Polyp Characteristics of Nonsyndromic and Potentially Syndromic Juvenile Polyps

Abstract

Background: Juvenile polyps (JPs) are the most common gastrointestinal polyps diagnosed in children. There is paucity of evidence differentiating polyp burden groups and the presence and significance of neoplastic changes. Methods: A retrospective chart review of patients, ages birth through 18 years with nonsyndromic JPs was performed from 2003 to 2017. Abstracted data included basic demographics, age, clinical presentation, colonoscopy findings, and pathology report. Slides of polyps with neoplasia were reviewed by a pathologist. Results: A total of 213 subjects underwent 326 procedures and 435 polypectomies. Subjects with positive family history, positive gene mutations, or numerous (>10) polyps were excluded. Groups were defined by polyp number (1, 2–4, 5–10). Polyp recurrence on repeat colonoscopy was significantly related to polyp burden (1 polyp: 1.5%/2–4 polyps 19.2%/5–10 polyps 82.6%: P < 0.001). Polyp distribution was significantly different amongst different groups with isolated polyps favoring a distal distribution. JPs harboring adenomatous foci were reported in 26 (12%) patients. JPs harboring adenomatous foci were significantly more likely to be proximally distributed but the presence of adenomatous transformation within the polyps did not correlate with polyp number or the likelihood of polyp recurrence on repeat colonoscopy. Conclusions: JP recurrence is positively and significantly related to polyp burden. JP harbored adenomatous changes independent of polyp number, underscoring a possible malignant potential in JPs. In the absence of a consistent genotype or pedigree, the presence of adenomatous transformation within JPs cannot be construed as a biomarker for syndromic juvenile polyposis.

Characteristics and potential malignancy of colorectal juvenile polyps in adults: a single-center retrospective study in China

“…They were all single polyps. Neither neoplasia nor carcinogenesis was associated with the number of polyps in adults, as reported in children 13 .…”

“…Based on the results of the immunohistochemical markers mentioned above, we hypothesized that juvenile polyps may follow a 'low-grade intraepithelial neoplasia to high-grade intraepithelial neoplasia to carcinoma' pathway. In a study involving 213 pediatric patients, the researchers also found adenomatous changes, suggesting the same progression 13 . Based on these ndings, the risk of carcinogenesis and route of cancerization are independent of age and the number of polyps.…”

“…In children, 42%-75.9% had a single polyp 12,13 . A total of 83.2% of the polyps were Paris 0-Isp/Ip according to the Paris endoscopic classi cation 14,15 in our study, which is similar to previous reports 16 .…”

Estudio de la relación entre alteraciones de la mucosa colónica y la alergia a leche de vaca en pacientes pediátricos

“…Los pacientes con menos de 3 pólipos generalmente se han considerado de bajo riesgo de recurrencia de pólipos. Sin embargo, resultados recientes sugieren que los niños que presentan incluso un solo pólipo pueden continuar formando pólipos con el tiempo, dándose la mayor tasa de recurrencia en pacientes con múltiples pólipos (no sindrómicos) (Fox et al, 2010;Ibrahimi et al, 2019).…”

“…Además, es conocido que el tratamiento con Omalizumab (anticuerpo monoclonal humano anti-IgE) de pacientes con asma y pólipos nasales ha logrado controlarlos síntomas nasales y bronquiales . Dado que existe una creciente sospecha sobre el riesgo de desarrollo de tumores a partir de los PJ (Ibrahimi et al, 2019) y que un porcentaje significativo de pacientes tienen recurrencia (Fox et al, 2010), se deben considerar nuevas estrategias para controlar el desarrollo de PJ, además de la polipectomía que se emplea actualmente. El control del proceso inflamatorio mucosal y de la síntesis de la IgE, no solo permitiría modular el proceso alérgico en pacientes sensibilizados, sino también el proceso de poliposis juvenil.…”