Red carpet of filiform polyposis!

Abstract

© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. A 27yearold man, already a diagnosed case of ulcerative colitis, on treatment with prednisolone, presented with bloody diarrhoea, rectal bleeding and severe anaemia for the last 2 months. There was no evidence of cytomegalovirus/clostridial/any other superimposed infection on biopsy or stool culture. The patient was in remission with corticosteroids for last 2 years. Subtotal colectomy was performed for steroid refractory ulcerative colitis. Gross examination revealed a diffuse carpet of closely packed slender, wormlike, polyps, >100 in number, ranging from 0.3 to 3 cm in length and 0.2–0.6 cm in diameter (figure 1). These polyps were thin, straight, fingerlike resembling stalks without heads and were diffusely involving almost the entireresected colon from distal caecum till descending colon over a span of 65 cm (figure 1). Focal intervening ulcerated mucosa was noted. Appendix and distal ileum were grossly unremarkable. On microscopy, the polypoidal mucosa showed features of chronic colitis with severe activity, without any evidence of dysplasia confirming the diagnosis of diffuse inflammatory polyposis/filiform polyposis (FP) (figure 2). Though in the classical setting of inflammatory bowel disease (IBD), FP is related to postinflammatory reparative process, but in the rare nonIBD scenario, submucosal neuromuscular and fibrovascular hyperplasia/disarray in response to chronic mucosal prolapse might be the possible aetiopathogenesis. On endoscopy and radiology, FP can mimic adenomatous polyp or malignancy in patients without any history of IBD, for which polypectomy and histological evaluation is necessary. 3 The index case reiterates the fact that such an extensive FP in a background of IBD is never premalignant given the absolute nondysplastic nature of these polyps and subtotal colectomy should be reserved only for complicated or refractory cases of symptomatic FP in IBD. Also, it is important to evaluate the resection margins, since inflammatory polyposis can recur as reparative sequelae of inflammation or residual disease at the resected margins. 2