IMAGE OF INTEREST Korean J Intern Med 2013;28:746-747 http://dx.doi.org/10.3904/kjim.2013.28.6.746
A giant fibroepithelial polyp mimicking a subepithelial tumor Dong Hwahn Kahng1, Gwang Ha Kim1, and Do Youn Park2 Departments of 1Internal Medicine and 2Pathology, Pusan National University School of Medicine, Busan, Korea
Received : July 11, 2013 Revised : July 22, 2013 Accepted : August 5, 2013 Correspondence to Gwang Ha Kim, M.D. Tel: +82-51-240-7869 Fax: +82-51-244-8180 E-mail:
[email protected]
A 48-year-old woman was referred to our hospital for evaluation of a large subepithelial rectal mass, which had been incidentally detected on abdominopelvic computed tomography (CT) (Fig. 1A). Two years prior, she had undergone hepatopancreaticoduodenectomy with right hemicolectomy to treat gallbladder cancer that had invaded the liver and ascending colon.
Subsequently, she received adjuvant chemotherapy and annual follow-up. CT revealed a 3-cm-diameter large pedunculated subepithelial mass covered by intact whitish mucosa in the distal rectum (Fig. 1B). On endoscopic ultrasonography (EUS), a heterogenously hypoechoic lesion with scattered hyperechogenic spots was obser ved i n t he deep mucosa l a nd
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Figure 1. Radiological and endoscopic findings on study of a giant fibroepithelial polyp. (A) Abdominopelvic computed tomography revealed a 3-cm-diameter subepithelial cystic mass in the rectum (arrow). (B) A 3-cm-diameter giant pedunculated subepithelial mass with intact whitish mucosa was observed in the distal rectum. (C) A heterogeneously hypoechoic lesion with scattered hyperechogenic spots was observed in the deep mucosal and submucosal layers on endoscopic ultrasonography (arrow). (D) The resected specimen.
Copyright © 2013 The Korean Association of Internal Medicine
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pISSN 1226-3303 eISSN 2005-6648 http://www.kjim.org
Kahng DH, et al. A fibroepithelial polyp like subepithelial tumor
submucosal layers (Fig. 1C). The CT and EUS findings raised the suspicion of an inflammatory fibrinoid polyp, a lymphangioma, or a rare form of metastatic cancer. She underwent endoscopic mucosal resection using a detachable snare. The resected specimen was approximately 4 cm in diameter and had a nodular shape (Fig. 1D). Pathologically, the tumor consisted of a fibrous stroma with small dilated vessels, and was covered with normal squamous epithelium (Fig. 2). The final diagnosis was a rectal fibroepithelial polyp. Recurrence was not observed on follow-up colonoscopy performed 2 years later. Fibroepithelial polyps are common benign polypoid tumors formed by squamous epithelium and subepithelial connective tissue. They are generally small in size and asymptomatic. However, a giant fibroepithelial polyp can cause intussusception or obstructive ileus. Therefore, if a tumor is larger than 3 cm in diameter, endoscopic or surgical resection is recommended. Follow-up is not essential, because no case of malignant transformation of a fibroepithelial polyp is known.
http://dx.doi.org/10.3904/kjim.2013.28.6.746
Figure 2. Pathological examination of the specimen revealed a fibrous stroma with small dilated vessels, covered with normal squamous epithelium (H&E, × 40).
Conflict of interest No potential conflict of interest relevant to this article is reported.
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