Rapid tumour‐like growth of giant filiform polyposis in a patient without a history of chronic bowel inflammation

Abstract

Long-term inflammation of the colonic mucosa during chronic inflammatory bowel disease with alternating periods of ulceration and healing may lead to the formation of finger-like projections, so-called filiform polyps. In rare cases, several filiform polyps form large tumour masses, termed giant filiform polyposis. We present a case of giant obstructing filiform polyposis in a patient without previous evidence of chronic bowel inflammation. The resected ascending colon from a 37-year-old woman was evaluated macroscopically and microscopically, and the presence of gene polymorphisms was studied by means of multiplex capillary electrophoresis single-strand conformation polymorphism assay, DNA sequencing, TaqMan analysis, and restriction enzyme cleavage. The giant filiform polyposis was restricted to a 15 cm segment of the ascending colon, and the remaining colonic mucosa was entirely without inflammatory changes. During the post-operative follow-up period, the patient developed symptoms and signs of distal bowel inflammation. Gene polymorphism studies were inconclusive as to Crohn's disease. In conclusion, we present an unusual pathological entity of giant filiform polyposis, which developed relatively rapidly in a colon without any history or macroscopic changes suggestive of chronic inflammatory bowel disease. Although the patient subsequently developed symptoms in keeping with Crohn's disease, studies of genetic polymorphism were unable to confirm this notion, and colorectal tissue has not been sampled postoperatively for histological evaluation.

Colonic mucosubmucosal elongated polyp: report of a series of 14 cases and review of the literature

“…Filiform polyps are slender finger‐like projections that are thought to represent a reparative phenomenon owing to repeated cycles of ulceration and healing, usually in the context of IBD . Unlike CMSEPs, filiform polyps are multiple, tend to occur in clusters, and sometimes occur as large tumour masses (hence the name giant filiform polyposis), with a predilection for the sigmoid colon . These polyps are often covered by variably inflamed colonic mucosa, sometimes with hyperplastic lymphoid follicles.…”

Rectal localized giant inflammatory polyposis with indeterminate colitis

“…Another 7 cases were reported thereafter [3][4][5][6][7][8]. Of these 82 cases, 45 were associated with UC, 35 were associated with CD, and only 2 were not associated with IBD.…”

Pólipos postinflamatorios y enfermedad inflamatoria intestinal. Reporte de caso y revisión de la literatura

“…Hay reportes recientes en los que se destaca el valor del uso de anti-FNT en el control de los focos de proliferación extracolónica, principalmente en el esófago, para aquellos pacientes con fracaso a la terapia inicial y síntomas relacionados persistentes (23)(24)(25)(26)(27)(28)(29)(30).…”