La edad, localización y criptas tortuosas y dilatadas hacen pensar como primera posibilidad en pólipo juvenil. No obstante existe claramente despoblación de células caliciformes, fenómenos regenerativos, células plasmáticas y eosinófilos en la lámina propia, así como microabscesos en las criptas, así que yo consideraría fuertemente el diagnóstico de pólipo inflamatorio asociado a Colitis Crónica Ulcerosa Idiopática (bien descrito en niños).

Saludos

Reynaldo Falcón-Escobedo

Hospital Central y Facultad de Medicina, UASLP

San Luis Potosí, S.L.P.

MEXICO

Pólipo Juvenil (inflamatorio)/ Juvenile Polyp.

Prolapso mucoso puede dar cambios similares en esta area anatomica.

Saludos desde Ciudad de Guatemala.

Pólipo juvenil associado a colite.

I agree with the diagnosis of juvenile polyp with colitis. In the last two pictures I see a dilated gland containing an amorphous material surrounded by granulocytes with one (perhaps two) PAS-positive bodies with a foamy vacuolated appearance and a central core. Are they amebic trophozoites?

I am not sure at this magnification but would like to exclude such an hypothesis (with trichrome and/or PTAH stains).

Ciao a tutti da Milano

Los neutrófilos están dentro de las criptas y algunos macrófagos. Insisto en la despoblación de células caliciformes, así como cél. plasmáticas y eosinófilos en la lámina propia.

La amibiasis de colon típicamente se asocia a necrosis con escasa reacción inflamatoria, que no presenta este pólipo. De manera que un PAS + no sería diagnóstico de amibiasis, sino inmunohistoquímica (CD 68 -, Ac anti-Entamoeba hystolitica +).

Por mi se trata de um polipe juvenile associado com collite

E verdade de que pode se pensar de collite cronica,mas nao podemos ter serteza pelo colite ulcerosa.

En el caso que se presenta están presentes todos los elementos relevantes del examen histopatológico que caracterizan la PJ típica: 1) la dilatación quística de las glándulas revestidas por un epitelio columnar; 2) la lámina propia presenta un infiltrado inflamatorio con neutrófilos y eosinófilos y 3) el epitelio muestra una hiperplasia inflamatoria reactiva que puede confundirse con displasia ¿O hay verdadera displasia?

No existen dudas actualmente de que la PJ es una condición pre-maligna. Así, en una serie de 272 pacientes, se encontró un carcinoma en 48 casos, es decir el 18%. En otro estudio del Hospital St Mark de Londres, la incidencia de carcinoma fue del 15%, la edad promedio de presentación del cáncer fue de 35 años y el riesgo acumulado fue del 68% a los 60 años de edad. En una revisión de 1.025 pólipos extirpados de pacientes con PJ, Jass encontró que el 81% correspondían a pólipos juveniles típicos, 16% eran atípicos y el 2% eran adenomas. La incidencia de displasia leve, moderada e intensa en los pólipos típicos fue de 8,4%, 0,07% y 0%, respectivamente, mientras que en los pólipos atípicos estas cifras alcanzan el 30, 15 y 1,7% respectivamente, lo que confirma que la displasia epitelial es un hecho frecuente en este tipo de pólipos. Por otra parte, cambios adenomatosos se han observado en niños menores de 3 años con PJ y algunos autores consideran que el cáncer surge de focos de adenoma con displasia desarrollados en el interior de un pólipo juvenil. En la práctica, lo habitual es encontrar pólipos juveniles con áreas de adenoma, pólipos juveniles mixtos (juvenil + adenoma) y adenomas puros en el colon del mismo paciente.

Un saludo para todos

Walter

Polipo Juvenil Inflamatorio

Saludos

Isidro Machado

Es importante hacer la distincion clinica entre polipo juvenil, poliposis juvenil y poliposis juvenil familiar, ya que, la patologia del polipo es la misma, pero su potencial preneoplasico es distinto.

Coffin CM, Dehner LP.

What is a juvenile polyp? An analysis based on 21 patients with solitary and multiple polyps.

Arch Pathol Lab Med. 1996 Nov;120(11):1032-8.

BACKGROUND: Juvenile polyps, the most common pediatric gastrointestinal polyp, have been typically characterized as either hamartomatous overgrowths or reactive inflammatory proliferations. Recent observations of excessive colonic and gastric carcinoma and dysplasia in juvenile polyposis have prompted reclassification of this entity as a premalignant condition. The relationship between solitary or multiple juvenile polyps and malignancy is less clear. PATIENTS AND METHODS: To further investigate the frequency and significance of dysplasia in juvenile polyps, we analyzed 28 polyps from 21 patients histologically and immunohistochemically for substances previously associated with neoplastic transformation in the colorectal adenomacarcinoma sequence. RESULTS: Fifteen patients had a solitary polyp, two had 2 to 9 polyps, and four had polyposis with 10 or more polyps. Most polyps exhibited inflammatory or regenerative atypia. Foci of dysplasia were noted in polyps from 11 patients, and immunoreactivity for p53 and human chorionic gonadotropin was present in 12 of the 28 polyps each. These findings were all more frequent in the polyposis specimens than in solitary polyps. CONCLUSIONS: These observations, in combination with reports of an increased risk of carcinoma in juvenile polyposis, suggest that juvenile polyps are lesions with a potential for neoplastic and malignant transformation, although they share features of an inflammatory reactive process. The implications for clinical management of patients and pathologic evaluation of juvenile polyps warrant further investigation.

Giardiello FM, Hamilton SR, Kern SE, Offerhaus GJ, Green PA, Celano P, Krush AJ, Booker SV.

