Intestinal obstruction caused by giant filiform polyposis in a patient with normal colon

A 31-year-old patient with no previous history of inflammatory bowel disease (IBD) underwent further evaluation for recurrent episodes of intestinal obstruction. Abdominal computed tomography revealed thickening of the wall of the ascending colon and dilated small-bowel loops ([Fig. 1]). Colonoscopy disclosed a large polypoid mass with fingerlike projections in the right colon ([Fig. 2]). Progression of the endoscope beyond this point was not possible. Biopsies were negative for malignancy. Prompted by the suspicious endoscopic appearance of the lesion and the signs of intestinal obstruction, a right-sided hemicolectomy was carried out. The resected specimen included a mass with multiple clustered polyps with several branches that almost completely obliterated the lumen of the colon ([Fig. 3]). Microscopic examination was consistent with giant filiform polyposis ([Fig. 4]). The nonpolypoid mucosa of the terminal ileum and right colon was normal.

Fig. 1 Computed tomography (CT) in a 31-year-old patient presenting with recurrent episodes of intestinal obstruction but with no previous history of inflammatory bowel disease (IBD). The wall of the right colon is thickened (asterisk) with intraluminal fingerlike lesions (arrow) and dilated small bowel loops (arrowhead).

Fig. 2 Colonoscopic view of the polypoid mass obstructing the lumen of the right colon.

Fig. 3 a Macroscopic findings of the resected segment. The mass filled the entire lumen of the colon. b The lesion had a coral reef-like surface appearance with soft, fingerlike protrusions into the lumen.

Fig. 4 Histological section showed filiform projections of the mucosa with evidence of chronic inflammation. No crypt abscesses were noted (hematoxylin and eosin staining).

Filiform polyposis of the colon is a rare entity, usually encountered in the colon of patients with IBD [1]. However, sporadic cases of filiform polyposis have been reported in patients with histiocytosis X [2], intestinal tuberculosis [3], and ischemic colitis [4]. Filiform polyposis is morphologically characterized by multiple, slender, wormlike projections consisting of submucosal cores lined with normal mucosa. The polyps can range in size from 1.5 cm to 3 cm in length and up to 0.5 cm in diameter [5]. When these polyps adhere to each other, they form large tumorlike masses [1] [6] [7] [8]. A Pubmed search revealed fewer than 20 reported cases of filiform polyposis without history of IBD [6] [7] [8] [9]. In only three of these cases was the lesion circumferential, measuring 4 – 15 cm across the largest diameter [6] [7] [8]. Filiform polyposis alone is not an indication for resection, but complications such as acute massive hemorrhage, intussusception, and intestinal obstruction may necessitate surgical intervention [1] [6] [9] [10].

Endoscopy_UCTN_Code_CCL_1AD_2AC

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