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Surgical Pathology Criteria
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Colonic Mucosubmucosal Elongated Polyp

Definition

  • Elongated pedunculated non-neoplastic polyp of the colon

Diagnostic Criteria

  • Elongated pedunculated polyp of the colon
    • Usually dumbbell or drumstick shaped
  • Surface covered by normal mucosa
    • May be eroded
      • Lacks prominent granulation tissue
      • Lacks prominent crypt distortion
    • No proliferation of muscularis mucosae
    • Lacks any neoplastic component
  • Stroma ranges from loose and edematous to fibrotic
    • Frequent dilated blood and lymphatic vessels
      • Characteristically show thick walled veins parallel to long axis of polyp
    • No muscularis propria
    • Inflammation not prominent
  • Mean length 3.7 cm, range 0.5-24
  • Rare, < 1% of polyps
    • Usually an incidental finding
    • Some cases associated with diverticulosis
  • Described in all segments of the colon
    • Not described in rectum
  • Occurs in adults, 30-90 years
  • Benign, non-recurrent

    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting/updates : 11/14/11, 11/17/11

Differential Diagnosis

Colonic Mucosubmucosal Elongated Polyp Inflammatory Polyp
Scant inflammation Prominent inflammation
Not associated with inflammatory  bowel disease Frequently associated with inflammatory bowel disease
Usually solitary and large Usually multiple and small

 

Colonic Mucosubmucosal Elongated Polyp Cloacogenic Polyp / Mucosal Prolapse
Scant inflammation Prominent inflammation associated with ulceration
Lacks crypt distortion and proliferation of muscularis mucosae Muscularis mucosae extends into lamina propria
Not reported in rectum/anus Usually occurs near anal verge

Bibliography

  • Matake H, Matsui T, Yao T, Iwashita A, Hoashi T, Yao K, Tsuda S, Takenaka K, Sakurai T, Yamada Y, Seo M, Odera K, Okada M, Tanaka K. Long pedunculated colonic polyp composed of mucosa and submucosa: proposal of a new entity, colonic muco-submucosal elongated polyp. Dis Colon Rectum. 1998 Dec;41(12):1557-61.
  • Kume K, Sakata H, Yoshikawa I, Watanabe T, Harada M. Polypectomy of a colonic  muco-submucosal elongated polyp. Endoscopy. 2009;41 Suppl 2:E265-6.
  • Tozawa K, Ohda Y, Matsumoto T, Hori K, Nishigami T. Clinical challenges and images in GI. Colonic mucosubmucosal elongated polyp. Gastroenterology. 2009 Jan;136(1):49, 366.
  • Alizart MM, Rosty C, Brown IS. Colonic Mucosubmucosal Elongated Polyp: A Clinicopathologic Study of 13 Cases and Review of the Literature. Am J Surg Pathol. 2011 Oct 10. [Epub ahead of print]
  • Ambrosio MR, Rocca BJ, Ginori A, Barone A, Onorati M, Lazzi S. Long pedunculated colonic polyp with diverticulosis: case report and review of the literature. Pathologica. 2011 Feb;103(1):8-10
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