A rather bland looking polyp
This lesion in the low rectum has been referred for endoscopic resection
WHAT IS YOUR DIAGNOSIS?
a) Mucosal prolapse syndrome
b) Sessile Serrated lesion
Looks just like it but it isn't!
c) Traditional Serrated Adenoma
That's a No!
d) Adenomatous polyp
Patient complained of constipation...
e) Malignant polyp
But it's not 'chunky', red and it has crypts ?!?
There is no distinct edge to the 'polyp' and the crypts look normal, although a little splayed out and larger than normal, reminiscent of a serrated polyp. In real life, I had the advantage of knowing that the patient had been sent for colonoscopy because of constipation. I low-risk indication of course.
There is no distinct edge to the 'polyp' and the crypts look normal, just a little splayed out and larger than normal. This 'polyp' is actually part of the "Mucosal prolapse syndrome", first described in 1983 by Du Boulay et al [J Clin Pathol. 1983;36:1264–8].
Obviously, this syndrome includes solitary rectal ulcers, inflammatory cloacogenic polyps but also rectal 'prolapse polyps' such as this. In addition, the 'Mucosal Prolapse Syndrome' includes those prolapsing mucosal folds in the sigmoid and perhaps most surprisingly - GAVE !
In a case like the above, a couple of superficial biopsies will usually reveal the true nature of the lesion as it's easy for pathologists to spot the fibromuscular hyperplasia with overlying epithelial crypt distortion rather than dysplasia.