Diffuse Giant Inflammatory Polyposis: A Challenging Clinicopathologic Diagnosis

Abstract Giant inflammatory polyposis of the colon is an uncommon manifestation of inflammatory bowel disease. We report a unique case of localized diffuse giant inflammatory polyposis in a 58-year-old white man, which was characterized by recurrence following initial surgical resection. The patient presented with symptoms of abdominal pain and passing blood per rectum. Colonoscopic examination revealed a near-obstructing, “fungating” mass in the sigmoid colon, which clinically was thought to represent colon carcinoma. Histology of several colon biopsies revealed marked acute inflammation with microabscess formation of the polyps and the adjacent mucosa. There was no evidence of dysplasia or malignancy. Because malignancy was strongly suspected and to relieve the obstructive symptoms, the patient underwent a segmental colectomy. The histologic features of the resected mass showed giant polyps with acute inflammation diagnostic of giant inflammatory polyposis. Again, there was no evidence of malignancy. Seven months later, following an uneventful initial postoperative recovery, the patient developed a recurrence of the mass with obstructive symptoms and required further surgical resection. The gross and histologic features of the lesion were similar to the previous findings. This case highlights the varied presenting symptoms and deceptive gross colonoscopic and radiologic features of localized diffuse giant inflammatory polyposis. Finally, the presence of inflammation at the resection margins appears to predict recurrence or persistence of the disease.

Download Full-text

Obstructive Giant Inflammatory Polyposis: Is It Related to the Severity or the Duration of the Inflammatory Bowel Disease? Two Case Reports

Case Reports in Gastrointestinal Medicine ◽

10.1155/2018/3251549 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Antoine Abou Rached ◽

Jowana Saba ◽

Leila El Masri ◽

Mary Nakhoul ◽

Carla Razzouk

Keyword(s):

Inflammatory Bowel Disease ◽

Surgical Resection ◽

Bowel Disease ◽

Transverse Colon ◽

Case Reports ◽

Rare Complication ◽

Inflammatory Bowel ◽

Inflammatory Polyposis ◽

One Year

We report two cases of giant inflammatory polyposis (GIP) with totally different presentation and evolution. The first patient had two giant pseudopolyps after one year of the diagnosis of UC. The second patient had one obstructive giant pseudopolyp secondary to CD at the level of the transverse colon, being totally asymptomatic years before the presentation. GIP is a rare complication of inflammatory bowel disease (IBD). It consists of numerous filiform polyps that look like a “mass of worms” or a “fungating” mass. Surgical resection is inevitable when GIP presents with obstructive symptoms.

Download Full-text

Radiation Therapy Improves Local Control in Juvenile Nasopharyngeal Angiofibroma following Disease Progression after Embolization and Surgical Resection: A Case Report

Case Reports in Oncology ◽

10.1159/000512061 ◽

2021 ◽

pp. 739-745

Author(s):

Zane Blank ◽

Richard Sleightholm ◽

Beth Neilsen ◽

Michael Baine ◽

Chi Lin

Keyword(s):

Radiation Therapy ◽

Disease Progression ◽

Surgical Resection ◽

Local Control ◽

Benign Neoplasm ◽

Good Prognosis ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Adjuvant Radiation ◽

Nasopharyngeal Angiofibroma ◽

Presenting Symptoms

Juvenile nasopharyngeal angiofibroma (JNA) is a relatively uncommon, benign neoplasm of the nasopharynx that can be very difficult to diagnose early due to inconspicuous and seemingly harmless presenting symptoms. Early diagnosis and treatment of JNA are essential for a good prognosis. JNA typically responds well to radiation therapy (RT), but when it does not, the most appropriate next course of action has not been readily defined due to the limited occurrence and experience with this neoplasm. Herein, we describe a JNA patient, who continued to progress after surgery and 36 Gy of adjuvant radiation, but after an additional 14.4 Gy, he has remained in remission for over 2 years. An 11-year-old boy who presented with JNA underwent treatment with embolization and surgical resection. Unfortunately, the tumor progressed within 2 months of surgical intervention and he required RT for adequate local control. While undergoing RT, he again demonstrated signs of progression; so his radiation regimen was increased from 3,600 cGy in 20 fractions to 5,040 cGy in 28 fractions. Since completing RT, the tumor has continued to decrease in size, and the patient is stable and has been without signs of disease progression for over 24 months now. Thus, escalating the radiation regimen to 5,040 cGy may improve local control in rapidly progressive JNA.

Download Full-text

The “proof-of-principle” evaluation of fiberoptic fluorescence microscopy for microresidues within surgical resection margins in pancreatic carcinoma

Pancreatology ◽

10.1016/j.pan.2021.05.182 ◽

2021 ◽

Vol 21 ◽

pp. S68

Author(s):

S. Ackermann ◽

V. Rohrbacher ◽

S. Thomann ◽

T. Hackert ◽

E. Ryschich ◽

...

