Filiform polyposis with sigmoid colon adenocarcinoma: a case report

Abstract

BackgroundFiliform polyposis is a rare form of inflammatory polyposis, which is occasionally formed in the colon of patients with history of inflammatory bowel disease (IBD). It is characterized by presence of several to hundreds of slender, worm-like polyps in the colon lined by histologically normal colonic mucosa and often coalesce, resulting in a tumor-like mass. Filiform polyposis is most frequently associated with a post-inflammatory reparative process in patients with IBD history, and only cases of filiform polyposis occurring in patients without IBD history have been reported. Filiform polyposis has been considered as a benign inflammatory polyposis without any risk of dysplasia, while the possibility of carcinogenesis of inflammatory polyps is not fully excluded. To date, only three cases of filiform polyposis coexisting with dysplasia have been reported.Case presentationA 59-year-old male patient with no past medical history of IBD underwent laparoscopic sigmoidectomy for obstructive filiform polyposis, which was associated with sigmoid colon adenocarcinoma. Based on the histological findings of the resected specimen, invasive sigmoid colon adenocarcinoma was surrounded by filiform polyposis, and adenocarcinoma also scattered uniformly on the surface of filiform polyposis. In immunohistochemistry, abnormal p53 expression was observed in adenocarcinoma, while it was not shown in mucosa on filiform polyposis.ConclusionsThis is the fourth case of filiform polyposis that is closely associated with colon dysplasia or adenocarcinoma based on histological findings. However, immunohistochemical findings did not support the theory that inflammation initiates adenocarcinoma in filiform polyposis like IBD. Hence, further immunohistochemical and genetic analyses are needed to clarify the association between filiform polyposis and carcinogenesis.

Filiform polyposis presenting with rapid growth and severe anemia case report

“…According to the data in the literature, the average duration reported for formation since diagnosis with UC is approximately 3 to 276 months [5] . With a length up to 16 cm [9] , the sigmoid colon is the most common site [7] , [10] , which is consistent with the fact that 30–50 % of UCs are confined to the rectum and sigmoid colon [11] . The histopathological appearance of FP is generally normal to acute or chronic inflammatory colonic mucosa [10] , [12] .…”

“…There are several hypotheses for the formation of inflammatory polyps, including severe mucosal inflammation that occurs due to the IBD, which overgrows the mucosa, after the inflammation subsides, due to fecal stream traction or repeated inflammation and healing of mucosa during the healing period [4] , [6] , [7] , this is seen in 17 % of UC with active colitis [8] . As in our patient, the histopathology component was acute on top of chronic UC, which formed within six months only.…”

Giant filiform polyposis with high-grade dysplasia: A case report and review of the literature

“…Generally, it forms in the colon of patients with a history of IBD. Eighteen cases (full text available) of filiform polyposis originated from the normal colon with no history of IBD, of which two (11%) cases were associated with adenocarcinoma ( Table 1 ) [ 2 , [6] , [7] , [8] , [10] , [11] , [12] , [13] , [14] , [15] , [16] ]. Eighty-six cases of filiform polyposis were associated with IBD, of which, 48 and 38 were associated with UC and Crohn's disease (CD), respectively ( Table 2 ) [ 3 , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] ].…”

“…Filiform polyposis has been considered a benign inflammatory polyp without any risk of dysplasia; however, a few cases of filiform polyposis associated with dysplasia and adenocarcinoma have been reported [ 7 , [16] , [17] , [18] ]. Although these reports suggest that filiform polyposis may have carcinogenic potential, the mechanism of carcinogenesis of filiform polyposis remains unclear; thus, further accumulation of cases is necessary.…”

Clinicopathologic Characteristics and Neoplasia Risk of Colorectal Inflammatory Polyposis in Inflammatory Bowel Disease

“…51,52 Importantly, FP/GIP is not pathognomonic for IBD because it has also been described in other conditions, albeit less frequently, including tuberculosis, histiocytosis X, diverticulosis, and ischemia, and in patients with colorectal adenocarcinoma and/or obstruction of no known etiology. [53][54][55][56][57][58][59][60][61][62][63] Given their macroscopic appearance, colonic IPs in IBD may resemble adenomatous polyps and, when multiple, may prevent sufficient certainty in excluding dysplasia in the surrounding colitic mucosa, thus often leading to surgical resection in these patients. 39,45,47,64 However, there have been only 2 reported cases of occult (ie, previously unknown or unexpected) dysplasia/carcinoma identified in colonic specimens from patients with localized GIP, and both patients had had long-standing IBD.…”