Introduction

Tumor budding is a significant prognostic value in the management of colorectal cancer (CRC). There are grades of tumor budding: 0-4 buds as low, 5-9 buds as intermediate, and more than 10 buds as high. However, the specific prognosis difference between cases with 0 buds and those with 1-4 buds, is not well-established due to a lack of comparative studies.

Aims & Methods

The aim of this study is to examine and compare the rate of lymph node (LN) metastasis and prognosis by distinguishing between 0 buds and 1-4 buds within the low-grade category (0-4 buds) of tumor budding in T1 and T2 CRC. This study retrospectively identified a total of 224 cases of T1 and T2 CRC from 2015 to 2018 across three medical institutions using medical records. The pathology, including the assessment of tumor budding, was subsequently reconfirmed, and the recurrence and survival of patients were evaluated up to December 2023.

Results

Patients in the BD1 group exhibited a higher T stage compared to BD0, accompanied by significantly increased rates of lymphovascular invasion and perineural invasion. The prevalence of LN metastasis was 14.8%. No significant difference in LN metastasis was observed between BD0 and BD1. In a multivariate analysis exploring factors associated with LN metastasis, relevant factors included lymphatic invasion, perineural invasion, and 5 buds or more. (Table 1) There were no significant distinctions in 5-year survival and progression free survival rate between the BD0 and BD1 groups (P=0.971).
Table 1. Univariate and multivariate analysis for risk factor of lymph node metastasis

Conclusion

The study confirmed that there was no significant difference in LN metastasis and prognosis between BD0 and BD1.

References

1. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA: A Cancer Journal for Clinicians 2023;73(1):17-48.
2. Lugli A, Kirsch R, Ajioka Y, Bosman F, Cathomas G, Dawson H, et al. Recommendations for reporting tumor budding in colorectal cancer based on the International Tumor Budding Consensus Conference (ITBCC) 2016. Mod Pathol 2017;30(9):1299-311.

Introduction

Colorectal cancer (CRC) is the third most diagnosed cancer worldwide¹, with a similar prevalence observed in Denmark, where it ranks as the third most frequent malignancy². In recent decades, the incidence of early-onset colorectal cancer—defined as CRC diagnosed in individuals under 50 years of age—has been rising^3,4. Since CRC is often asymptomatic in the early stages, late-stage diagnosis is associated with high mortality rates⁵. Therefore, it is crucial to develop new strategies to identify risk factors and early tumour formation, enabling timely prevention, treatment, and improved patient outcomes⁶. While colonoscopy remains the gold standard, it is invasive and often unnecessary; data from Region Zealand show that nearly 60% of individuals undergoing colonoscopy after a positive faecal immunochemical test (FIT) do not have lesions requiring treatment⁷. The development of molecular diagnostics, such as faecal DNA-based screening, offers a promising alternative that could significantly improve early detection while reducing the number of unnecessary colonoscopies, particularly in high-risk populations such as those with inflammatory bowel disease (IBD), previous CRC history, or genetic predispositions.

Aims & Methods

We evaluated two alternative approaches for detecting colorectal cancer-related mutations from faecal-derived human DNA: short-read next-generation sequencing (NGS) and digital PCR (dPCR). The aim was to assess whether these methods could support a non-invasive screening strategy that does not rely on the detection of occult blood. Faecal samples were collected from patients in Region Zealand who tested positive in the Danish national colorectal cancer (CRC) screening programme between January 2022 and January 2023 (FIT ≥100 ng/mL).
Faecal DNA was extracted using the QIAamp Fast DNA Stool Mini Kit (Qiagen) with RNase treatment. Formalin-fixed paraffin-embedded (FFPE) tumour samples were processed with the GeneRead DNA FFPE Kit (Qiagen). For next-generation sequencing (NGS), libraries were prepared with the QIAseq Targeted DNA Pro kit (Qiagen), targeting regions commonly mutated in CRC. Digital PCR (dPCR) was performed using the QIAcuity Probe PCR Kit and a panel targeting six validated single-nucleotide variants (SNVs) in CRC driver genes.

