Single filiform polyp in asymptomatic healthy Korean without history of inflammatory bowel disease

Here we report the first published case of a single filiform polyp discovered during routine screening in an individual without symptoms or a history of colonic disease.

A 47-year-old man was transferred to our outpatient department for treatment of a single colon polyp which had been incidentally found on medical examination. Other results including upper endoscopy and laboratory test except colonoscopy were normal. The patient was asymptomatic and in good health. He had no significant history of intestinal complaint or gastrointestinal bleeding. We carried out a routine colonoscopic examination. Colonoscopy demonstrated a long, thin and finger-like polyp in the transverse colon ([Fig. 1] a, b). We carried out an endoscopic polypectomy by snare. Histologically, the polyp was filiform and covered by normal mucosa ([Fig. 2] a, b). Observation has continued to date, but no gastrointestinal symptoms or signs have been observed.

Fig. 1 Endoscopic appearance of the transverse colon. a A long, vermiform polyp was seen in the transverse colon. It was approximately 4.5 cm in the length and about 0.7 cm in diameter. b Mucosa was nearly normal except for focal erythema.

Fig. 2 Histologic views of the transverse colon (H & E). a A long slender appearance was shown (H &E, × 1). b In submucosa, many stromal vessels with dilatation and congestion were found, as well as many adipocytes and mild fibrosis. Normal mucosa and lymphoid follicle below the mucosa were noted (H & E, × 40).

Filiform polyposis is a rare condition of postinflammatory polyposis as a benign, nonspecific sequela characterized by multiple, slender, arborizing, vermiform projections of submucosa covered by mucosa on all sides. Filiform polyps are often long and thin (2-5 cm in length and 0.5 cm in diameter), and almost always multiple. Filiform polyposis has been rarely reported in patients without previous colonic disease. A review of the literature revealed only six cases of filiform polyposis without evidence and history of inflammatory bowel disease [1] [2]. All of the patients experienced diarrhea or gastrointestinal bleeding. A single filiform polyp was shown in only two patients with severe hemorrhage [1] [2].

To our knowledge, this is the first report of filiform polyposis, which was fortunately found in an asymptomatic adult without evidence of inflammatory bowel disease on health screening. Our case is the first that shows no symptoms and a single filiform polyp. It is difficult to explain why a filiform polyp is born in an asymptomatic adult.

Endoscopy_UCTN_Code_CCL_1AD_2AC

References

• 1 Rozenbajgier C, Ruck P, Jenss H, Kaiserling E. Filiform polyposis: a case report describing clinical, morphological, and immunohistochemical findings.  Clin Investig. 1992;  70 520-528
• 2 Macaigne G, Boivin J F, Cheaib S. et al . Single filiform polyp revealed by severe hemorrhage in a patient with normal colon. Report of a case and review of the literature [abstract].  Gastroenterol Clin Biol. 2006;  30 913-915