1
Department of Pathology, Children Medical Center of Excellence, Tehran University of Medical
Sciences, Iran (Islamic Republic of)
2Department of Pathology, Children Medical Center of Excellence, Tehran University of Medical Sciences, Iran (Islamic Republic of)
Corresponding author details:
Bahar Ashjaei
Department of Pediatric Surgery, Children Medical Center of Excellence
Tehran University of Medical Sciences
Iran (Islamic Republic of)
Copyright: © Safavi M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 international License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
A boy was referred to our hospital who was suffering from rectal straining, hematochezia,
and anal pain from 2 years ago. He was 13-year-old and had no disease in his past medical
history. He looked pale in the primary physical examination and we did not find any
abnormalities in inspection at lithotomy position. We palpated two polypoid lesions in
11 and 2 o’clock in the rectal examination. His lab tests were as the following WBC=5600,
Hgh=9, Plt=289000, PT=13 seconds, PTT=33 seconds. Rectosigmoidoscopy was done for
the patient and we found two cauliflower-shaped polyps in the mentioned regions, but
we could not remove them by endoscopic procedure therefore the patient was prepared
for operation. Surgical removal of cauliflower-like polyps was done successfully (Figure
1). Rectal polyp histologic examination revealed both squamous and colonic epithelium
with tubulopapillary architecture and surface ulceration consistent with cloacogenic polyp
(Figure 2). A small focus of adenomatous epithelium with low-grade dysplasia was also
observed. The patient became symptom-free after surgical resection.
Figure 1: Cauliflower-shaped polyps at the time of operation.
Figure 2: Inflammatory cloacogenic polyp (Hematoxylin & Eosin,
magnification x40)
Cloacogenic polyp (CP) is a rare lesion that was described in 1981 for the first time
[1]. The first case of (CP) in childhood was reported in 1992 in a 6-year-old boy who had
anal fissure since birth and was suffering from rectal bleeding [2]. One year later, another
case of CP was reported in a child with Marshall-Smith syndrome which is a rare coexisting
condition [3]. Its location is in transitional zone of anorectal junction [1,4]. This polyp is
usually located on the anterior surface of the rectum [5]. CP can be multiple or single or
with other kinds of polyps [1]. Its pathologic mechanism is mucosal injury; therefore it
can occur in some underlying diseases such as diverticulosis, and colorectal tumors [4]. It
can occur in patients with defecation problems and hemorrhoids [6]. Although this kind of
polyp is rare, we should consider it as a differential diagnosis in patients who are suffering
from hematochezia and tenesmus [7]. Other symptoms of CP are straining, diarrhea and
constipation [1]. On the contrary, some patients may be asymptomatic [1]. These patients
should undergo serial colonoscopy after surgical or endoscopic removal because of the
potential risk of recurrence and malignancy [1,4]. Papillomavirus should be tested in
patients because of the possibility of this virus detection in some patients [1,8]. This kind of
polyp is rare and the most reported cases are adults and women. Since this polyp relapse
if the underlying disease is not treated, we must look for such condition for complete
treatment [9]. Although CP is often associated with solitary rectal ulcer or rectal prolapse,
it can be seen in other underlying diseases [8]. Coexistence of CP with solitary rectal ulcer
and rectal prolapse, suggests the transitional zone mucosal prolapse as pathogenesis of this
polyp [5].
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