1Department of Internal Medicine, NYC H+H/ Metropolitan Hospital, NY, and New York Medical College, Valhalla, NY, USA
2Department of Gastroenterology, NYC H+H/ Metropolitan Hospital, NY, and New York Medical College, Valhalla, NY, USAFulltext PDF
Introduction: Hyperplastic Polyps (HPs) are a benign subgroup of serrated polyps. HP larger than 10 mm is considered a large polyp and larger than 2 cm carry a risk for malignancy. A case of near obstructing giant hyperplastic polyp of the recto-sigmoid colon with no malignant features is presented with review and proposed follow-up.
Case Report: A 29-year-old African American man with a 1-year history of persistent dyspepsia and epigastric pain with associated intermittent rectal bleeding and weight loss. Endoscopies identified a large pedunculated mass with near-complete obstruction in the recto-sigmoid colon. Biopsies show hyperplastic mucosa with no evidence of malignancy. Imaging revealed a 6cm colonic mass. Tumor markers were unremarkable. Laparoscopic sigmoid resection was performed. Histology reported a giant serrated polyp with hyperplasia and no evidence of malignancy.
Discussion: HPs are now believed to be a subgroup of Serrated Polyps (SPs). SPs are sub-classified based on malignant potential. The majority of the serrated carcinomas arising from HP follow BRAF and KRAS pathways. Microsatellite instability has also been associated. Serrated polyposis syndrome is associated with the risk of colorectal cancer. Parallel to the polyp size increases the malignant potential. Risk stratification of giant, pedunculated polyps is advised prior to endoscopy due to the risk of perforation and bleeding.
Conclusion: Further discussions are needed to establish clear guidelines for surveillance of single, giant, non-malignant polyps. We propose our own management including surgical vs. endoscopic resection, genetic testing, and colonoscopy in 1,3, and 5- year intervals, followed by standard surveillance.
Hyperplastic Polyp; Epigastric pain; Endoscop; Malignant
Joanna M. Lenik, Yvette Achuo- Egbe, Jennifer M. Harley, Jean Atallah- Vinograd. Giant Hyperplastic Polyp with No Malignant Features. Int Case Rep Jour. 2022;2(6):1-6.