Fritz, Cassandra D. L.

Kushnir, Vladimir

Mutch, Matthew

Navale, Pooja

English

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Washington University School of Medicine Digital Commons@Becker Open Access Publications 2021 Inflammatory myoglandular polyps presenting with diarrhea Cassandra D. L. Fritz Washington University School of Medicine in St. Louis Pooja Navale Washington University School of Medicine in St. Louis Matthew Mutch Washington University School of Medicine in St. Louis Vladimir Kushnir Washington University School of Medicine in St. Louis Follow this and additional works at: https://digitalcommons.wustl.edu/open_access_pubs Recommended Citation Fritz, Cassandra D. L.; Navale, Pooja; Mutch, Matthew; and Kushnir, Vladimir, ,"Inflammatory myoglandular polyps presenting with diarrhea." ACG Case Reports Journal.,. . (2021). https://digitalcommons.wustl.edu/open_access_pubs/10969 This Open Access Publication is brought to you for free and open access by Digital Commons@Becker. It has been accepted for inclusion in Open Access Publications by an authorized administrator of Digital Commons@Becker. For more information, please contact scales@wustl.edu. Downloadedfromhttp://journals.lww.com/acgcrbyBhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws=on12/13/2021Downloadedfromhttp://journals.lww.com/acgcrbyBhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws=on12/13/2021ACG CASE REPORTS JOURNALIMAGE | COLONInflammatory Myoglandular Polyps PresentingWith DiarrheaCassandra D.L. Fritz, MD1, Pooja Navale, MD2, Matthew Mutch, MD3, and Vladimir Kushnir, MD11Division of Gastroenterology, Department of Medicine, Washington University, St. Louis, MO2Department of Pathology and Immunology, Washington University, St. Louis, MO3Section of Colon and Rectal Surgery, Division of General Surgery, Washington University, St. Louis, MOCASE REPORTA 49-year-old man without a pertinent medical history reported a 7-month history of diarrhea occurring 6–8 times per day. Hereported formed bowel movements before developing watery stools with nocturnal symptoms. He denied new diet changes,new medications, and recent travel. Stool studies were reportedly negative, and he had mild hyponatremia. His symptoms didnot improve with the maximum dose of loperamide. He subsequently underwent colonoscopy, which demonstrated 3 large(.20 mm) “adenomatous-appearing” polyps and greater than 10 large polyps of unclear etiology, all in the descending colon. Hepresented to our academic institution for endoscopic mucosal resection. However, on our endoscopic inspection, the sigmoid anddescending colon had .20 subpedunculated polyps without distinct adenomatous characteristics, measuring 15–30 mm(Figure 1). Owing to the number of lesions, definitive endoscopic therapy was not possible, and the polyps’ proximal extent wastattooed. Two representative polyps were resected (Figure 2). Histopathologic examination was consistent with inflammatorymyoglandular polyps (Figures 3 and 4). After a multidisciplinary discussion, colonic resection was deemed necessary because ofpolyp number and persistent diarrhea. Laparoscopic extended left hemicolectomy with primary anastomosis was performedwithout issue. At his 1-month surgical follow-up, he was doing well and reported complete resolution of diarrhea.Inflammatorymyoglandular polyps (IMGPs) are a rare clinical entity.1Most IMGP cases have been described inmiddle-agedmen.1,2The 3 distinct histologic features of IMGP are inflammatory granulation in the lamina propria, smooth muscle proliferation, andhyperplastic glands with some cystic dilation.1 IMGPs are usually solitary asymptomatic lesions. When symptomatic, IMGPs canpresent with positive fecal occult blood,1 hematochezia,3 or rarely intussusception.4We describe one of the first cases in the literatureFigure 1. Large sigmoid colon polyp on endoscopic view (singlepolyp shown but multiple polyps found in this area). Figure 2. A large spherical, red polyp located in the sigmoid.ACG Case Rep J 2021;8:e00685. doi:10.14309/crj.0000000000000685. Published online: November 3, 2021Correspondence: Dr. Fritz, MD (cfritz@wustl.edu).ACG Case Reports Journal / Volume 8 acgcasereports.com 1detailing multiple large IMGPs in the descending colonresulting in diarrhea.We suspect his diarrhea was related to thelarge surface area that had increased granulation tissue andsmooth muscle proliferation, likely decreasing the absorptivecapacity of the distal colon. Similar to our case, IMGPs arepredominately found in the descending colon, with most de-scribed as semipedunculated to pedunculated. Endoscopically,these polyps are described as red, usually spherical, and smooth.Nevertheless, the correct diagnosis of IMGPs requires pathol-ogy for confirmation because similar clinical entities (in-flammatory fibroid polyps, Peutz-Jeghers-type polyps, orjuvenile polyps) have increased malignant potential comparedwith IMGPs.5 Most isolated IMGPs can be managed endo-scopically. However, surgical management should be consid-ered when endoscopic management is not possible.DISCLOSURESAuthor contributions: C. Fritz wrote the manuscript and is thearticle guarantor. P. Navale, M. Mutch, and V. Kushnir revisedand approved the final manuscript.Financial disclosure: C. Fritz is supported by T32 DK007130.Informed consent was obtained for this case report.Received December 18, 2020; Accepted June 3, 2021REFERENCES1. Nakamura S, Kino I, Akagi T. Inflammatory myoglandular polyps of thecolon and rectum. A clinicopathological study of 32 pedunculated polyps,distinct from other types of polyps. Am J Surg Pathol. 1992;16:772–9.2. Hirasaki S, Kanzaki H, Matsubara M, Suzuki S. Inflammatory myo-glandular polyps: A case series of four patients and review of the literature.Gastroenterol Res Pract. 2010;2010:984092.3. Chung SH, Son BK, Park YS, et al. Inflammatory myoglandular polypscausing hematochezia. Gut Liver. 2010;4:146–8.4. Griffiths A, Hopkinson J, Dixon M. Inflammatory myoglandular polypcausing ileo–ileal intussusception. Histopathology. 1993;23:596–8.5. Becheanu G, Stamm B. Inflammatory myoglandular polyp–A rare butdistinct type of colorectal polyps. Pathology Res Pract. 2003;199:837–9.Copyright:ª 2021 The Author(s). Published byWolters Kluwer Health, Inc. on behalf ofThe American College of Gastroenterology. This is an open access article distributedunder the terms of the Creative Commons Attribution-Non Commercial-No DerivativesLicense 4.0 (CCBY-NC-ND), where it is permissible to download and share the workprovided it is properly cited. The work cannot be changed in any way or used com-mercially without permission from the journal.Figure 3. Hyperplastic and cystically dilated crypts surrounded byradially arranged smooth muscle bundles. The surface of the polypshows fibroinflammatory exudate and granulation tissue (black arrow).Figure 4. Mucin-filled cysts within smooth muscle fibers.ACG Case Reports Journal / Volume 8 acgcasereports.com 2Fritz et al Inflammatory Myoglandular Polyps

Inflammatory myoglandular polyps presenting with diarrhea

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Inflammatory myoglandular polyps presenting with diarrhea

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