Colorectal neoplasia in juvenile polyposis or juvenile polyps.

Arch Dis Child. 1991 Aug;66(8):971-5.

Juvenile (retention) polyps are usually solitary lesions in the colorectum but may be multiple in juvenile polyposis. The association between juvenile polyps and colorectal neoplasia is controversial. We present three patients with juvenile polyposis who had colorectal adenomas or adenomatous epithelium in juvenile polyps at ages 3, 4, and 7 years. In a retrospective study of 57 additional patients with one or more juvenile polyps, 10 patients (18%) had colorectal neoplasia including three with adenocarcinoma, two with tubular adenoma, and six with adenomatous epithelium in a juvenile polyp (one had both adenomatous epithelium and an adenocarcinoma). Nine of these 10 patients had juvenile polyposis defined by the presence of at least three juvenile polyps; and eight of the nine had a family history of juvenile polyps. Colorectal neoplasia occurred at young age (mean (SEM) 37 (5) years). Our findings suggest that patients with juvenile polyps who have three or more juvenile polyps or a family history of juvenile polyps should undergo surveillance for colorectal neoplasia.

Kapetanakis AM, Vini D, Plitsis G.

Solitary juvenile polyps in children and colon cancer.

Hepatogastroenterology. 1996 Nov-Dec;43(12):1530-1.

BACKGROUND/AIMS: Solitary Juvenile Polyps (SJP) are quite common in preschool children, although they may occur at any age. It is not known whether the existence of a single juvenile polyp in a child predisposes to future development of new SJP or is related to colorectal neoplasia. The present study was designed to follow up young patients who had undergone polypectomy for SJP and their first degree relatives to elucidate the development of adenomatous polyps or colon cancer. MATERIALS AND METHODS: From 31 children polypectomized for histologically proven SJP between 1983-1995, we were able to contact and gather information on 24. From our records and the information collected we studied age, gender, site of the polyp in the bowel, personal history, and family history. RESULTS: Mean time of follow up was 4.1 years (range 0.4-10, SD +/- 3.1) Mean age was 4.6 years (Range 3.5-9, SD +/- 1.2). There were 14 boys and 10 girls (ratio 1.4/1). Eighteen polyps were located at the rectosigmoid area, 5 in the lower descending colon, and one in the splenic flecture. From the 24 children, only one girl developed rectal bleeding at the age of 15 years, 8 years after polypectomy. However, subsequent evidence from the large bowel did not reveal any abnormality and the symptom was attributed to hemorrhoidal bleeding. Thorough investigation of the history of 146 first degree relatives (dead or alive) siblings, parents, and grandparents revealed that none of them were diagnosed with adenomatous polyps or colorectal cancer. CONCLUSION: SJP does not predispose to future development of new juvenile polyps and is not associated with a high risk of colorectal malignancy.

Mandhan P.

Juvenile colorectal polyps in children: experience in Pakistan.

Pediatr Surg Int. 2004 May;20(5):339-42.

Juvenile colorectal polyps are the most common cause of pediatric hematochezia and contribute to significant morbidity if not treated early. This report describes an experience with juvenile colorectal polyps in children (< or =14 years) from Pakistan. In a 3-year period, 154 polyps were documented in 129 children. The mean age at presentation was 5.2 years, with a male predominance. Most children presented with painless rectal bleeding (+/-13 months) associated with other symptoms, such as protrusion of a mass through the anus, diarrhea, and recurrent abdominal pain. Anemia was observed in 54 children, of whom 14 (26%) required blood transfusion before intervention. Diagnosis was made by digital rectal examination, proctosigmoidoscopy, and barium enema. The average distance of a colorectal polyp was 4 cm from the anal verge. In 108 (84%) children the polyps were solitary, whereas 21 patients had more than one polyp (maximum three) at different locations in the rectosigmoid area. All polyps were successfully removed by proctosigmoidoscopy. Histological examination revealed dysplastic changes in one case, while the rest were inflammatory. Recurrence occurred in seven children within 1 year of initial removal. Juvenile colorectal polyps contribute to a substantial morbidity in children and do carry a minimal risk of developing dysplastic changes, and therefore should be removed early.

Se les saluda a todos desde Guatemala, tierra que fue recientemente acariciada por Adriancito.

Me parece también que tiene todas las características de un Polipo Juvenil con áreas adenomatosas.

Saludos.

Esther.

Estoy de acuerdo en que se trata de un pólipo juvenil. Los elementos infalmatorios que se ven podrían o no estar asociados con colitis crónica inespecífica que podría constatarse si hubiese mucosa adyacente al pólipo.

Saludos desde El Salvador

Laboratorio Serpas

histologic picture of polyp is of juvenile polyp.if patient is having many such polyps ,possibility of juvenile

polyposis syndrome may be entertained.

Es un caso, que en mi opinion se hubiese aprovechado mas, contando desde su inicio con las fotos de los bichos.

Muy agradecido por las enseñansas...

Hernan

En todas las fotos mostradas desde un principio se observan los "bichos". La primera al estar a poco aumento son inapreciables, pero en todas las demás pueden verse si se observa con detalle. Como digo en el comentario, la foto nº 6 es la más resolutiva, además de las mostradas al cierre.

Gracias por vuestras participaciones y perdonar si se ha "escondido" un poco el diagnóstico.

Emili

Bueno mas que un comentario es una pregunta, despues que se retira el polipo, como es la recuperacion? lenta, dolorosa o al dia siguiente puede regresarse a la rutina diaria sin ninguna complicacion.

Espero que me respondan, gracias.