Inflammatory cap polyposis
Contributed by by Andrea L. Wiens, D.O. and Janet E. Roepke, M.D., Ph.D, Ball Memorial Hospital, Muncie, IN.
A 28-year-old man presented with a 9-year history of chronic ulcerative colitis (UC), treated initially with Asacol and more recently with Imuran, and rectal polyps. Biopsies one year ago were diagnosed as adenoma-like low grade dysplasia in association with chronic active colitis. The patient subsequently underwent a transanal excision of the irregular folds, and the tissue sections were read as markedly inflamed hyperplastic polyps with superficial mucosal ulcerations and no evidence of dysplasia or malignancy. The patient now has recurrence of a circumferential nodular mucosal fold in the rectum that is concerning for malignancy, in addition to a continuous inflammatory process involving the rectum and left colon. The right colon is relatively free of inflammatory disease. Biopsies were obtained.