Results

Of the 71 sequencing DNA libraries generated from faecal samples, only three yielded more than 100 high-quality human reads, highlighting the challenge of recovering host DNA from stool material due to high gut microbiome content and inhibitory substances. Across the 33 patients successfully analysed, a total of 163 faecal DNA variants were detected by either NGS or dPCR. Of these, 21 were classified as oncogenic or likely oncogenic in colorectal cancer, and five were pathogenic variants not directly linked to CRC. These combined results demonstrate the feasibility of faecal DNA-based mutation detection as a non-invasive screening tool and underscore the importance of adequate DNA recovery for reliable variant identification.

Conclusion

Our study provides compelling evidence that mutation-based faecal DNA screening is feasible and may augment current CRC detection strategies. While current sensitivity remains suboptimal, the high PPV of dPCR under stringent quality control is encouraging. Our findings contribute to a growing body of literature supporting the transition toward precision diagnostics in cancer screening. When implemented within a personalised framework, faecal DNA mutation analysis may reduce unnecessary colonoscopies and enable early detection of high-risk lesions.

References

1. Sung, H., et al. (2021). Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians 71(3), 209–249. DOI: 10.3322/caac.21660.
2. Njor, S. H., et al. (2018). Three years of colorectal cancer screening in Denmark. Cancer Epidemiology 57, 39–44. DOI: 10.1016/j.canep.2018.09.003.
3. Vuik, F. E., et al. (2019). Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Gut 68(10), 1820–1826. DOI: 10.1136/gutjnl-2018-317592.
4. Akimoto, N., et al. (2021). Rising incidence of early-onset colorectal cancer – a call to action. Nature Reviews Clinical Oncology 18(4), 230–243. DOI: 10.1038/s41571-020-00445-1.
5. Ilyas, M. I. M. (2023). Epidemiology of Stage IV Colorectal Cancer: Trends in the Incidence, Prevalence, Age Distribution, and Impact on Life Span. Clinics in Colon and Rectal Surgery 37(2), 57–61. DOI: 10.1055/s-0043-1761447.
6. Wolf, A. M. D., et al. (2018). Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians 68(4), 250–281. DOI: 10.3322/caac.21457.
7. Nielson, C. M., et al. (2018). Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial. Cancer Medicine 7(9), 4781–4790. DOI: 10.1002/cam4.1727.

Disclosure

The authors declare no competing interests.

Introduction

Massive gastrointestinal bleeding is a clinical condition that is poorly studied due to its abrupt presentation, involvement of various clinical services, and the high and rapid mortality of patients. We present the preliminary results of a multicenter registry that includes 21 hospitals from Spain and Hispanic America, analyzing factors related to mortality and need for intervention.

Aims & Methods

Since January 2023, 403 patients over 18 years old who presented to the emergency departments of participating hospitals with massive gastrointestinal bleeding, defined as bleeding accompanied by signs of shock and requiring transfusion of at least 2 units of blood within the first 24 hours of admission, were included. Demographic variables, comorbidities, treatments including NSAIDs, antiplatelets, and anticoagulants, clinical presentation variables, medical, endoscopic, and surgical variables, and a 6-month follow-up were collected.
The aim of this study was to analyze factors related to mortality and the need for intervention in patients with massive gastrointestinal bleeding.

Results

A total of 403 patients with a mean age of 64.5 ± 15.7 years were included (male 68.7%). Main comorbidities were cirrhosis (31%), diabetes (28%) and a previous UGIB (25%). 8.4% of patients had already been admitted to the hospital, and 29% were on antithrombotic (16.6% antiplatelets and 16.4% anticoagulants). On admission we observed SPB: 91±22 mmHg, heart rate 101 ± 21; and an altered mental status in 31%. Mean hemoglobin levels 7.6±2.5 g/dl, urea: 98±67, albumin 2.16±1.3, INR: 3.9±7. The most common causes were esophageal varices (29%), gastric ulcer (25%) and duodenal ulcer (25%). Endoscopic intervention was needed in 60%, with mortality rate of15.4%. Mean admission was 8.6±10 days, and patients needed 4±3 red blood cells units. When analyzing in-hospital mortality, we observed that the age of patients who died was higher than that of survivors (68.2±15 vs. 63.6±16; p=0.033), with the former requiring more packed red blood cells (5±5.5 vs. 3.5±2; p=0.043). Patients who died had a lower frequency of gastric ulcer (14% vs. 27%; p=0.034), a higher frequency of altered mental status (42.6% vs. 29%; p=0.036), and a lower rate of endoscopic therapy applied (43.3% vs. 63.6%; p<0.0001). In logistic regression, gastric ulcer etiology and endoscopic therapy were protective factors against mortality (Table 2).
Regarding the need for intervention, more patients with liver cirrhosis required it (73% vs. 60%, p=0.018), patients with hematemesis (73% vs. 52%; p<0.0001), patients without melena (60% vs. 76%; p=0.002), with syncope (76.3% vs. 61%; p=0.06), etiologies other than gastric ulcer (78% vs. 56%; p=0.028), and the presence of esophageal varices (83% vs. 57%; p<0.0001). In binary logistic regression, liver cirrhosis, hematemesis, and syncope were risk factors for the need for intervention.

