P0177 - A Rare Case of Large Polyploid AVM Presenting as Intermittent Abdominal Pain in a Young Patient

Nishit Patel, MD¹, Hammad Liaquat, MD², Brittney Shupp, DO³, Mina Aiad, DO³, Ahmed Hassan, MD³, Lisa Stoll, MD³, Ayaz Matin, MD^3
1St. Luke's University Hospital, Easton, PA; ²St. Luke's University Health Network, Fountain Hill, PA; ³St. Luke's University Hospital, Bethlehem, PA

Introduction: Vascular lesions of colon like angiodysplasias and arteriovenous malformations(AVM) are typically large, solitary, and flat or elevated. Polyploid appearance is extremely rare. Polyploid AVM can be mistaken for malignancy, inflammatory polyp or athero-emboli-associated polyps. We present an interesting case of an incidental polyploid mass in the descending colon, treated with hemi-colectomy and later diagnosed histologically as vascular ectasia.

Case Description/Methods: A 30-year-old male was initially seen in the office for incidental mass seen in the descending colon on abdominal imaging, which was done as a part of trauma work up after fall. The only pertinent complain at the time was occasional abdominal cramping ongoing for many months. The CT scan with IV contrast revealed a 2.3 cm x 2.6 cm sub-mucosal lesion with coarse calcification without enhancement with contrast [image A]. Upon review of old records, he had a similar lesion in imaging done 5 years ago, however he denied any prior knowledge of the same or any prior colonoscopy. He underwent a colonoscopy which revealed a nearly 3 cm traversable mass with cobblestone appearance and patchy erythema suggestive of inflammation [image B]. Cold biopsy was performed which showed fragments of normal mucosa without dysplasia or evidence of malignancy. He underwent EUS for better characterization which showed heterogenous, hypoechoic mass with multiple hyperechoic areas, arising from muscularis propria without vascular flow [image C]. Considering ongoing abdominal pain without any other source, along-with significant bleeding risk, size & appearance of the lesion, and unclear histological diagnosis, endoscopic resection was avoided and surgical resection was recommended. He underwent left hemicolectomy with colorectal anastomosis and lymph node resection. Excision biopsy of the mass and lymph ndoes revealed no malignant process. Histological examination showed thick-walled arteries (black arrow) and thin-walled veins (white arrow), consistent with AVM with calcification [image D].

Discussion: Usually AVMs usually present with anemia or are asymptomatic like our patient. Most of the similar cases described in literature were diagnosed with endoscopic biopsy and treated with endoscopic options, however in our case biopsy was not conclusive. This can make management challenging. This report highlights the colonoscopy and endoscopic ultrasound(EUS) findings of a polyploid AVM in the colon.


Figure: A. Abdominal CT scan. B. Colonoscopic view. C. Lower Endoscopic Ultrasound View. D. Histopathology.


Disclosures:
Nishit Patel indicated no relevant financial relationships.
Hammad Liaquat indicated no relevant financial relationships.
Brittney Shupp indicated no relevant financial relationships.
Mina Aiad indicated no relevant financial relationships.
Ahmed Hassan indicated no relevant financial relationships.
Lisa Stoll indicated no relevant financial relationships.
Ayaz Matin indicated no relevant financial relationships.


Nishit Patel, MD¹, Hammad Liaquat, MD², Brittney Shupp, DO³, Mina Aiad, DO³, Ahmed Hassan, MD³, Lisa Stoll, MD³, Ayaz Matin, MD³. P0177 - A Rare Case of Large Polyploid AVM Presenting as Intermittent Abdominal Pain in a Young Patient, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.