Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2020; 26(8): 877-882
Published online Feb 28, 2020. doi: 10.3748/wjg.v26.i8.877
Diagnosis and management of a solitary colorectal juvenile polyp in an adult during follow-up for ulcerative colitis: A case report
You-Wei Chen, Jiang-Feng Tu, Wen-Juan Shen, Wan-Yuan Chen, Jie Dong
You-Wei Chen, Jiang-Feng Tu, Jie Dong, Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Wen-Juan Shen, Department of Gastroenterology, Nanxun District People's Hospital of Huzhou City, Huzhou 313009, Zhejiang Province, China
Wan-Yuan Chen, Department of Pathology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Author contributions: Chen YW was the patient’s doctor in charge and was responsible for collecting medical history, performing the colonoscopy, reviewing the literature, and drafting the paper; Tu JF and Shen WJ did the literature review; Chen WY was a pathologist who gave the pathological results; Dong J reviewed the literature and made contribution to revising the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jie Dong, MD, Doctor, Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, No. 158, Shangtang Road, Hangzhou 310014, Zhejiang Province, China. dj1104@zju.edu.cn
Received: December 10, 2019
Peer-review started: December 10, 2019
First decision: January 7, 2020
Revised: January 16, 2020
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: February 28, 2020
Processing time: 79 Days and 22.8 Hours
Abstract
BACKGROUND

Juvenile polyps are the most common type of polyps in children but are rare in adults. Inflammatory bowel disease (IBD) patients have a similar spectrum of symptoms as patients with juvenile polyps. Both patients with juvenile polyps and those with active IBD have high fecal calprotectin levels. Four cases of children with ulcerative colitis (UC) with solitary juvenile polyps and one case of an adult with UC with juvenile polyposis syndrome have been reported upon diagnosis of UC, while there have been no cases of adults with UC with solitary juvenile polyp reported in the literature.

CASE SUMMARY

A 37-year-old man with a 12-year history of UC was admitted to our clinic because of increased stool frequency. UC was diagnosed at the age of 25. As the lesion was confined to the rectum, sulfasalazine suppositories or mesalazine suppositories were used. The patient was followed in an outpatient clinic, and colonoscopy was performed every one or two years. The latest examination was undertaken three years prior in the presence of proctitis. Recently, the patient complained of three to five bowel movements a day. There was mucus in the stool but no visible blood. Colonoscopy revealed a solitary polyp, about 1.5 cm in diameter, with a short and broad peduncle in the transverse colon surrounded by congestive and edematous mucosa. The patient had no family history of colorectal polyps or cancer. The polyp was successfully removed by endoscopic mucosal resection. Histopathological examination revealed that the polyp was a juvenile polyp without any malignant signs. Immunohistochemical staining for p53 showed wild-type expression and p53 overexpression was not detected. Ki-67 labeling index was 3%.

CONCLUSION

This is the first case of an adult UC patient with a solitary juvenile polyp at the 12-year follow-up. The correlation between juvenile polyps and the activity of IBD needs further study.

Keywords: Solitary juvenile polyp; Ulcerative colitis; Endoscopic mucosal resection; Case report

Core tip: Juvenile polyps are the most common type of polyps in children but are rare in adults. Although sporadic juvenile polyps are not associated with an increased cancer risk, they may also undergo dysplastic changes. Inflammatory bowel disease patients have a similar spectrum of symptoms as patients with juvenile polyps. Both patients with juvenile polyps and those with active inflammatory bowel disease have high fecal calprotectin levels. Here, we present the first case of adult ulcerative colitis patient with a solitary juvenile polyp, which was treated by endoscopic mucosal resection, at his 12-year follow-up.