Sabato 27 ottobre 2012 - Pacini Editore

PoStER
Grossly, an irregular villous polypoid lesion, measuring 9 cm in
largest diameter was found in the ascending colon, near the IC
valve. The lesion showed circumferential growth, with a centrally
depressed area and extension with small, warm-like polyps of
gradually decreasing size into the neighbouring normal mucosa
(Figg. 1, 2).
Histological examination revealed irregular finger-like projections
of the mucosa of various sizes 4 (Fig. 3). Crypt architecture
was markedly distorted, the lamina propria was obliterated by
fibro-muscular tissue and contained a dense mixed inflammatory
infiltrate 5 . Crypt abscesses as well as hyperplastic lymphoid follicles
were frequently observed, while epithelial dysplasia was
lacking. Some slides showed a circumscribed superficial ulcer
with a granulation tissue border. The polyps showed fibrous
cores containing congested and hyalinized vessels with evidence
of thrombosis 6 . The non-polypoid mucosa of the resection specimen
was entirely normal, with no evidence of inflammation and
Fig. 3. microscopic features of the filiform polyps: all lesions are
finger-like projections (stained with hematoxylin-eosin).
Fig. 4. appearance of polypoid and nonpolypoid colon, both without
dysplasia (stained with hematoxylin-eosin). On high magnification,
crypt abscess and a mixed inflammatory infiltrate within the lamina
propria are present.
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in particular no evidence of IBD (3) (Fig. 4). In addition, there
was no evidence of arborizing smooth muscle central cores or
hyperplastic mucosa to suggest Peutz-Jeghers polyps or evidence
of cystically dilated glands or expansion of the lamina propria to
suggest juvenile polyps.
These findings constituted a diagnosis of localized giant inflammatory
polyp.
Discussion. Localized giant inflammatory pseudopolyps were
first described in 1968 and are usually associated with IBD 2 .
Little is known about the etiopathogenesis of this entity, mostly
because of its rarity: some theories consider them as an excessive
mucosal response due to chronic injury, for example inflammation
and regeneration in ulcerative colitis 3 . Their distribution and
size depends on the extent of the primary disorder.
The appearance (bulky mass, central depression, concentric
thickening in colon) generally leads to a clinical suspicion of
carcinoma.
Our case is a rare localized giant inflammatory polyp not associated
with IBD; the adjacent colonic mucosa was normal, with no
evidence of inflammation.
Two cases of non IBD associated polyps have been previously
described: both were found in middle aged men, without specific
symptoms or history of inflammatory bowel disease. Both cases
lacked dysplastic lesions. Histologic features are similar to our
case 7 3 .
In conclusion, localized giant inflammatory polyps of the colon
represent an uncommon distinct entity. They may very rarely occur
in patients lacking a history of IBD which may cause serious
diagnostic problems, especially if malignancy is suspected.
references
1 Rosai and Ackerman’s; Tenth Edition; Chapter 11, pp. 773-4.
2 Hinrichs HR, Goldman H. Localized giant pseudopolyps of the colon.
JAMA 1968;205:248-9.
3 Wolf EM, Strasser C, Geboes K, et al. Localized giant inflammatory
polyp of the colon in a patient without inflammatory bowel disease.
Virchows Arch 2011;459:245-6.
4 Lee CG, Lim YJ, Choi JS, et al. Filiform polyposis in the sigmoid
colon: A case series. World J Gastroenterol 2010;16:2443-7.
5 Tendler DA, Aboudola S, Zacks JF, et al. Prolapsing Mucosal Polyps:
An Underrecognized Form of Colonic Polyp - A Clinicopathological
Study of 15 Cases. The American Journal Of Gastroenterology
2002;97:370-6.
6 Oakley GJ III, Schraut WH, Peel R, et al. Diffuse Filiform Polyposis
With Unique Histology Mimicking Familial Adenomatous Polyposis in
a Patient Without Inflammatory Bowel Disease. Arch Pathol Lab Med
2007;131:1821-4.
7 Tan KH, Meijer S, Donner R. Giant localized pseudopolip of the colon
without colonic inflammation disease – case report. Neth J Surg
1987;39:95-97.
regenerative hepatic nodules in children treated for
malignancy: a case report and review of literature
P. Ceriolo1 , V. Vitale2 , M. Bertamino2 , S. Bruno3 , F. Pitto3 ,
C. Rossi3 , M. Bruzzone3 , L. Mastracci3 , F. Grillo3 1 2 Histopathology and Department of Pediatric Hematology and Oncology,
Giannina Gaslini Institute IRCC, Genova; 3 Histopathology, DISC,
University of Genova - IRCCS Azienda Ospedaliera Universitaria San
Martino - IST - Istituto Nazionale per la Ricerca sul Cancro, Genova
Introduction. The discovery of liver nodules during post-cancer
surveillance is a diagnostic challenge. Detection of these lesions
is frequently accidental, during imaging performed in the follow
up of oncologic patients and it raises important queries as to differential
diagnosis, including primary and metastatic liver lesions.
Benign regenerative lesions however have been described in pediatric
patients after administration of cytoreductive agents or bone
marrow transplant (BMT) and may be seen frequently 1 . Few of
these benign lesions however have been biopsied and, in particular,
no systematic case series of biopsied liver nodules exists. Most au-