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Case of the Month: Numerous Colonic Polyps

By Kristen Larsen, MS3

Clinical History

A 59-year-old male undergoes a total colectomy following the identification of a large polyp with high-grade dysplasia on biopsy.

Past Medical History 

Past medical history is significant for smoking, GERD, and gastric polyps. His family history is significant for numerous gastrointestinal cancers.

Recent History

Abdominal CT four months prior to surgery revealed a mildly distended small bowel and diffuse inflammatory stranding in the central mesentery with scattered small nodules. Imaging of the large bowel shows no definitive evidence of masses.

Abdominal colectomy with ileorectal anastomosis was performed. Gross examination demonstrated approximately 300 pink-tan mucosal polyps ranging in size from 0.2 to 2.3 cm in greatest dimension, with the largest polyp identified in the ascending colon (Figures 1, 2). The majority of the polyps were sessile but those in the distal colon were more frequently pedunculated.

Microscopic examination of the smaller polyps in the ascending colon demonstrated tubular adenomas, characterized by classical adenomatous low-grade dysplasia with pseudostratification of elongated, hyperchromatic nuclei (Figure 3). The largest polyp, located in the ascending colon, demonstrated an adenocarcinoma extending into the submucosa (Figures 4, 5).

Next: Diagnosis