polyp management is necessary.
- Recommend aggressive approach for multiple juvenile polyps.
- Suggest colonoscopic biopsies and potential colectomy for adenomatous changes.
Abstract:
The presence of juvenile polyps with resulting bleeding and abdominal pain has traditionally been considered a benign, self-limiting process which would resolve with age. The dictum that these polyps were usually solitary, were found predominantly in the rectosigmoid area, and were without malignant potential has been reconsidered in recent years with the increased use of colonoscopy. Several case reports in both adults and children have documented the presence of adenomatous changes in this syndrome. We report 3 cases of children, ages 3, 11, and 11 who were found to have adenomatous polyps in the midst of fields of juvenile polyps on evaluation for rectal bleeding. All three were treated definitively with endorectal pull-through. Two of these patients had atypia on histological evaluation, one of which was severe. We recommend a more aggressive approach to patients found to have multiple juvenile polyps on barium enema, including colonoscopic biopsies at several sites to determine the presence of adenomatous changes, with colectomy and endorectal pull-through should these be found.