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Polypectomy of a colonic muco-submucosal elongated polyp
... Since its first appearance in the literature, there have been various reports of such polyps, although mostly from Japanese institutions. [3][4][5][6][7][8][9][10][11] The characteristic endoscopic feature is the "worm-like" appearance. Histologically, the polyps are covered by normal mucosa and a loose to dense submucosal layer containing a variably prominent mixture of blood vessels and lymphatics, in the absence of significant active inflammation. ...
... Such polyps have been reported in all parts of the large intestines, as well as in the small intestines. [3][4][5][7][8][9][10][11][12][13][14][15][16][17] Overall, the histologic findings of our case are similar to those of previously reported cases, and our case meets the suggested criteria for the diagnosis of CMSEP by Alizart et al. 12 and Tan et al. 16 In the literature to date, a total of 48 cases of CMSEPs have been reported (Table 1). [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Based on the review of these reports, there seems to be a slight predilection for males (male:female = 1.4:1). ...
... [3][4][5][7][8][9][10][11][12][13][14][15][16][17] Overall, the histologic findings of our case are similar to those of previously reported cases, and our case meets the suggested criteria for the diagnosis of CMSEP by Alizart et al. 12 and Tan et al. 16 In the literature to date, a total of 48 cases of CMSEPs have been reported (Table 1). [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Based on the review of these reports, there seems to be a slight predilection for males (male:female = 1.4:1). All but one of these cases 12 were a single polyp occurring in the colon, and the sigmoid colon was the most common site. ...
Colonic muco-submucosal elongated polyp (CMSEP), a newly categorized non-neoplastic colorectal polyp, is a pedunculated and elongated polyp composed of normal mucosal and submucosal layers without any proper muscle layer. We herein report a giant variant of CMSEP associated with intussusception in the rectosigmoid colon, with a review of the literature. A 48-year-old woman underwent a laparoscopic low anterior resection due to multiple large submucosal polypoid masses associated with intussusception. Grossly, the colonic masses were multiple pedunculated polyps with a long stalk and branches ranging in size from a few millimeters to 14.0 cm in length. Microscopically, there was no evidence of hyperplasia, atypia or active inflammation in the mucosa. The submucosal layers were composed of edematous and fibrotic stroma with fat tissue, dilated vessels, and lymphoid follicles.
... Given reports suggesting an association between EMSEP and neoplasms, endoscopic resection may need to be considered. [11][12][13] We report the cases of 2 siblings who presented with GI bleeding and were diagnosed with EMSEP in the proximal jejunum. They had similar past history of ischemic heart disease and were on dual antiplatelet therapy. ...
We report 2 cases of enteric muco-submucosal elongated polyps (EMSEPs) that presented with gastrointestinal bleeding. The 2 patients are siblings. They both had a history of percutaneous coronary intervention for coronary artery disease and were on dual antiplatelet therapy. They underwent endoscopic resection of the polyps, which displayed identical endoscopic and histological features compatible with EMSEP. This is the first report of familial occurrence of EMSEP, suggesting possible genetic involvement. It is also important to note that the use of antiplatelet agents appears to be a predisposing factor for gastrointestinal bleeding from EMSEP.
Aims:
Most colorectal polyps can be reliably classified into one of the known polyp categories but a subset of polyps named colonic mucosubmucosal elongated polyps (CMSEP) do not fall into any of these categories. First described in the Japanese literature, CMSEP seem to be under-recognized in the Western literature. Our aim is to describe the clinicopathological features of 14 CMSEPs, discuss potential pathogenetic mechanisms and increase awareness of this entity among pathologists.
Methods and results:
Fourteen pedunculated colorectal polyps that met the histopathological criteria of CMSEP (as described by Matake et al and Alizart et al) were assessed (12 males, 2 females, mean age 59.7 years). Five polyps were located in the sigmoid colon, 4 in the rectum, 2 in the descending colon, and 3 not otherwise specified. Nine of 14 polyps were discovered incidentally; 2/9 on routine screening colonoscopy, 2/9 on surveillance colonoscopy for inflammatory bowel disease (IBD), and 5/9 upon surgical intervention for carcinoma or IBD but none coexisted with diverticular disease. The polyps were long and slender, varied from 5-30 mm in length (mean= 15.9 mm), and showed normal-looking colonic mucosal layer and underlying loose submucosa with thick-walled and congested blood vessels and lymphatics.
Conclusions:
CMSEPs demonstrate subtle but distinctive pathological features and occur in normal and diseased colons. Pathologists need to be aware of this entity to avoid confusion with other more commonly encountered colorectal polyps. With the increasing colon cancer screening programmes and surveillance colonoscopy it is likely that CMSEPs will be encountered more often. This article is protected by copyright. All rights reserved.
Recently a new entity has been described - a colonic muco-submucosal elongated polyp (CMSEP)- that did not fall into traditional classification of colorectal polyps. The CMSEP is endoscopically characterised by elongated, worm-like appearance with a normal overlying mucosa. Histologic characteristics of the CMSEP comprise mucosa and expanded submucosa with dilated vasculature and lymphatics. Herein, we report a case of CMSEP, that to the best of our knowledge, has not been previously described in our literature. With regard to the on-going National colorectal cancer screening programme, our intention is to draw attention of gastrointestinal pathologst and ednoscopists to this distinctive and very rare phenomenon.
We present three cases of gastrointestinal muco-submucosal elongated polyps, two located in the duodenum and one in the descending colon. All three cases had a characteristic, "worm-like" endoscopic appearance and were lined by unremarkable mucosa. The vascular component was located in the submucosa and was composed of a mixture of variably dilated blood vessels (capillaries and veins) and lymphatics. The duodenal polyps displayed lipomatous metaplasia of the submucosal stroma. The dual vascular phenotype of the vascular component was confirmed by immunohistochemistry with D2-40 and CD31.
We encountered 15 patients with colonic polyps showing histologic features that did not belong to any of the known categories. All polyps were elongated and drumstickshaped, with lengths of 12 to 160 (mean, 29 mm) mm. Histologically, the polyps were covered with normal mucosa and consisted of edematous, loose, fibrous, connective tissues and dense, fibrous submucosal layers, often showing dilation of blood vessels and lymphatics. Although the mechanism of generation of such polyps remains unknown, their elongation may be caused by intestinal motion. Because this kind of polyp has not been described previously outside Japan, we here introduce a new type of polyp, which we have proposed calling the colonic muco-submucosal elongated polyp.
Long pedunculated colonic polyp composed of mucosa and submucosa. Report of four cases. A proposal of colonic mucosubmucosal elongated polyp (CMSEP) [in Japanese with English abstract].
- H Matake
- M Seo
- K Oh