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Juvenile Polyp of the Gastrointestinal Tract

Definition

  • Gastrointestinal polyp with prominent cystically dilated glands and inflammatory stroma

Alternate/historical Names

  • Juvenile hamartomatous polyp
  • Juvenile type polyp

Covered Separately

Diagnostic Criteria

  • Usually smoothly spherical pedunculated polyp
  • Mucous retention cysts
    • Prominent cystically dilated glands
    • Lined by cuboidal to columnar mucinous cells
    • Other glands may be irregularly dilated
    • Dilation may be less prominent in small, early polyps
  • Abundant inflamed stroma
    • Lymphoplasmacytic infiltrate
    • Eosinophils may be prominent
    • May be edematous
    • Surface may be eroded
  • No smooth muscle component
  • Dysplasia and carcinoma are very rare in sporadic polyps
  • Sporadic polyps confined to colon and rectum
    • May be multiple (usually 1-3)
    • ≥5 polyps or extra-colorectal location may indicate Juvenile Polyposis syndrome
  • No clinically useful stains

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

    Original posting/updates: 12/27/09, 11/12/11

Differential Diagnosis

Sporadic Juvenile Polyp Hyperplastic Polyp
Prominent cystically dilated glands Cystic dilation not prominent
Irregular glands Glands are vertically arranged and not complex

 

Mucosal Prolapse / Cloacogenic Polyp Sporadic Juvenile Polyp
Surface erosions with granulation tissue frequent Surface erosions infrequent
Irregular glands with scattered dilation Prominent, regularly dilated glands
Smooth muscle extension into lamina propria of polyps No smooth muscle in lamina propria of polyps
Restricted to rectum (rarely in sigmoid) May involve any part of colorectum

 

Sporadic Juvenile Polyp Reactive / Inflammatory Polyp
Prominent cystically dilated glands May have irregular dilation but not typically prominent and regular
Common in children without other GI disease More common in inflammatory bowel disease and diverticulitis but may be sporadic
The two can be similar in areas

 

Sporadic Juvenile Polyp Tubular Adenoma
Lacks cytologic dysplasia Requires cytologic dysplasia
Prominent cystically dilated glands Cystic dilation usually not prominent
Abundant inflamed stroma Inflamed stroma usually not prominent

 

Solitary Juvenile Polyp Solitary Peutz-Jeghers Type Hamartomatous Polyp
Smooth muscle absent in lamina propria Prominent arborizing smooth muscle bundles
Frequent mucous retention cysts Lacks retention cysts
Lacks pseudoinvasion May have displaced mucosa with pseudoinvasion of underlying muscularis propria

Clinical

  • Common in children
    • May occur at any age
  • Not associated with carcinoma when sporadic
  • May cause bleeding or intussusception

Bibliography

  • Bosman FT, Carneiro F, Hruban RH, Thiese ND (Eds). WHO Classifiication of Tumors of the Digestive System, IARC, Lyon 2010
  • Schreibman IR, Baker M, Amos C, McGarrity TJ. The hamartomatous polyposis syndromes: a clinical and molecular review. Am J Gastroenterol. 2005 Feb;100(2):476-90.
  • Coffin CM, Dehner LP. What is a juvenile polyp? An analysis based on 21 patients with solitary and multiple polyps. Arch Pathol Lab Med. 1996 Nov;120(11):1032-8.
  • Wu TT, Rezai B, Rashid A, Luce MC, Cayouette MC, Kim C, Sani N, Mishra L, Moskaluk CA, Yardley JH, Hamilton SR. Genetic alterations and epithelial dysplasia in juvenile polyposis syndrome and sporadic juvenile polyps. Am J Pathol. 1997 Mar;150(3):939-47.
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