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Abstract
Purpose
Colonic polyposis is less common in children than in adults. The clinical data pertaining to colonic polyposis in children are limited. Children with colonic polyposis have complications associated with numerous polyps, malignant transformation of the polyps, and extraintestinal neoplasms. We studied the clinical spectrum, endoscopic characteristics, and histologic findings of colonic polyposis in Korean children.
Methods
We reviewed the clinical data of 37 children with multiple colonic polyps between 1987 and 2009. The mean age at the time of diagnosis of colonic polyposis was 8.0±3.2 years.
Results
Peutz-Jeghers syndrome, juvenile polyposis syndrome, familial adenomatous polyposis (FAP), and lymphoid polyposis was diagnosed in 22, 7, 6, and 2 children, respectively. The most common clinical presentation in children with colonic polyposis was hematochezia. A family history of colonic polyposis was noted in 7 children. The colonoscopic findings of colonic polyposis varied with the size and number of polyps. The majority of polyps were multi-lobulatd and pedunculated in children with Peutz-Jeghers syndrome. The polyps in children with juvenile polyposis syndrome were primarily round and pedunculated. For the children with FAP, the colon was carpeted with small, sessile polyps. There were multiple sessile polyps in the patients with lymphoid polyposis. Surgical polypectomy was performed in 14 children (38%). Intestinal segmental resection was performed in 13 children (35%). Four patients with FAP underwent total colectomy. Four children with Peutz-Jeghers syndrome had extraintestinal neoplasms. No malignant transformation of polyp was identified.
Figures and Tables
Fig. 1
A 15-year-old girl with Peutz-Jeghers syndrome. (A) Colonoscopic finding showing multilobulated polyps identified in the descending colon. (B) Photomicrograph showing hyperplastic glandular structures without cellular atypia divided by smooth muscle fiber (arrowhead) from muscularis mucosa (H&E, ×100).
Fig. 2
A 13-year-old girl with juvenile polyposis syndrome. (A) Colonoscopic finding showing pedunculated juvenile polyps with a stalk identified in the sigmoid colon. (B) Photomicrograph showing dilated cystic glands retaining mucus (arrowhead), markedly expanded lamina propria with diffuse infiltration of chronic inflammatory cells, and surface erosion (H&E, ×100).
Fig. 3
A 14-year-old girl with familial adenomatous polyposis. (A) Colonoscopic finding showing typical features of familial adenomatous polyposis carpeted with small adenomatous polyps. (B) Photomicrograph showing tubular adenoma with low grade dysplasia (H&E, ×100).
Fig. 4
A 9-year-old boy with lymphoid polyposis. (A) Colonoscopy showing large sessile polyp noted on the ascending colon with an ileocecal valve deformity. (B) Photomicrograph showing benign reactive lymphoid follicle with an active germinal center (arrowhead; H&E, ×100).
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