High Grade Dysplastic Villous Adenoma Arising from a Giant Hamartomatous Polyp- A Rare Case Presentation
Adenomatous polyps can be found throughout the colon, most commonly in right colon. Microscopically they are classified as tubular, villous or tubulovillous subtypes. Tubular adenomas are the most common subtype with villous component less than 25%. Tubulovillous adenomas have a villous component th...
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JCDR Research and Publications Private Limited
2022-12-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://www.jcdr.net/articles/PDF/17338/59064_CE(AD)_F(IS)_PF1(SC_SS)_PFA(NC)_PN(SS).pdf |
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| author | Sayan Bhowmik J Thanka Rajendran Shanmugasundaram |
| author_facet | Sayan Bhowmik J Thanka Rajendran Shanmugasundaram |
| author_sort | Sayan Bhowmik |
| collection | DOAJ |
| description | Adenomatous polyps can be found throughout the colon, most commonly in right colon. Microscopically they are classified as tubular, villous or tubulovillous subtypes. Tubular adenomas are the most common subtype with villous component less than 25%. Tubulovillous adenomas have a villous component that accounts for 25-75%, while villous adenomas have a villous component that accounts for more than 75% of the polyp. Peutz-Jeghers syndrome which is an autosomal dominant condition is characterised by gastrointestinal hamartomatous polyp with distinctive arborization of smooth muscle within the lamina propria. Peutz-Jeghers type polyp is a hamartomatous polyp without associated mucocutaneous pigmentation or a family history of Peutz-Jeghers syndrome. In the present case study, a 82-year-old male presented with the chief complaint of constipation and abdominal distension since six months. A polypoidal rectal growth was identified on sigmoidoscopy. The clinical diagnosis of mid rectal growth with acute colonic obstruction was made. Positron Emission Tomography and Computed Tomography (PET CT) was done which was suggestive of malignancy and therefore, Hartmann’s procedure was performed and lesion was excised. On gross examination, a portion of large intestine including sigmoid colon and rectum was received and a pedunculated polypoidal lesion measuring 4.5×3.5×3 cm along with stalk measuring 2.5 cm was seen. On microscopy, the polyp with extensive arborization of muscularis mucosa into the lamina propria was seen with one area showing features of villous adenoma with high-grade dysplasia. Hence, a final diagnosis was given as villous adenoma with high grade dysplasia arising from a hamartomatous polyp consistent with Peutz-Jeghers polyp. The identification of a villous adenoma with high-grade dysplasia in a Peutz-Jegher type polyp is essential in such situations since it is a precursor of invasive malignancy. |
| first_indexed | 2024-04-10T21:08:54Z |
| format | Article |
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| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-04-10T21:08:54Z |
| publishDate | 2022-12-01 |
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| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-82a8bffd31e549699188349121dc67b32023-01-21T05:25:35ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2022-12-011612ED09ED1110.7860/JCDR/2022/59064.17338High Grade Dysplastic Villous Adenoma Arising from a Giant Hamartomatous Polyp- A Rare Case PresentationSayan Bhowmik0J Thanka1Rajendran Shanmugasundaram2Postgraduate Student, Department of Pathology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.Professor, Department of Pathology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.Professor, Department of Surgical Gastroenterology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.Adenomatous polyps can be found throughout the colon, most commonly in right colon. Microscopically they are classified as tubular, villous or tubulovillous subtypes. Tubular adenomas are the most common subtype with villous component less than 25%. Tubulovillous adenomas have a villous component that accounts for 25-75%, while villous adenomas have a villous component that accounts for more than 75% of the polyp. Peutz-Jeghers syndrome which is an autosomal dominant condition is characterised by gastrointestinal hamartomatous polyp with distinctive arborization of smooth muscle within the lamina propria. Peutz-Jeghers type polyp is a hamartomatous polyp without associated mucocutaneous pigmentation or a family history of Peutz-Jeghers syndrome. In the present case study, a 82-year-old male presented with the chief complaint of constipation and abdominal distension since six months. A polypoidal rectal growth was identified on sigmoidoscopy. The clinical diagnosis of mid rectal growth with acute colonic obstruction was made. Positron Emission Tomography and Computed Tomography (PET CT) was done which was suggestive of malignancy and therefore, Hartmann’s procedure was performed and lesion was excised. On gross examination, a portion of large intestine including sigmoid colon and rectum was received and a pedunculated polypoidal lesion measuring 4.5×3.5×3 cm along with stalk measuring 2.5 cm was seen. On microscopy, the polyp with extensive arborization of muscularis mucosa into the lamina propria was seen with one area showing features of villous adenoma with high-grade dysplasia. Hence, a final diagnosis was given as villous adenoma with high grade dysplasia arising from a hamartomatous polyp consistent with Peutz-Jeghers polyp. The identification of a villous adenoma with high-grade dysplasia in a Peutz-Jegher type polyp is essential in such situations since it is a precursor of invasive malignancy.https://www.jcdr.net/articles/PDF/17338/59064_CE(AD)_F(IS)_PF1(SC_SS)_PFA(NC)_PN(SS).pdfarborizationchristmas tree patterngiant polyphartmann’s procedurepeutz-jeghers polyp |
| spellingShingle | Sayan Bhowmik J Thanka Rajendran Shanmugasundaram High Grade Dysplastic Villous Adenoma Arising from a Giant Hamartomatous Polyp- A Rare Case Presentation Journal of Clinical and Diagnostic Research arborization christmas tree pattern giant polyp hartmann’s procedure peutz-jeghers polyp |
| title | High Grade Dysplastic Villous Adenoma Arising from a Giant Hamartomatous Polyp- A Rare Case Presentation |
| title_full | High Grade Dysplastic Villous Adenoma Arising from a Giant Hamartomatous Polyp- A Rare Case Presentation |
| title_fullStr | High Grade Dysplastic Villous Adenoma Arising from a Giant Hamartomatous Polyp- A Rare Case Presentation |
| title_full_unstemmed | High Grade Dysplastic Villous Adenoma Arising from a Giant Hamartomatous Polyp- A Rare Case Presentation |
| title_short | High Grade Dysplastic Villous Adenoma Arising from a Giant Hamartomatous Polyp- A Rare Case Presentation |
| title_sort | high grade dysplastic villous adenoma arising from a giant hamartomatous polyp a rare case presentation |
| topic | arborization christmas tree pattern giant polyp hartmann’s procedure peutz-jeghers polyp |
| url | https://www.jcdr.net/articles/PDF/17338/59064_CE(AD)_F(IS)_PF1(SC_SS)_PFA(NC)_PN(SS).pdf |
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