Keyword(s):

Fluorescence Microscopy ◽

Pancreatic Carcinoma ◽

Surgical Resection ◽

Resection Margins ◽

Proof Of Principle

Download Full-text

Redefining Adequate Surgical Resection Margins for Oral Squamous Cell Carcinoma: Our Institutional Experience in 5 Consecutive Years

Journal of Surgery and Research ◽

10.26502/jsr.10020152 ◽

2021 ◽

Vol 04 (03) ◽

Author(s):

Irene Urquiza-Fornovi ◽

Mario Santás-Alegret ◽

Ana Ramos-Zayas ◽

Irene Ruiz-Martín ◽

María Mejía-Nieto ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Surgical Resection ◽

Squamous Cell ◽

Resection Margins ◽

Institutional Experience

Download Full-text

Pancreatic Cancer Surgical Resection Margins: Molecular Assessment by Mass Spectrometry Imaging

PLoS Medicine ◽

10.1371/journal.pmed.1002108 ◽

2016 ◽

Vol 13 (8) ◽

pp. e1002108 ◽

Cited By ~ 41

Author(s):

Livia S. Eberlin ◽

Katherine Margulis ◽

Ivette Planell-Mendez ◽

Richard N. Zare ◽

Robert Tibshirani ◽

...

Keyword(s):

Mass Spectrometry ◽

Pancreatic Cancer ◽

Surgical Resection ◽

Mass Spectrometry Imaging ◽

Resection Margins ◽

Molecular Assessment

Download Full-text

Clozapine-induced stercoral colitis: a surgical perspective

BMJ Case Reports ◽

10.1136/bcr-2018-227718 ◽

2019 ◽

Vol 12 (8) ◽

pp. e227718 ◽

Cited By ~ 2

Author(s):

Jayan George ◽

Richard Hotham ◽

William Melton ◽

Keith Chapple

Keyword(s):

Abdominal Pain ◽

Ct Scan ◽

Total Colectomy ◽

Postoperative Recovery ◽

Presenting Symptoms ◽

History Of

We describe a case of a 46-year-old man with schizophrenia treated with clozapine who presented as an emergency with abdominal pain on the background of a 1 month history of constipation. The initial presenting symptoms were vague and a diagnosis was difficult to establish. Initial CT of the abdomen and pelvis demonstrated only minor abnormalities. He continued to deteriorate until a further CT scan revealed worsening stercoral colitis. He subsequently underwent an emergency total colectomy and ileostomy formation and had a complicated prolonged postoperative recovery. This case highlights the risks that clozapine can have on slowing bowel transit and the dangerous consequences that can occur if not identified early.

Download Full-text

492 Reduced Surgical Resection Rates With Increasing Immunosuppressant use in a Population-Based Inflammatory Bowel Disease (IBD) Cohort in Cardiff (1988-2003)

Gastroenterology ◽

10.1016/s0016-5085(10)60318-6 ◽

2010 ◽

Vol 138 (5) ◽

pp. S-70

Author(s):

Arvind Ramadas ◽

Cassandra Gwinnutt ◽

Gareth Thomas ◽

Geraint Williams ◽

Antony B. Hawthorne

Keyword(s):

Inflammatory Bowel Disease ◽

Surgical Resection ◽

Bowel Disease ◽

Population Based ◽

Inflammatory Bowel

Download Full-text

Regnase-1 controls colon epithelial regeneration via regulation of mTOR and purine metabolism

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1809575115 ◽

2018 ◽

Vol 115 (43) ◽

pp. 11036-11041 ◽

Cited By ~ 12

Author(s):

Yasuharu Nagahama ◽

Mayuko Shimoda ◽

Guoliang Mao ◽

Shailendra Kumar Singh ◽

Yuuki Kozakai ◽

...

Keyword(s):

Acute Inflammation ◽

Intestinal Inflammation ◽

Intestinal Barrier ◽

Body Weight Loss ◽

Purine Metabolism ◽

Intestinal Epithelial ◽

Beneficial Effects ◽

Epithelial Regeneration ◽

Mtorc1 Signaling ◽

Inflammatory Bowel

Damage to intestinal epithelial cell (IEC) layers during intestinal inflammation is associated with inflammatory bowel disease. Here we show that the endoribonuclease Regnase-1 controls colon epithelial regeneration by regulating protein kinase mTOR (the mechanistic target of rapamycin kinase) and purine metabolism. During dextran sulfate sodium-induced intestinal epithelial injury and acute colitis, Regnase-1∆IEC mice, which lack Regnase-1 specifically in the intestinal epithelium, were resistant to body weight loss, maintained an intact intestinal barrier, and showed increased cell proliferation and decreased epithelial apoptosis. Chronic colitis and tumor progression were also attenuated in Regnase-1∆IEC mice. Regnase-1 predominantly regulates mTORC1 signaling. Metabolic analysis revealed that Regnase-1 participates in purine metabolism and energy metabolism during inflammation. Furthermore, increased expression of ectonucleotidases contributed to the resolution of acute inflammation in Regnase-1∆IEC mice. These findings provide evidence that Regnase-1 deficiency has beneficial effects on the prevention and/or blocking of intestinal inflammatory disorders.

Download Full-text