Conclusion

Age, altered mental status, and lower frequency of endoscopic therapy are risk factors for mortality due to massive gastrointestinal bleeding. Gastric ulcer as an etiology and receiving endoscopic therapy acted as protective factors against mortality. Indeed, in both situations, it might be related to an opportunity window to receive appropriate treatment, especially when compared with more cataclysmic types of bleeding, such as variceal or posterior duodenal bulb wall, which sometimes can be challenging and utterly abrupt. Regarding the need for intervention, liver cirrhosis, hematemesis, and syncope were independent risk factors for the need for endoscopy, surgery, or interventional radiology.

Introduction

Colonoscopic surveillance reduces colorectal cancer (CRC) incidence and mortality in Lynch syndrome (LS) carriers. Still, its invasiveness and high costs highlight the need for a non-invasive approach to predict the presence of neoplastic lesions.

Aims & Methods

This study aimed to identify faecal bacterial biomarkers to discern between carriers with colorectal lesions and those with normal colon.
Two independent Spanish cohorts (a training and a validation cohort) were recruited through two multicenter studies (Table 1). Participants provided a faecal sample before surveillance colonoscopy to quantify the abundance of F. prausnitzii (FPRA) and its phylogroups I and II (PHGI and PHGII), P. stomatis (PTST), B. fragilis (BCTF), B. thetaiotaomicron (BCTT), B46 (best BLAST match S. variabile), G. morbillorum (GMLL), B48 (best BLAST match R. faecis), and E. coli (ECO) through qPCR. Eubacteria (EUB) was quantified as the total bacterial load. Participants were classified based on colonoscopy findings as normal colonoscopy (NC), non-advanced adenoma (NAA), and advanced neoplasia (AN, including advanced adenoma and CRC). A bacterial signature for neoplasia prediction was defined and validated in the training and validation cohorts, respectively.

Table 1. Main characteristics of the study participants. NC, normal colonoscopy; NAA, non-advanced adenoma; AA, advanced adenoma; CRC, colorectal cancer.

Results

The bacterial abundances were analysed in the training cohort according to age, sex, body mass index (BMI), germline mutation, and colonoscopy findings. Significant moderate positive correlations were identified between the abundances of BCTF and age (r=0.325, p=0.040), and PHGII and BMI (r=0.399, p=0.010). A significant negative correlation was identified between GMLL abundance and BMI (r=-0.331, p=0.036). Patients harbouring MLH1 mutations exhibited a significantly higher abundance of FPRA compared to PMS2 carriers (p=0.048). Patients with neoplasia (NAA+AN) presented significantly lower abundances of BCTF (p=0.027) and B48 (p=0.038) than patients with NC. Patients with AN presented a significantly lower abundance of PTST compared to patients with NC or NAA (p=0.032).
Although all the bacterial markers achieved a sensitivity of 100% to predict the presence of neoplasia, none of them presented a specificity higher than 25% by itself. To maintain sensitivity and increase specificity a bacterial signature was defined including ECO, BCTF, GMLL, FPRA, PHGI, PHGII, and B46 combined with the inherited mutation. The signature showed 100% sensitivity (SS), 52.50% specificity (SP), 34.48% positive predictive value (PPV), and 100% negative predictive value (NPV). This signature was subsequently validated demonstrating 100% SS, 56.45% SP, 53.44% PPV, and 100% NPV.

Conclusion

A new faecal bacterial signature to predict the presence of colorectal neoplasia in LS carriers has been identified, showcasing its potential usefulness to improve and personalise LS surveillance, optimising endoscopic resources, and providing a less invasive and cost-effective approach.

