What is a juvenile polyp? An analysis based on 21 patients with solitary and multiple polyps.
BACKGROUND
Juvenile polyps, the most common pediatric gastrointestinal polyp, have been typically characterized as either hamartomatous overgrowths or reactive inflammatory proliferations. Recent observations of excessive colonic and gastric carcinoma and dysplasia in juvenile polyposis have prompted reclassification of this entity as a premalignant condition. The relationship between solitary or multiple juvenile polyps and malignancy is less clear.


METHODS
To further investigate the frequency and significance of dysplasia in juvenile polyps, we analyzed 28 polyps from 21 patients histologically and immunohistochemically for substances previously associated with neoplastic transformation in the colorectal adenomacarcinoma sequence.


RESULTS
Fifteen patients had a solitary polyp, two had 2 to 9 polyps, and four had polyposis with 10 or more polyps. Most polyps exhibited inflammatory or regenerative atypia. Foci of dysplasia were noted in polyps from 11 patients, and immunoreactivity for p53 and human chorionic gonadotropin was present in 12 of the 28 polyps each. These findings were all more frequent in the polyposis specimens than in solitary polyps.


CONCLUSIONS
These observations, in combination with reports of an increased risk of carcinoma in juvenile polyposis, suggest that juvenile polyps are lesions with a potential for neoplastic and malignant transformation, although they share features of an inflammatory reactive process. The implications for clinical management of patients and pathologic evaluation of juvenile polyps warrant further investigation.
Coffin
C M
CM
Division of Pediatric Pathology, Primary Children's Medical Center, University of Utah Health Sciences, Salt Lake City 84113, USA.
Dehner
L P
LP
D002648:Child; D002675:Child, Preschool; D006063:Chorionic Gonadotropin / Q000378:metabolism; D003111:Colonic Polyps / Q000145:classification / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007417:Intestinal Polyps / Q000145:classification / Q000378:metabolism / Q000473:pathology*; D008297:Male; D011230:Precancerous Conditions / Q000145:classification / Q000378:metabolism / Q000473:pathology; D012004:Rectal Neoplasms / Q000145:classification / Q000378:metabolism / Q000473:pathology; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism
D006063:Chorionic Gonadotropin; D016159:Tumor Suppressor Protein p53