P0212 - Colonic Mucosubmucosal Elongated Polyp

Shaadi Abughazaleh, MD, Ramon Minjares, MD, Donna Coffey, MD, Alberto Barroso, MD
Houston Methodist Hospital, Houston, TX

Introduction: Colonic Mucosubmucosal Elongated Polyps are rare benign lesions which have a distinctive histological and endoscopic appearance. We present a rare case of one found in a patient who presented for screening colonoscopy.

Case Description/Methods: A 52 year-old Hispanic female with a medical history of migraines presented for screening colonoscopy. A colonoscopy was completed where she was found to have a 21 mm pedunculated and elongated polyp in the descending colon. The polyp stalk was injected with epinephrine and a hot snare polypectomy was achieved with complete resection and retrieval

On pathology examination, the polyp was described a pedunculated, elongated and composed of normal colonic mucosa overlying submucosa with edema and thick-walled vessels. There was no inflammation, fibromuscular proliferation, amyloid deposition, dysplasia or malignancy seen on 11 levels which were examined. Histological and endoscopic findings were most consistent with colonic mucosubmucosal elongated polyp (CMSEP). The case was discussed in a multidisciplinary fashion and given the benign nature of these polyps without known risk for malignant transformation, it was recommended that she repeat colonoscopy in 10 years given as the presence of CMSEP did not modify the recommended follow-up interval.

Discussion: CMSEP is a distinctive benign colorectal polyp which has been characterized by a pedunculated, elongated, or drumstick appearance composed mainly of expanded submucosa with a normal epithelial lining. These findings allow CMSEP to belong to a unique and separate category of polyps apart from inflammatory, hyperplastic, neoplastic, or hamartomatous polyps. These rare polyps were first described in the Japanese literature and are less-so described in the Western literature with less than 25 total abstracts appearing in Pub-Med. The largest case series was published in 2016 reporting 14 cases of CMSEPs. Given the distinctive histological and endoscopic features, Pathologist should be aware to avoid confusion with more commonly encountered colorectal polyps.



Disclosures:


Shaadi Abughazaleh, MD, Ramon Minjares, MD, Donna Coffey, MD, Alberto Barroso, MD. P0212 - Colonic Mucosubmucosal Elongated Polyp, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.