Colonic muco-submucosal elongated polyp (CMSEP), a newly categorized non-neoplastic colorectal polyp, is a pedunculated and elongated polyp composed of normal mucosal and submucosal layers without any proper muscle layer. We herein report a giant variant of CMSEP associated with intussusception in the rectosigmoid colon, with a review of the literature. A 48-year-old woman underwent a laparoscopic low anterior resection due to multiple large submucosal polypoid masses associated with intussusception. Grossly, the colonic masses were multiple pedunculated polyps with a long stalk and branches ranging in size from a few millimeters to 14.0 cm in length. Microscopically, there was no evidence of hyperplasia, atypia, or active inflammation in the mucosa. The submucosal layers were composed of edematous and fibrotic stroma with fat tissue, dilated vessels, and lymphoid follicles.
Jejunal intussusception and perforation due to enteric muco-submucosal elongated polyp: a case report and literature review Ryosuke Kikuchi, Shigenobu Emoto, Hiroaki Nozawa, Kazuhito Sasaki, Koji Murono, Shinya Abe, Hirofumi Sonoda, Aya Shinozaki-Ushiku, Soichiro Ishihara Surgical Case Reports.2023;[Epub] CrossRef
A stalk with no polyp—A muco‐submucosal elongated polyp in the duodenum Neil O’Morain, Ciaran McCloskey, Sinead Flanagan, Glen Doherty United European Gastroenterology Journal.2023; 11(4): 392. CrossRef
Duodenal Worm-Like Polyp Pan Pan, Guoshan Zhang, Xiao Cui, Liang Liu Digestive Diseases and Sciences.2023; 68(12): 4275. CrossRef
Colonic Mucosubmucosal Elongated Polyp in the Sigmoid Colon on Surveillance Colonoscopy Xiaowen Fan, Melissa Hershman, Gabriel Levi, Ilan Weisberg ACG Case Reports Journal.2019; 6(6): e00110. CrossRef
A 75-year-old man was referred to our hospital with intestinal obstruction caused by intussusception. Abdominal computed tomography (CT) revealed seven polypoid masses in the small intestine, while chest CT revealed a mass in the right lower lobe. Preoperative laboratory tests showed white blood cell (WBC) and neutrophil differential counts of 63,630/mm3 and 95%, respectively. The serum granulocyte colony-stimulating factor (G-CSF) was 114 pg/mL, which was elevated (normal range, <18.1 pg/mL). After resection of the small bowel, the WBC count decreased to 20,510/mm3. The pathology showed a poorly differentiated carcinoma with sarcomatous components confirmed by positive immunostaining of cytokeratin (AE1/AE3) and vimentin in the small intestine. Furthermore, immunohistochemistry with specific monoclonal antibodies against G-CSF was positive. A lung biopsy revealed the same histological findings as the small intestine lesion. Therefore, the patient was diagnosed as having a G-CSF producing sarcomatoid carcinoma of the lung with metastasis to the small intestine.
Metastatic osteosarcoma most commonly affects the lungs and other bones. Intestinal intussusception caused by metastatic osteosarcoma is very rare. We report a case of metastatic osteosarcoma of the intestine in a 39-year-old female. She underwent surgical resection of the left femur due to osteosarcoma and received additional chemotherapy 3 years ago. Pulmonary metastasis was found two years later and the patient complained of abdominal pain, nausea and vomiting after 8 months following excision of the lung nodules.
Abdominal computed tomography revealed intussusception with a suspected polypoid mass in the distal portion of the jejunum. The histologic findings of the resected bowel were those of osteosarcoma. This is the first case of documented intestinal metastasis of osteosarcoma in Korea. It is suggested that the tumor metastasis to the small intestine should be considered in patients with previous osteosarcoma, when the patient presents with acute abdominal symptoms and intussusception.