Filiform polyposis of the colon in chronic inflammatory bowel disease* (so-called giant inflammatory polyps)

Abstract

On the basis of 3 of our own cases, we describe unusually intense forms of filiform polyposis and local giant polyposis as a consequence of chronic inflammatory bowel disease. The patients are: A 52-year-old woman who for 7 years has been known to have Crohn's disease (CD); a 55-year-old man who for 14 years has been known to have chronic inflammatory bowel disease, which was first thought to have been ulcerative colitis, but, as a result of the findings on the subtotal colectomy specimen, had to be classified as Crohn's disease or colitis indeterminate; and a 53-year-old woman known to have had ulcerative colitis for 37 years. From the literature on the subject, we drew up a chronological list of a total of 43 cases with similar or completely identical findings. The clinical significance of the findings in their particularly massive intensity results from their necessary differentiation--in the context of differential diagnosis--from a malignant tumor, in particular from a carcinoma in association with chronic inflammatory bowel disease, or from a villous adenoma. The indication of a need to operate results from the impossibility of being able definitely to rule out a malignant degeneration by means of clinical methods. Also, experience shows that with massive findings of the kind described a spontaneous disappearance cannot be expected. Finally, too, the clinical symptoms and the patients subjective complaints necessitate balanced surgical treatment, taking into consideration the site and the extent of the lesion.

Colonic Filiform Polyposis in a Patient without Inflammatory Bowel Disease

“…Filiform polyps themselves are not considered precancerous [9]. However, tight collections of filiform polyps or "giant inflammatory polyps" can mimic adenomatous polyps and even malignancy [8]. While some authors believe that filiform polyposis itself is not an indication to operate [9,17] local resections have been performed in many of the reported cases because an occult adenocarcinoma was reported to have been found in a giant pseudopolyp [10].…”

“…In some cases, the polyps are difficult to distinguish from villous adenomas, and biopsies are needed to make the diagnosis [8,9]. On microscopic examination, the polyps are lined by normal, edematous, or superficially ulcerated colonic mucosa [10].…”

“…Filiform polyposis has a slight preponderance in men, affecting a range of ages from 6 to 77 years, with an average of 38 years [8]. In some cases, the polyps are difficult to distinguish from villous adenomas, and biopsies are needed to make the diagnosis [8,9].…”

“…The term filiform polyposis was used to define a condition characterized by the presence of numerous, densely packed, filiform polyps in the gastrointestinal tract, which microscopically have wormlike projections of mucosa and submucosa [8]. Although filiform polyposis typically occurs in the setting of IBD, it is important to realize that rare cases, including ours, have occurred with no prior history or symptoms of IBD.…”

Giant filiform polyposis in a patient with inflammatory bowel disease presenting with intestinal obstruction

“…The colon remains the most involved site and the sigmoid colon is the commonest location; additionally oesophageal, gastric and small intestinal involvement has been described. Sparing of the rectum is also documented in the literature [4,5].…”