Disclosure

S. Taboada-López, M. Malagón, S. Ramió-Pujol and M. Serra-Pagès are employees of GoodGut.

Introduction

Filgotinib (FIL) is an oral, JAK1 preferential inhibitor approved for the treatment of ulcerative colitis (UC). Although the clinical efficacy of FIL in UC has been demonstrated in the SELECTION trial,¹ real-world data are limited.

Aims & Methods

In total, 600 adult patients with moderately to severely active UC who initiate FIL treatment in routine clinical care will be enrolled in GALOCEAN (NCT05817942), an ongoing, European, multi-site, prospective, observational study. Here, we report baseline characteristics of the first 100 enrolled patients and effectiveness data from patients who reached week 10. Baseline demographics, disease characteristics, prior UC-related treatment and reasons for starting FIL were collected. At week 10, mean changes from baseline (CFBs) in the partial Mayo Clinic Score (pMCS) and the PRO-2 score, and the proportions of patients in pMCS remission (pMCS of ≤2) or PRO-2 remission (rectal bleeding subscore of 0 and stool frequency subscore of ≤1) were assessed. Mean CFBs at week 10 in patient-reported outcomes (Short Inflammatory Bowel Disease Questionnaire [SIBDQ], Urgency Numerical Rating Scale [NRS] and Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-Fatigue] scores) were also calculated. Safety was evaluated by documenting adverse events.

Results

As of January 2024, 100 patients (FIL 200 mg, 97% [97/100]; FIL 100 mg, 3% [3/100]) were enrolled, and had baseline data available; out of which 55 reached week 10. Baseline characteristics are shown in the Table. In total, 70% of patients (67/96) had up to moderate disease activity (pMCS of ≤6) and 30% (29/96) had severe disease activity (pMCS of ≥7) at baseline; 42% (42/100) were biologic-naive. The most common cardiovascular risk factor was active or prior smoking (37% [37/100]). FIL was used as monotherapy in 47% of patients (47/100). At week 10, the mean (standard deviation [SD]) CFB in the pMCS was –2.7 (2.5; n=43), and 58% of patients (25/43) achieved pMCS remission. The mean (SD) CFB in the PRO-2 score at week 10 was –1.8 (1.7; n=46), and 72% of patients (33/46) achieved PRO-2 remission. Mean (SD) CFBs in patient-reported outcomes at week 10 were 10.1 (12.4; n=42) for the SIBDQ score, –1.3 (2.8; n=38) for the Urgency NRS score and 4.0 (9.3; n=42) for the FACIT-Fatigue score. Overall, 10 patients discontinued FIL because of adverse events, lack of effectiveness or physician decision. No new safety signals were identified.

Conclusion

In this first interim report of GALOCEAN, week 10 data show that FIL improves symptoms in patients with UC in real-world clinical practice and has beneficial effects on health-related quality of life and fatigue. GALOCEAN is ongoing and long-term data with higher patient numbers will be evaluated to further characterize the real-world effectiveness of FIL in UC.

Table. Baseline characteristics.

