Hematochezia with colonic polypoid angiodysplasia in a young female patient

Abstract

A 18-year-old girl visited the hospital due to hematochezia. Colonoscopy revealed a 6-mm Yamada type II polyp with stigmata of bleeding, and a shallow ulcer on top was found at the cecum base. The polyp was removed by snare polypectomy, and hematochezia stopped thereafter. Angiodysplasia was diagnosed histopathologically. Generally, angiodysplasia appears as a flat or elevated, bright-red lesion on endoscopy, with a polypoid shape being extremely rare. This case is significant because the lesion occurred at the youngest reported age and was the smallest that has been reported, and is the only polypoid arteriovenous malformation to be discovered in the cecum.

Keywords: Angiodysplasia; Cecum; Hematochezia; Polyp; Young.

Fig. 1

Colonoscopic view of the polypoid lesion with stigmata of bleeding (6 mm, Yamada type II), with a shallow ulcer on top at the cecum base.

Fig. 2

Colonoscopic view of the polyp removed by snare polypectomy.

Fig. 3

(A) The submucosa layer was thickened and had an eroded surface (elastic stain, original magnification (×40)). (B) The thickened submucosa is due to proliferation of both large and small vessels and cell infiltrates (Elastic stain, (×100)).

Fig. 4

Staining was negative for CD34 marker, which is specific for inflammatory fibroid polyps (×40).