Gurbir Sehmbey, MD1, Keng-Yu Chuang, MD2
1Banner University Medical Center, Phoenix, AZ; 2Maricopa Integrated Health System, Phoenix, AZ
Introduction: Colonic hamartomas are non-neoplastic polypoid lesions that are rare in adults and most commonly encountered in children between the age of 1 and 7 years. They are histologically characterized by cystic dilation of mucus-filled glands, prominent bands of fibrous stroma, and a rich vascular network. Hamartomatous polyps are often diagnosed during endoscopy and require histological identification.
Case Description/Methods: A 43-year old male was referred due to intermittent rectal bleeding and positive fecal occult blood test (FOBT). He did endorse a positive family history of colon cancer in his mother. Colonoscopy was performed, revealing: 3 small sessile polyps < 3 mm in size and a single 2 cm pedunculated polyp in the sigmoid colon (Figure 1). Polypectomy was performed for each noted polyp. Histopathological examination of the sigmoid polyp revealed a benign hamartomatous polyp with cystic dilation and focal crypt abscess (Figure 2). Pathology of rest of polyps revealed benign colonic mucosa with mild non-specific inflammation. The patient did well and remained symptom-free on follow up visit.
Discussion: Hamartomatous polyps are characterized by disorganized growth of tissue native to the organ in which it occurs. The reported prevalence of hamartomatous polyps in the adult population is around 0.15%. The prevalence of hamartomas in patients with colon polyps at index colonoscopy is 0.073%. Colonic hamartomas can occur sporadically or may present with distinct syndromic and hereditary features. The syndromes commonly associated with hamartomatous polyps are Peutz–Jeghers syndrome (PJS), juvenile polyposis, and phosphatase and tensin homolog (PTEN) hamartoma syndrome (PTHS). Endoscopically, these polyps can appear as pedunculated or sessile lesions making them indistinguishable from adenomatous polyps, which makes it prudent for the endoscopist to remove these lesions for histologic examination. In pediatric patients, hamartomas usually are localized to the rectum, the left colon, and may cause rectal bleeding, abdominal pain, and transanal prolapse. In adults, colonic hamartomas are most frequently found in the left colon and the rectosigmoid region. Patients are most commonly referred for colonoscopy due to positive FOBT or rectal bleeding. It is important to distinguish sporadic polyps from syndromic polyps as the sporadic polyps generally have a relatively benign course, while those associated with a syndrome have a higher lifetime malignancy risk.
Citation: Gurbir Sehmbey, MD; Keng-Yu Chuang, MD. P0178 - SPORADIC COLONIC HAMARTOMA IN AN ADULT PATIENT: A RARE FINDING. Program No. P0178. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.