Colorectal Inflammatory Pseudopolyps: A Retrospective Analysis of 70 Patients

DOI: 10.4236/ojpathology.2014.43015   PDF   HTML     5,242 Downloads   6,308 Views   Citations

Abstract

Introduction: Inflammatory pseudopolyps (IPs) are a well-recognized entity in patients with inflammatory bowel disease (IBD), most likely developing from long-standing chronic inflammation. Similarly, IPs have been associated with ischemic and infectious colitis, intestinal ulcers, and mucosal anastomoses. This study aimed to analyze inflammatory pseudopolyps without a history of these known associated pathologies. Materials and Methods: A database search was conducted for patients who underwent biopsies at Thomas Jefferson University Hospital from 2003-2013 for the presence of colorectal IPs. Exclusion criteria consisted of patients with a history of IBD, mucosal anastomoses, ischemic and infectious colitis. Spatial and temporal associations between colonic pathologies and IPs were assessed via Fisher’s exact and chi-square test, respectively. Results: Seventy-five polyps from 70 patients fulfilled the database search criteria. Forty-one pseudopolyps (55%) arose from the rectosigmoid region. Twenty-two patients had no associated colon pathology (31%); 35 patients had epithelial polyps (50%), such as tubular adenomas, serrated adenomas, and hyperplastic polyps; 10 patients had colonic adenocarcinoma (16%), and 18 patients had diverticulosis (26%). Epithelial polyps were significantly associated with IPs in the same region. However, diverticulosis was independent of IPs in regard to space and time. Conclusion: Colorectal inflammatory pseudopolyps may develop sporadically in up to one third of the cases while others frequently arise in the background of non-IBD colonic pathology. The increased presence of these polyps in the left colon raises the possibility that a subset of them may arise in predisposed mucosa. These polyps need to be differentiated from other morphologically similar colonic polyps.

Share and Cite:

Gandhi, A. , Malik, S. and Palazzo, J. (2014) Colorectal Inflammatory Pseudopolyps: A Retrospective Analysis of 70 Patients. Open Journal of Pathology, 4, 94-100. doi: 10.4236/ojpathology.2014.43015.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Iofel, E., Kahn, E., Lee, T. and Chawla, A. (2000) Inflammatory Polyps after Necrotizing Enterocolitis. Journal of Pediatric Surgery, 35, 1246-1247. http://dx.doi.org/10.1053/jpsu.2000.8763
[2] Levine, D.S., Surawicz, C.M., Spencer, G.D., Rohrmann, C.A. and Silverstein, F.E. (1986) Inflammatory Polyposis Two Years after Ischemic Colon Injury. Digestive Diseases and Sciences, 31, 1159-1167. http://dx.doi.org/10.1007/BF01300268
[3] Quirke, P., Risio, M., Lambert, R., Karsa, L. and Vieth, M. (2011) Quality Assurance in Pathology in Colorectal Cancer Screening and Diagnosis—European Recommendations. Virchows Archiv, 458, 1-10. http://dx.doi.org/10.1007/s00428-010-0977-6
[4] Christos, P., Konstantinos, F., Kanelina, B., Afrodite, P., Stilianos, A. and Hatzitheoharis, G. (2006) Colonic Obstruction Due to Localized Giant Pseudopolyposis Complicating Ulcerative Colitis. The Internet Journal of Surgery, 8.
[5] Vaněk, J. (1949) Gastric Submucosal Granuloma with Eosinophilic Infiltration. The American Journal of Pathology, 25, 397.
[6] Stolte, M. and Finkenzeller, G. (1990) Inflammatory Fibroid Polyp of the Stomach. Endoscopy, 22, 203. http://dx.doi.org/10.1055/s-2007-1012848
[7] Shalom, A., Wasserman, I., Segal, M. and Orda, R. (2000) Inflammatory Fibroid Polyp and Helicobacter Pylori. Aetiology or Coincidence? European Journal of Surgery, 166, 54-57.
[8] Sen, G.R. (2001) Inflammatory Fibroid Polyps of the Gastrointestinal Tract. Pathologe, 22, 333-338. http://dx.doi.org/10.1007/s002920100473
[9] Makhlouf, H.R. and Sobin, L.H. (2002) Inflammatory Myofibroblastic Tumors (Inflammatory Pseudotumors) of the Gastrointestinal Tract: How Closely Are They Related to Inflammatory Fibroid Polyps? Human Pathology, 33, 307-315. http://dx.doi.org/10.1053/hupa.2002.32213
[10] Merkel, I.S., Rabinovitz, M. and Dekker, A. (1992) Cecal Inflammatory Fibroid Polyp Presenting with Chronic Diarrhea. Digestive Diseases and Sciences, 37, 133-136.
http://dx.doi.org/10.1007/BF01308356
[11] Chetty, R., Bhathal, P. and Slavin, J. (1993) Prolapse-Induced Inflammatory Polyps of the Colorectum and Anal Transitional Zone. Histopathology, 23, 63-67. http://dx.doi.org/10.1111/j.1365-2559.1993.tb01184.x
[12] Corman, M.L. (1985) Rectal Prolapse in Children. Diseases of the Colon & Rectum, 28, 535-539. http://dx.doi.org/10.1007/BF02554107
[13] Groff, D.B. and Nagaraj, H.S. (1990) Rectal Prolapse in Infants and Children. The American Journal of Surgery, 160, 531-532. http://dx.doi.org/10.1016/S0002-9610(05)81022-0

  
comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.