Endoscopy Challenge #4 - Jan '11

12 year old female with intermittent blood in her stool


12 year old female with no significant past medical history with 2 episodes separated by 9 months of passing small amounts of blood and blood clots in her stool. Each episode lasted 1 day, was not associated with abdominal pain, or a change in her bowel movements. She reports no history of constipation. Infectious stools studies were negative and she had a normal complete blood count and erythrocyte sedimentation rate. There was no significant family history.

Colonoscopy reveals the following finding:

A pedunculated polyp was found in the proximal sigmoid colon. The polyp was approximately 30 mm and the diameter and 50 mm in length (image 1).

It was removed by hot-snare polypectomy (image 2).

Removal was complete. Polyp was retrieved and sent to pathology for examination. The rest of the colon and ileum were normal in appearance. Histologic findings include hyperplastic mucosa with slightly dilated small glandular tissue (image 3).

Large sections of the polyp revealed glandular structures with crowded nuclei. p53 staining was positive (image 4).