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AN UNEXPECTED FINDING OF INFLAMMATORY MYOGLANDULAR POLYP
Syed Mujtaba Baqir
*, Samar Pal Sandhu, Sadat Iqbal, Dmitriy O Khodorskiy
Internal Medicine, Maimonides Medical Center, Brooklyn, NY
Inflammatory myoglandular polyps (IMPs) are rare non-neoplastic polyps. We present a case of IMP found in the rectum on routine screening colonoscopy. Fifty-three-year-old man with a past medical history of diabetes mellitus type 2 and hypertension was referred by his primary care physician for colonoscopy for first colorectal cancer screening. Patient did not report any family history of inflammatory bowel disease or colon cancer. The review of systems was negative for abdominal pain, constipation, diarrhea, melena and hematochezia. The physical exam was unremarkable. On Screening colonoscopy, was found to have a single dimunitive polyp in the recto-sigmoid junction and three polyps in the rectum. Two of the polyps in the rectum were described as protruding and sessile, measuring five and seven millimeters, respectively, and removed with cold snare. The third polyp in the rectum was a thirteen millimeters granular lateral spreading lesion and removed via snare mucosal resection with five milliliters of epinephrine injected to lift polyp prior to resection. No other significant findings on colonoscopy. The three polyps in the rectum all came back showing IMP on pathology. Usually found in males of middle age with some extremes of presentation. Patients may be asymptomatic with polyps often found incidentally during screening or can present with hematochezia, occult bleeding and anemia. Where generally in literature IMP has been described on endoscopy as solitary, pedunculated, with a smooth hyperemic surface with surface erosions, our case teaches clinicians that IMP can be more than 1 at a particular time, they may not be pedunculated, and they may be predominantly granular with lateral spreading. Furthermore, different IMPs at a certain time may exhibit different features and the increased number of polyps may still be present asymptomatically. Other polyps such as juvenile and inflammatory fibroid polyps have overlapping features with IMP, making accurate sampling and histopathological evaluation of the utmost importance. IMP has a benign course and endoscopic resection is suffice, with no further surveillance needed.
Two protruding and sessile polyps in the rectum (A) and the granular laterally spreading lesion in (B).
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