P0233 - Masquerading Benign Polyp: A Case Report of Prolapse Polyps

Joseph Asemota, MD, MPH¹, Temitayo Gboluaje, MD¹, Adeyinka Laiyemo, MD, MPH², Angesom Kibreab, MD², Victor Scott, MD³, Hassan Ashktorab, PhD², Walid Ali, MD¹, Kathriel Brister, MD¹, Charles Howell, MD², Farshad Aduli, MD^2
1Howard University Hospital, Washington, DC; ²Howard University College of Medicine, Washington, DC; ³Howard University, Washington, DC

Introduction: Mucosal prolapse (MP) syndrome is a rare and benign entity that can be mistaken for a neoplastic lesion on endoscopy. We report a case of an asymptomatic patient discovered incidentally on screening colonoscopy with an appearance suspicious for neoplasm.

Case Description/Methods: A 65-year-old male who presented to the gastroenterology clinic for average risk colorectal cancer screening. Physical examination was unremarkable, and laboratory tests were normal. He underwent colonoscopy which revealed diverticulosis. Two large pedunculated sigmoid colon polyps, were removed with snare. Histology of both polyps showed colonic mucosa with features of MP (figure 1).

Discussion: MP can easily be misdiagnosed as it may various other pathology. Its true prevalence is largely unknown due to under-recognition. It is often diagnosed in the 4^th to 6^th decade of life with a 3:1 male to female ratio. The etiology of MP is unknown; it is speculated that spastic contraction of the bowel wall with chronic straining during defecation causes mucosal redundancy, passive venous congestion and obstruction.
Endoscopically, MP can be categorized into 3 groups; ulcerated lesions (55%), flat erythematous lesions (21%), or polypoid lesions (24%). Polypoid lesions may be sessile, pedunculated or broad-based. There remains no pathognomonic endoscopic finding for MP.
Upon diagnosis of MP by pathology, conservative management is often sufficient and treatment options such as high-fiber diet results in significant regression. There have been few reports of adenomatous foci in patients with MP polyps. The existing evidence does not suggest an elevated risk for malignant transformation and it is consequently not considered a precursor of colorectal cancer.
In summary, endoscopic evaluation with appropriate biopsies and follow-up histopathologic analysis are the sine-qua-non for an accurate diagnosis. It guides management and follow-up surveillance strategies, preventing unnecessary invasive procedures and unwarranted follow-up.



Disclosures:


Joseph Asemota, MD, MPH¹, Temitayo Gboluaje, MD¹, Adeyinka Laiyemo, MD, MPH², Angesom Kibreab, MD², Victor Scott, MD³, Hassan Ashktorab, PhD², Walid Ali, MD¹, Kathriel Brister, MD¹, Charles Howell, MD², Farshad Aduli, MD². P0233 - Masquerading Benign Polyp: A Case Report of Prolapse Polyps, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.