Crohn's-like clinical and pathological manifestations of giant inflammatory polyposis in IBD

A potential diagnostic pitfall

Steven Naymagon, Michael Mikulasovich, Xianyong Gui, Thomas A. Ullman, Noam Harpaz

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background & aims: Giant inflammatory polyposis (GIP), characterized by mass-like agglomerations of inflammatory polyps, is a rare complication of inflammatory bowel disease (IBD). We reviewed a series of cases of GIP to determine its diagnostic impact on the clinical and pathologic distinction between ulcerative colitis (UC) and colonic Crohn's disease (CD). Methods: All colons with GIP resected over a 13-year period were identified prospectively and the corresponding clinical and pathologic records were reviewed. Results: Twelve cases of GIP were identified, accounting for 0.8% of colectomies for IBD during the same time interval. Preoperatively, 6 (50%) patients were diagnosed with UC, 2 (17%) with CD and 4 (33%) with indeterminate colitis (IC). Postoperatively, 6 of the diagnoses (50%) were revised based on strict histopathologic criteria: all 4 diagnoses of IC to UC, one diagnosis of CD to UC, and one diagnosis of UC to CD, for a total of 10 diagnoses of UC (83%) and two of CD (17%). Significantly, 7 of 10 cases with postoperative diagnoses of UC (70%) had Crohn's-like transmural inflammation exclusively within the polyposis segments attributed to fecal entrapment and stasis and accounting for the Crohn's-like clinical complications in these cases. Conclusions: This case series of GIP, the largest reported from a single center, highlights the high rate of Crohn's-like clinical and pathological manifestations of GIP and their potential to confound the accurate classification of patients with IBD. A diagnosis of UC should not be amended to CD based on the findings of the polyposis segment alone.

Original languageEnglish (US)
Pages (from-to)635-640
Number of pages6
JournalJournal of Crohn's and Colitis
Volume8
Issue number7
DOIs
StatePublished - Jul 1 2014

Fingerprint

Ulcerative Colitis
Inflammatory Bowel Diseases
Crohn Disease
Colitis
Colonic Diseases
Colectomy
Polyps
Colon
Inflammation

Keywords

  • Crohn's disease
  • Giant filiform polyposis
  • Giant inflammatory polyposis (GIP)
  • Inflammatory bowel disease
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology
  • Medicine(all)

Cite this

Crohn's-like clinical and pathological manifestations of giant inflammatory polyposis in IBD : A potential diagnostic pitfall. / Naymagon, Steven; Mikulasovich, Michael; Gui, Xianyong; Ullman, Thomas A.; Harpaz, Noam.

In: Journal of Crohn's and Colitis, Vol. 8, No. 7, 01.07.2014, p. 635-640.

Research output: Contribution to journalArticle

Naymagon, Steven ; Mikulasovich, Michael ; Gui, Xianyong ; Ullman, Thomas A. ; Harpaz, Noam. / Crohn's-like clinical and pathological manifestations of giant inflammatory polyposis in IBD : A potential diagnostic pitfall. In: Journal of Crohn's and Colitis. 2014 ; Vol. 8, No. 7. pp. 635-640.
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abstract = "Background & aims: Giant inflammatory polyposis (GIP), characterized by mass-like agglomerations of inflammatory polyps, is a rare complication of inflammatory bowel disease (IBD). We reviewed a series of cases of GIP to determine its diagnostic impact on the clinical and pathologic distinction between ulcerative colitis (UC) and colonic Crohn's disease (CD). Methods: All colons with GIP resected over a 13-year period were identified prospectively and the corresponding clinical and pathologic records were reviewed. Results: Twelve cases of GIP were identified, accounting for 0.8{\%} of colectomies for IBD during the same time interval. Preoperatively, 6 (50{\%}) patients were diagnosed with UC, 2 (17{\%}) with CD and 4 (33{\%}) with indeterminate colitis (IC). Postoperatively, 6 of the diagnoses (50{\%}) were revised based on strict histopathologic criteria: all 4 diagnoses of IC to UC, one diagnosis of CD to UC, and one diagnosis of UC to CD, for a total of 10 diagnoses of UC (83{\%}) and two of CD (17{\%}). Significantly, 7 of 10 cases with postoperative diagnoses of UC (70{\%}) had Crohn's-like transmural inflammation exclusively within the polyposis segments attributed to fecal entrapment and stasis and accounting for the Crohn's-like clinical complications in these cases. Conclusions: This case series of GIP, the largest reported from a single center, highlights the high rate of Crohn's-like clinical and pathological manifestations of GIP and their potential to confound the accurate classification of patients with IBD. A diagnosis of UC should not be amended to CD based on the findings of the polyposis segment alone.",
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