Background
Case presentation
Discussion
Historical perspective
Clinical demographics
Ref. | No of cases | Mean age in years (Range) | F:M | Distal to transverse colon | Mean size (Range) in mm | Endoscopic description | No of cases with polyps elsewhere in colon |
---|---|---|---|---|---|---|---|
[1] | 14 | 62 (37-84) | 8:6 | 13/14 | 5.1 (2 – 15) | ‘polyps’ | 10/14 |
5 | 65 (52-77) | 3:2 | 4/5 | 3 (2 – 4) | NS | 4/4 | |
[8] | 9 | 51 (35-72) | 7:2 | 7/8 | 6.8 (2-30) | Small sessile polyps | 5/9 |
[7] | 4 | 66 (58-71) | 2:2 | 3/4 | 9.8 (6-15) | Two sessile polyps depicted | 3/4 |
60 | 60 (36-84) | 30:30 | 52/60 | 3.4 (1-8) | Flat/sessile to round/ pedunculated | 21/60 | |
[9] | 4 | 59 (47-80) | 3:1 | 4/4 | 3.8 (3-5) | Sessile polyps | 3/4 |
[13] | 1 | 54 | 0:1 | NS | 5 | NS | NS |
[14] | 1 | 50 | 0:1 | 1/1 | 6 | Polypoid lesion | 0/1 |
[3] | 29 | 64 (43-84) | 23:6 | 26/28 | 2.7 (3-9) | NS | 19/29 |
[4] | 20 | 58 (44-87) | 9:11 | 17/20 | 5.1 (3-15) | NS | 15/20 |
[16] | 9 | 62 (45-84) | 5:4 | 4/9 | 4 (NS) | NS | 6/9 |
[17] | 1 | 51 | 1:0 | 1/1 | 15 | ‘Submucosal lesion’ | 0/1 |
Current case | 1 | 42 | 0:1 | 0/1 | 5 | Pedunculated polyp | 0/1 |
Total | 158 | 60 (35-87) | F:M = 1.3 | 132/155 85% | 4.1 (1 – 30) | 86/156 55% |
Microscopic findings
Ref. | No of cases | Serrated crypts | EMA+a | Claudin-1+ | GLUT1+ | Collagen IV+ | CD34+a | BRAF mutation |
---|---|---|---|---|---|---|---|---|
[1] | 14 | 3/14 | 0/14 | ND | ND | ND | 3/14 | ND |
5 | 2/4 | 3/5 | 4/5 | 5/5 | ND | 2/4 | ND | |
[8] | 9 | 5/9 | 9/9 | 4/9 | ND | ND | 2/9 | ND |
[7] | 4 | 4/4 | ND | ND | ND | ND | 0/4 | ND |
60 | 45/60 | 39/45 | 40/45 | 42/45 | 45/45 | 0/10 | 5/20 | |
[9] | 4 | NS | 4/4 | 4/4 | 4/4 | ND | ND | ND |
[13] | 1 | 1/1 | NS | NS | NS | 1/1 | ND | ND |
[14] | 1 | 0/1 | ND | ND | ND | ND | 0/1 | ND |
[3] | 29 | 29/29 | 21/26 | 15/17 | 20/26 | 17/17 | 8/27 | 14/22 |
[4] | 20 | 18/20 | 20/20 | ND | ND | ND | ND | 18/20 |
[16] | 9 | NS | 7/9 | 9/9 | 7/9 | ND | ND | ND |
[17] | 1 | NS | 0/1 | ND | 1/1 | 1/1 | 1/1 | ND |
Current case | 1 | 1/1 | 1/1 | ND | 1/1 | 1/1 | 0/1 | 1/1 (IHC) |
Total | 158 | 108/143 75% | 104/134 78% | 76/89 85% | 80/91 88% | 65/65 100% | 16/71 23% | 38/63 60% |
Differential diagnosis and immunohistochemical findings
Perineurioma | GIST [25] | Schwann cell hamartoma [21] | Ganglio-neuroma [25] | Neurofibroma [21] | Schwannoma [26] | Inflammatory fibroid polyp [25] | Inflammatory myoglandular polyp [20] | Leiomyoma of the MM [27] | |
---|---|---|---|---|---|---|---|---|---|
Most common location | Distal colon | Stomach, small bowel | Distal colon | Distal colon | Stomach, small bowel | Stomach | Stomach, ileum | Distal colon | Distal colon |
Epicentre | Mucosa | MP | Mucosa | Mucosa | Submucosa | MP | Submucosa | Mucosa | MM |
Typical size | < 10 mm | Two-thirds > 50 mm | ≤5 mm | 10 - 20 mm | Wide size range | > 10 mm | 10 - 50 mm | 5 - 20 mm | < 10 mm |
Histological clues | Entrapped serrated crypts, peri-cryptic growth, bland cytology | Spindled to epithelioid, variable palisading, paranuclear vacuoles, collagen fibrils | Ample eosinophilic cytoplasm, no serration in entrapped crypts | Ganglion cells present | Diverse cellular composition: Schwann cells, fibroblasts, perineurial-like cells, axons | Circumscribed, peripheral lymphoid cuff with germinal centres, focal atypia | Many eosinophils, perivascular concentric cuffing, fibromyxoid background | Inflamed granulation tissue, proliferation of smooth muscle in LP, occasional cystic glands | Originates from MM, circum-scribed, eosinophilic cytoplasm |
Positive IHC stains | EMA, claudin1, GLUT1 | C-Kit, DOG1, CD34 | S100 (all cells), NFP (rare) | S100 in spindled cells | S100 (subset of cells), CD34 | S100, GFAP | CD34, cyclin D1, fascin | SMA, desmin in smooth muscle | SMA, desmin |