Juvenile polyp

Juvenile polyps are a type of polyp found in the colon. While juvenile polyps are typically found in children, they may be found in people of any age. Juvenile polyps are a type of hamartomatous polyps, which consist of a disorganized mass of tissue. They occur in about two percent of children.[1] Juvenile polyps often do not cause symptoms (asymptomatic); when present, symptoms usually include gastrointestinal bleeding and prolapse through the rectum. Juvenile polyps are diagnosed via colonoscopy or flexible sigmoidoscopy. If symptoms are present, then removal of the polyp (polypectomy) is warranted. In the absence of symptoms, removal is not necessary. Recurrence of polyps following removal is relatively common.[2] Juvenile polyps are usually sporadic, occurring in isolation, although they may occur as a part of juvenile polyposis syndrome. Sporadic juvenile polyps may occur in any part of the colon, but are usually found in the distal colon (rectum and sigmoid). In contrast to other types of colon polyps, juvenile polyps are not premalignant and are not usually associated with a higher risk of cancer;[3] however, individuals with juvenile polyposis syndrome are at increased risk of gastric and colorectal cancer.[1][4] Unlike juvenile polyposis syndrome, solitary juvenile polyps do not require follow up with surveillance colonoscopy.

Juvenile polyp
SpecialtyGastroenterology
SymptomsAsymptomatic
Rectal bleeding
Rectal prolapse
Usual onsetChildhood
TypesSolitary
Juvenile polyposis syndrome
Diagnostic methodColonoscopy
Differential diagnosisHyperplastic polyp, Inflammatory polyp, Cowden syndrome
Peutz-Jeghers syndrome
TreatmentPolypectomy
Frequency2% of children

Signs and symptoms

Juvenile polyps often do not cause symptoms (asymptomatic); when present, symptoms usually include gastrointestinal bleeding and prolapse through the rectum. Juvenile polyps are usually sporadic, occurring in isolation, although they may occur as a part of juvenile polyposis syndrome. Sporadic juvenile polyps may occur in any part of the colon, but are usually found in the distal colon (rectum and sigmoid).

Histopathology

Under microscopy, juvenile polyps are characterized by cystic architecture, mucus filled glands, and prominent lamina propria. Inflammatory cells may be present. Compared with sporadic polyps, polyps that occur in juvenile polyposis syndrome tend to have more of a frond-like (resembling a leaf) growth pattern with fewer stroma, fewer dilated glands, and smaller glands with more proliferation.[1] Syndrome-related juvenile polyps also demonstrate more neoplasia and increased COX-2 expression compared with sporadic juvenile polyps.[1]

Diagnosis

Juvenile polyps are diagnosed via colonoscopy or flexible sigmoidoscopy.Juvenile polyps cause fecal calprotectin level to be elevated.[5]

Treatment

If symptoms are present, then removal of the polyp (polypectomy) is warranted. Recurrence of polyps following removal is relatively common.[2] Unlike juvenile polyposis syndrome, solitary juvenile polyps do not require follow up with surveillance colonoscopy.

Epidemiology

Juvenile polyps occur in about 2 percent of children.[1] In contrast to other types of colon polyps, juvenile polyps are not premalignant and are not usually associated with a higher risk of cancer;[3] however, individuals with juvenile polyposis syndrome are at increased risk of gastric and colorectal cancer.[1][4]

References
  1. Brosens, LA; Langeveld, D; van Hattem, WA; Giardiello, FM; Offerhaus, GJ (28 November 2011). "Juvenile polyposis syndrome". World Journal of Gastroenterology. 17 (44): 4839–44. doi:10.3748/wjg.v17.i44.4839. PMC 3235625. PMID 22171123.
  2. Fox, VL; Perros, S; Jiang, H; Goldsmith, JD (September 2010). "Juvenile polyps: recurrence in patients with multiple and solitary polyps". Clinical Gastroenterology and Hepatology. 8 (9): 795–9. doi:10.1016/j.cgh.2010.05.010. PMID 20580940.
  3. Nugent, KP; Talbot, IC; Hodgson, SV; Phillips, RK (September 1993). "Solitary juvenile polyps: not a marker for subsequent malignancy". Gastroenterology. 105 (3): 698–700. doi:10.1016/0016-5085(93)90885-g. PMID 8395444.
  4. Hood, B; Bigler, S; Bishop, P; Liu, H; Ahmad, N; Renault, M; Nowicki, M (October 2011). "Juvenile polyps and juvenile polyp syndromes in children: a clinical and endoscopic survey". Clinical Pediatrics. 50 (10): 910–5. doi:10.1177/0009922811407177. PMID 21576185. S2CID 8295632.
  5. Olafsdottir, I; Nemeth, A; Lörinc, E; Toth, E; Agardh, D (January 2016). "Value of Fecal Calprotectin as a Biomarker for Juvenile Polyps in Children Investigated With Colonoscopy". Journal of Pediatric Gastroenterology and Nutrition. 62 (1): 43–6. doi:10.1097/MPG.0000000000000893. PMID 26147630. S2CID 19284840.
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