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Recurrent myoglandular polyps in a sixteen year old

Serge A. Sorser, Mohammed Barawi, Hernando Lyons

Am J Case Rep 2011; 12:134-136

DOI: 10.12659/AJCR.882092

Published: 2011-11-03

Abstract: Background: An Inflammatory Myoglandular Polyp (IMP) most commonly presents as lower GI bleeding, with distinct findings on histology. IMP has been described in adults, but never as a recurrent entity in Pediatrics.
Case Report: We present an 11-year-old Caucasian male complaining of periumbilical abdominal pain and up to eight loose, bloody bowel movements daily. A colonoscopy was performed, which was grossly normal until retroflexion in the rectum showed multiple polypoid lesions with ulcerated mucosa. Histologically, the lesions displayed extensive inflammatory granulation tissue especially along the surface, which exhibited focal erosions, but a fibrin cap was absent. The crypts were hyperplastic and cystically dilated, and there was abundant extravasated mucin. These findings were reminiscent of juvenile polyps. However, there were also abundant smooth muscle cells in the lamina propria interspersed with the crypts and extending radially from the muscularis mucosae toward the surface. Trichrome stains confirmed proliferation of smooth muscle cells in the lamina propria. The quantity of smooth muscle was considerably more than the occasional smooth muscle cell seen in juvenile polyps. Of interest, while the symptoms that the patient had presented with had almost completely resolved immediately after endoscopy, they recurred approximately three and one half years later, and then again one year after that. A colonoscopy was performed both times, which showed the same anatomic lesions, with pathology confirming the diagnosis of IMP. The diagnosis of IMP is based strictly on the histological findings.
Conclusions: While case reports and case series have presented these polyps in the adult population, they have not been documented in the pediatric population or as a recurring entity.

Keywords: Myoglandular polyps, gastrointestinal bleed, local recurrence