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Pathological Case of the Month FREE

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Section Editor: Enid Gilbert-barness, MD


Arch Pediatr Adolesc Med. 1998;152(11):1152. doi:.
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DIAGNOSIS AND DISCUSSION: JUVENILE POLYPOSIS COLI

Figure 1. Computed tomographic scan of abdomen showing mass in the cecum with distended proximal bowel.

Figure 2. Gross photograph of the specimen showing multiple pedunculated polyps in the cecum and ascending colon.

Figure 3. Microscopic photograph of a polyp showing cystically dilated crypts filled with mucus and inflammatory cells. There is abundant granulation tissue and inflmamatory exudate composed of plasma cells, polymorphonuclear leukocytes, and histiocytes in the stroma (hematoxylin-eosin, original magnification ×100).

JUVENILE POLYPS are the most common type of gastrointestinal polypoid lesions in childhood.13 Most of them are solitary and confined to the rectosigmoid region. Juvenile polyps have been described as retention polyps or inflammatory polyps, and are routinely grouped with hamartomas in the literature.4 Juvenile polyposis syndrome is characterized by numerous polyps throughout the colon (juvenile polyposis coli)5 or the entire gastrointestinal tract (generalized juvenile polyposis)6 and presents with rectal bleeding, abdominal pain, and intussusception. Jass et al7 have suggested a working diagnostic criteria for juvenile polyposis syndrome that includes one of the following: (1) more than 5 juvenile polyps of the colon or rectum, (2) juvenile polyps throughout the gastrointestinal tract, or (3) any number of juvenile polyps with a family history of juvenile polyposis.

Goodman et al8 have suggested that juvenile polyps represent one step in a spectrum, beginning with hyperplasia, progressing to typical juvenile polyps that then develop adenomatous changes, and progressing eventually to a true adenoma. Familial juvenile polyposis is one of the inherited polyposis syndromes associated with a predisposition to gastrointestinal tract malignant neoplasms.9 It is inherited as an autosomal dominant trait, but no specific genetic defect has been identified. The risk of colon cancer is increased, although the magnitude of the increased risk is controversial.10

Once a diagnosis of juvenile polyposis syndrome is established, the entire gastrointestinal tract must be periodically examined by upper and lower endoscopy because of the increased risk of recurrence and subsequent development of a carcinoma.11 Only prolonged observation will allow accurate assessment of the neoplastic potential of these lesions. Genetic studies may enlighten us further as to the nature of this condition and in particular its relationship to adenomatous polyposis coli.12 No guidelines have been suggested on the indications for prophylactic colectomy.12

Harrilleno  EGEckert  CAckerman  LV Polyps of the rectum and colon in children. Cancer. 1957;101210- 1220
Mauro  JPrior  JT Gastrointestinal polypoid lesions in childhood. Cancer. 1957;10131- 137
Louw  JH Polypoid lesions of the large bowel in children. S Afr Med J. 1972;461347- 1352
Heiss  KFSchaffner  DRicketts  RRWinn  K Malignant risk in juvenile polyposis coli: increasing documentation in the pediatric age group. J Pediatr Surg. 1993;281188- 1193
Grotsky  HWRickert  RRSmith  WDNewsome  JF Familial juvenile polyposis coli: a clinical and pathologic study of a large kindred. Gastroenterology. 1982;82495- 501
Kent  THMitros  FA Polyps of the colon and small bowel, polyps syndrome, and the polyp cancer sequence. Norris  HTed.Pathology of the Colon, Small Intestine, and Anus. New York, NY Churchill-Livingstone1983;167- 199Contemporary Issues in Pathology 2
Jass  JRWilliams  CBBussey  JHR  et al.  Juvenile polyposis: a precancerous condition. Histopathology. 1988;13619- 630
Goodman  ZDYardley  JHMilligan  FD Pathogenesis of colonic polyps in multiple juvenile polyposis: report of a case associated with gastric polyps and carcinoma of the rectum. Cancer. 1979;431906- 1913
Burt  RWBishop  DTLynch  HTRozen  PWinawer  SJand the WHO Collaborating Centre for the Prevention of Colorectal Cancer, Risk and surveillance of individuals with heritable factors for colorectal cancer. Bull World Health Org. 1990;68655- 665
Leggettt  BAThomas  LRKnight  NHealey  SChenevix-Trench  GSearle  J Exclusion of APC and MCC as the gene defect in one family with familial juvenile polyposis. Gastrointest Endosc. 1995;42560- 564
Rodriguez-Bigas  MAPenetrante  RBHerrera  LPetrelli  NJ Intraoperative small-bowel enteroscopy in familial adenomatous and familial juvenile polyposis. Gastrointest Endosc. 1995;42560- 564
O'Riordan  DSO'Dwyer  PJCullen  AFMcDermott  EWMurphy  JJ Familial juvenile polyposis coli and colorectal cancer. Cancer. 1991;68889- 892

Tables

References

Harrilleno  EGEckert  CAckerman  LV Polyps of the rectum and colon in children. Cancer. 1957;101210- 1220
Mauro  JPrior  JT Gastrointestinal polypoid lesions in childhood. Cancer. 1957;10131- 137
Louw  JH Polypoid lesions of the large bowel in children. S Afr Med J. 1972;461347- 1352
Heiss  KFSchaffner  DRicketts  RRWinn  K Malignant risk in juvenile polyposis coli: increasing documentation in the pediatric age group. J Pediatr Surg. 1993;281188- 1193
Grotsky  HWRickert  RRSmith  WDNewsome  JF Familial juvenile polyposis coli: a clinical and pathologic study of a large kindred. Gastroenterology. 1982;82495- 501
Kent  THMitros  FA Polyps of the colon and small bowel, polyps syndrome, and the polyp cancer sequence. Norris  HTed.Pathology of the Colon, Small Intestine, and Anus. New York, NY Churchill-Livingstone1983;167- 199Contemporary Issues in Pathology 2
Jass  JRWilliams  CBBussey  JHR  et al.  Juvenile polyposis: a precancerous condition. Histopathology. 1988;13619- 630
Goodman  ZDYardley  JHMilligan  FD Pathogenesis of colonic polyps in multiple juvenile polyposis: report of a case associated with gastric polyps and carcinoma of the rectum. Cancer. 1979;431906- 1913
Burt  RWBishop  DTLynch  HTRozen  PWinawer  SJand the WHO Collaborating Centre for the Prevention of Colorectal Cancer, Risk and surveillance of individuals with heritable factors for colorectal cancer. Bull World Health Org. 1990;68655- 665
Leggettt  BAThomas  LRKnight  NHealey  SChenevix-Trench  GSearle  J Exclusion of APC and MCC as the gene defect in one family with familial juvenile polyposis. Gastrointest Endosc. 1995;42560- 564
Rodriguez-Bigas  MAPenetrante  RBHerrera  LPetrelli  NJ Intraoperative small-bowel enteroscopy in familial adenomatous and familial juvenile polyposis. Gastrointest Endosc. 1995;42560- 564
O'Riordan  DSO'Dwyer  PJCullen  AFMcDermott  EWMurphy  JJ Familial juvenile polyposis coli and colorectal cancer. Cancer. 1991;68889- 892

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