Cap polyposis of the colon and rectum: An analysis of endoscopic findings
ABSTRACT Because of the rarity of cap polyposis of the colon and rectum, the endoscopic features of this condition have not been specified to date. The aim of this study is to characterize the endoscopic features of cap polyposis.
The diagnosis of cap polyposis was established by histologic findings in specimens obtained endoscopically or surgically from four patients. Colonoscopic findings in the four patients were retrospectively reviewed.
The endoscopic features were divided into semipedunculated type (three patients) and flat-topped protruding type (one patient). In the semipedunculated type, the polyps were characterized by reddish protrusions of various configurations with eroded surface in the rectosigmoid colon. In the remaining patient, all the lesions were flat protrusions with a reddish central depression. The polyps of both types became smaller in size and fewer in number at the proximal part of the sigmoid colon. Multiple white specks were observed in the intervening mucosa in all four patients.
The prominence of the polyps at the distal part of the colon and rectum and multiple white specks in the intervening mucosa seem to be the additional endoscopic features suggestive of cap polyposis.
[Show abstract] [Hide abstract]
ABSTRACT: To evaluate the clinicopathological features and treatment outcomes of cap polyposis in the pediatric population. All pediatric patients with histologically proven diagnosis of cap polyposis were identified from our endoscopy and histology database over a 12 year period from 2000-2012 at our tertiary pediatric center, KK Women's and Children's Hospital in Singapore. The case records of these patients were retrospectively reviewed. The demographics, clinical course, laboratory results, endoscopic and histopathological features, treatments, and outcomes were analyzed. The study protocol was approved by the hospital institutional review board. The histological slides were reviewed by a pediatric histopathologist to confirm the diagnosis of cap polyposis. Eleven patients were diagnosed with cap polyposis. The median patient age was 13 years (range 5-17 years); the sample included 7 males and 4 females. All of the patients presented with bloody stools. Seven patients (63%) had constipation, while 4 patients (36%) had diarrhea. All of the patients underwent colonoscopy and polypectomies (excluding 1 patient who refused polypectomy). The macroscopic findings were of polypoid lesions covered by fibrinopurulent exudates with normal intervening mucosa. The rectum was the most common involvement site (n = 9, 82%), followed by the rectosigmoid colon (n = 3, 18%). Five (45%) patients had fewer than 5 polyps, and 6 patients (65%) had multiple polyps. Histological examination of these polyps showed surface ulcerations with a cap of fibrin inflammatory exudate. Four (80%) patients with fewer than 5 polyps had complete resolution of symptoms following the polypectomy. One patient who did not consent to the polypectomy had resolution of symptoms after being treated with sulphasalazine. All 6 patients with multiple polyps experienced recurrence of bloody stools on follow-up (mean = 28 mo). Cap polyposis is a rare and under-recognised cause of rectal bleeding in children. Our study has characterized the disease phenotype and treatment outcomes in a pediatric cohort.World Journal of Gastroenterology 07/2013; 19(26):4185-91. DOI:10.3748/wjg.v19.i26.4185 · 2.43 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Continued advances in the field of histo-pathology (and cyto-pathology) over the past two decades have resulted in dramatic changes in the manner in which these disciplines are now practiced. This is especially true in the setting of a large university hospital where the role of pathologists as clinicians (diagnosticians), undergraduate and postgraduate educators, and researchers has evolved considerably. The world around us has changed significantly during this period bringing about a considerable change in our lifestyles and the way we live. This is the world of the internet and the world-wide web, the world of Google and Wikipedia, of Youtube and Facebook where anyone can obtain any information one desires at the push of a button. The practice of histo (and cyto) pathology has also evolved in line with these changes. For those practicing this discipline in a poor, developing country these changes have been breathtaking. This is an attempt to document these changes as experienced by histo (and cyto) pathologists practicing in the biggest center for Histopathology in Pakistan, a developing country in South Asia with a large (180 million) and ever growing population. The Section of Histopathology, Department of Pathology and Microbiology at the Aga Khan University Hospital (AKUH) in Karachi, Pakistan's largest city has since its inception in the mid-1980s transformed the way histopathology is practiced in Pakistan by incorporating modern methods and rescuing histopathology in Pakistan from the primitive and outdated groove in which it was stuck for decades. It set histopathology in Pakistan firmly on the path of modernity and change which are essential for better patient management and care through accurate and complete diagnosis and more recently prognostic and predictive information as well.Asian Pacific journal of cancer prevention: APJCP 05/2014; 15(9):3829-3849. DOI:10.7314/APJCP.2014.15.9.3829 · 1.50 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Inflammatory cap polyposis (CP) is an uncommon, non-malignant condition whose pathogenesis is poorly understood. Initial presentation of CP may mimic other gastrointestinal conditions like inflammatory bowel disease, pseudomembranous colitis, irritable bowel syndrome, and colon cancer. A 42-year-old male presented with symptoms of constipation, abdominal pain and weight loss, which were suggestive of a malignancy. Since the symptoms of CP resemble closely those of other gastrointestinal diseases, particularly colon cancer, making the initial diagnosis can be challenging and it is often delayed. The mainstay of initial treatment is conservative, however symptomatic and complicated cases require prompt surgical intervention with close clinical follow-up. We chose to report this case because it represents a rare and unique disease process that may masquerade as a colon cancer. It is important for surgeons to be aware of this non-malignant condition since inadequate surgery usually results in recurrence.01/2013; 4(3):351-3. DOI:10.1016/j.ijscr.2012.12.014