Polypoid mucosal prolapse complicating low rectal adenomas: beware the inflammatory cloacogenic polyp!
Article first published online: 28 JUN 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Limited
Volume 53, Issue 1, pages 91–96, July 2008
How to Cite
Parfitt, J. R. and Shepherd, N. A. (2008), Polypoid mucosal prolapse complicating low rectal adenomas: beware the inflammatory cloacogenic polyp!. Histopathology, 53: 91–96. doi: 10.1111/j.1365-2559.2008.03035.x
- Issue published online: 28 JUN 2008
- Article first published online: 28 JUN 2008
- Date of submission 28 November 2007 Accepted for publication 1 January 2008
- gastrointestinal neoplasms;
- inflammatory cloacogenic polyp;
- mucosal prolapse;
- polypoid mucosal prolapse
Aims: Polypoid mucosal prolapse near the anorectal junction mimics adenomas endoscopically and histopathologically. The aim was to describe the phenomenon of polypoid mucosal prolapse arising secondary to adenomas at the anorectal junction.
Methods and results: Four cases of low rectal adenoma with polypoid mucosal prolapse were assessed histopathologically, as well as with p53 and Ki67 antibodies. Two were male and two female; the mean age was 45 years. Available follow-up has revealed no recurrence in any patient. All cases showed mucosal expansion with ulceration or erosion, crypt architectural irregularity, fibromuscular proliferation between crypts and variable epithelial serration and inflammation. Each case also showed unequivocal dysplasia, often co-mingled with features of prolapse, highlighted by p53 and Ki67 immunohistochemistry, which demonstrated positivity within dysplastic areas.
Conclusions: Histopathologists must recognize the potential for adenomatous/dysplastic foci in anorectal lesions to superficially resemble inflammatory cloacogenic polyps. We recommend use of immunomarkers p53 and Ki67 to aid the interpretation of challenging cases. We believe that polypoid mucosal prolapse changes can be a secondary phenomenon, due to adenomas close to or at the anorectal junction.