University of Connecticut Health Center farmington, CT
Jaimy Villavicencio Kim, MD1, Alexander Perelman, DO, MS2, Rahul Sao, MD3, Sheena Mago, DO4, Rishabh Sachdev, MD4; 1University of Connecticut Health Center, West Hartford, CT; 2University of Connecticut, Farmington, CT; 3University of Connecticut Health Center, Annapolis, MD; 4University of Connecticut Health Center, Farmington, CT
Introduction: First described by Nakamura et al. in 1992, inflammatory myoglandular polyps (IMGPs) are rare, non-neoplastic polyps. Most commonly located in the rectosigmoid colon, they typically present with non-specific symptoms and have distinctive endoscopic and histologic features. We present a case of a young male with altered bowel habits and rectodynia who was found to have an IMGP incidentally on colonoscopy.
Methods: A 32-year-old male with no past medical history presented to clinic complaining of fatigue, constipation and pencil-like stools over several months. He denied any rectal bleeding, weight loss, or family history of colorectal cancer. A bowel regimen was started. Routine lab work was notable for normocytic hypochromic anemia with normal iron studies and folate and vitamin B12 deficiency. At follow-up, the patient noted no significant improvement in constipation along with decreased appetite, post-prandial fullness, bloating, early satiety, and new reports of rectodynia and 5-lb weight loss. Given his constellation of symptoms, the decision was made to pursue further evaluation with colonoscopy. Findings included a normal rectal exam, grade 1 internal hemorrhoids, an adenomatous polyp in the descending colon, and an atypical pedunculated polyp (Figure 1) in the rectosigmoid colon removed with hot snare. Histologic examination of the latter showed smooth muscle proliferation and hyperplastic glands with some cautery artifact, consistent with an IMGP (Figures 2 & 3). Discussion: IMGPs are usually solitary, pedunculated, with a smooth and hyperemic surface with patchy erosions and mucus exudation. They can appear similar to juvenile polyps. However, the former does harbor neoplastic potential, thus the importance of distinguishing them histologically. IMGPs are characterized by smooth muscle proliferation, hyperplastic glands, and inflammatory granulation tissue within the lamina propria. While the pathogenesis is not clearly understood, it has been proposed that chronic trauma from intestinal peristalsis or fecal stream, mucosal prolapse, and possibly ischemia may contribute to their development.
Small lesions are usually asymptomatic and found incidentally as in our patient. However, they can present with occult or overt GI bleeding, altered bowel habits, abdominal pain, anemia, tenesmus, or rectodynia. IMGPs can be removed endoscopically, while surgical treatment is reserved for large polyps ( >4-5 cm) or difficult location with increased risk of bleeding or perforation.
Atypical pedunculated polyp in rectosigmoid
This 200x H&E stained view shows distorted mucus glands seen in the polyp surrounded by inflammation, although true granulation tissue was not apparent. Figure courtesy of Melinda Sanders, MD
This 200x H&E stained view shows the muscle bundles at the right and top of the photo. There is some artifact from the specimen removal to the glands. Figure courtesy of Melinda Sanders, MD
Disclosures: Jaimy Villavicencio Kim indicated no relevant financial relationships. Alexander Perelman indicated no relevant financial relationships. Rahul Sao indicated no relevant financial relationships. Sheena Mago indicated no relevant financial relationships. Rishabh Sachdev indicated no relevant financial relationships.