Kasuga So, Anzai Hiroyuki, Makise Naohiro, Sonoda Hirofumi, Nagai Yuzo, Abe Shinya, Yokoyama Yuichiro, Ozawa Tsuyoshi, Emoto Shigenobu, Murono Koji, Sasaki Kazuhito, Kawai Kazushige, Nozawa Hiroaki, Ushiku Tetsuo, Ishihara Soichiro
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
Department of Pathology, The University of Tokyo, Tokyo, Japan.
Ann Med Surg (Lond). 2022 Sep 2;82:104433. doi: 10.1016/j.amsu.2022.104433. eCollection 2022 Oct.
Filiform polyposis, a rare condition also referred to as inflammatory polyposis or pseudopolyposis, is commonly observed in cases of inflammatory bowel disease, such as ulcerative colitis or Crohn's disease. It is generally considered a benign tumour characterised by multiple finger-like projections that are mostly observed in the transverse and descending colon.
A 69-year-old woman with a history of ulcerative colitis for 18 years who underwent temporary decompression ileostomy for large bowel obstruction at another hospital was referred to our institution for further investigation. Abdominal computed tomography revealed bowel wall thickening of the transverse colon, and colonoscopy revealed stenosis in the hepatic flexure obstructing the endoscope. Although several biopsies of the tumour showed no malignancy, laparoscopic subtotal colectomy with lymph node dissection was performed. Histopathological findings revealed localised filiform polyposis with dysplasia.
Filiform polyposis has been considered a benign inflammatory polyp without any risk of dysplasia. We accumulated previous cases of giant filiform polyposis and reviewed their characteristics. The presented case of filiform polyposis with ulcerative colitis complicated with high-grade dysplasia highlights the importance of considering malignancy in patients with filiform polyposis.
In cases of giant filiform polyposis, even when no malignancy is detected, surgical resection should be considered for the possibility of a malignant component of dysplasia.
丝状息肉病是一种罕见病症，也被称为炎性息肉病或假息肉病，常见于炎性肠病病例，如溃疡性结肠炎或克罗恩病。它通常被认为是一种良性肿瘤，其特征为多个手指状突起，多见于横结肠和降结肠。
一名69岁女性，有18年溃疡性结肠炎病史，曾在另一家医院因大肠梗阻接受临时减压回肠造口术，现转诊至我院作进一步检查。腹部计算机断层扫描显示横结肠肠壁增厚，结肠镜检查显示肝曲处狭窄，阻碍了内镜通过。尽管对肿瘤进行的多次活检均未显示恶性，但仍进行了腹腔镜次全结肠切除术并清扫淋巴结。组织病理学检查结果显示为局限性丝状息肉病伴发育异常。
丝状息肉病一直被认为是一种良性炎性息肉，不存在发育异常风险。我们收集了既往巨大丝状息肉病病例并回顾了其特征。本例溃疡性结肠炎合并高级别发育异常的丝状息肉病病例凸显了在丝状息肉病患者中考虑恶性病变的重要性。
在巨大丝状息肉病病例中，即使未检测到恶性病变，也应考虑手术切除，因为存在发育异常的恶性成分的可能性。