References

1. Feagan BG et al. Lancet 2021;397:2372–84.

Disclosure

The GALOCEAN study was sponsored by Galapagos NV (Mechelen, Belgium), who funded these analyses.
Medical writing support for the development of this abstract was provided by Risha Bulusu, MBiochem, of PharmaGenesis London, London, UK, and was funded by Alfasigma S.p.A.
WS, AM, MZ are employees of Alfasigma S.p.A at the time of abstract submission.
AA reports consulting and/or advisory board fees from AbbVie, Allergan, Amgen, Arena Pharmaceuticals, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion, Eli Lilly, Ferring Pharmaceuticals, Galapagos, Gilead Sciences, Janssen Pharmaceuticals, Lionhealth, MSD, Mylan, Nestlé, Pfizer, Roche, Samsung Bioepis, Sandoz and Takeda; lecture and/or speaker bureau fees from AbbVie, Amgen, Biogen, Bristol Myers Squibb, Celltrion, Eli Lilly, Ferring Pharmaceuticals, Galapagos, Gilead Sciences, Janssen Pharmaceuticals, Mitsubishi Tanabe Pharma Corporation, MSD, Novartis, Pfizer, Roche, Samsung Bioepis, Sandoz, Takeda and Teva Pharmaceuticals; and research grants from Biogen, MSD, Pfizer and Takeda.
CGdSJ reports speaker and/or consultancy fees from AbbVie, Alfasigma, Amgen, Celltrion, Janssen, Galapagos, MSD, Pfizer and Takeda.
ER reports speaker fees from AbbVie, Faes Farma, Ferring Pharmaceuticals, Galapagos, Janssen Pharmaceuticals, Kern Pharma, MSD, Pfizer and Takeda; and consulting fees from AbbVie, Eli Lilly, Fresenius Kabi, Galapagos, Janssen Pharmaceuticals, MSD and Pfizer.
GD reports research/educational grants from Abbott, AbbVie, Celltrion, Genuity, Janssen Pharmaceuticals, MSD, Pfizer, Takeda and Tillotts Pharma; and speaker/personal fees from AbbVie, Amgen, Bristol Myers Squibb, Celltrion, Dr Falk Pharma, Galapagos, Gilead Sciences, Janssen Pharmaceuticals, MSD, Pfizer, Takeda/Shire and Tillotts Pharma.
JPS reports speaker fees from AbbVie, Fresenius Kabi, Galapagos, Janssen-Cilag, Pharmacosmos, Takeda and Tillotts Pharma; and advisory board fees from AbbVie, Bristol Myers Squibb, Dr Falk Pharma and Galapagos.
ML reports consultancy/lecture fees from AbbVie, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen-Cilag, Johnson & Johnson, Medtronic, Pfizer, Takeda, and Tillotts, grants from
Galapagos and NFU and central reading services for Alimentiv.
MLH reports research grants from Ferring, Janssen, Pfizer, Tilllotts, and Takeda, speaker fees from AbbVie, Ferring, Galapagos, Meda, MSD, Tilllotts and Takeda; and advisory board fees from AbbVie, Eli Lilly, Galapagos, Janssen, MSD, Pfizer and Takeda.
RS reports no financial disclosures or conflicts of interest.
SV reports financial support for research from AbbVie, Galapagos, Johnson & Johnson, Pfizer and Takeda; speaker and/or consultancy fees from AbbVie, Abivax, AbolerIS Pharma, AgomAb Therapeutics, Alimentiv, Arena Pharmaceuticals, AstraZeneca, Bior Therapeutics (formerly Progenity), Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cytoki Pharma, Dr Falk Pharma, Eli Lilly, Ferring Pharmaceuticals, Galapagos, Genentech-Roche, Gilead Sciences, GSK, Hospira, IMIDomics, Janssen Pharmaceuticals, Johnson & Johnson, Materia Prima, Mestag Therapeutics, MiroBio, Morphic Therapeutic, MRM Health, MSD, Mundipharma, Pfizer, ProDigest, Prometheus Biosciences, Robarts Clinical Trials, Surrozen, Takeda, Theravance Biopharma, Tillotts Pharma AG, VectivBio, Ventyx Biosciences and Zealand Pharma.
SS reports personal fees from AbbVie, Amgen, Arena Pharmaceuticals, Biogen, Bristol Myers Squibb, Celgene, Celltrion, Dr Falk Pharma, Eli Lilly, Ferring Pharmaceuticals, Fresenius Kabi, Galapagos/Gilead Sciences, Hikma Pharmaceuticals, I-Mab, Janssen Pharmaceuticals, Morphic Therapeutic, MSD, Mylan, Pfizer, Protagonist Therapeutics, Provention Bio, Sandoz/Hexal, Takeda, Theravance Biopharma and Ventyx Biosciences.
WR reports speaker fees from AbbVie, Celltrion, Ferring Pharmaceuticals, Galapagos, Janssen Pharmaceuticals, MEDICE, MSD, Pfizer, Roche, Sobi and Takeda; consulting fees from AbbVie, Amgen, AOP Health (formerly AOP Orphan), Boehringer Ingelheim, Bristol Myers Squibb, Calyx, Celltrion, Eli Lilly, Galapagos, Gilead Sciences, InDex Pharmaceuticals, Janssen Pharmaceuticals, MedAhead, Microbiotica, Pfizer and Takeda; advisory board fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion, Galapagos, Janssen Pharmaceuticals and Pfizer; and research funding from AbbVie, Janssen Pharmaceuticals, Sandoz, Sanofi and Takeda.
AJ and WS were employees of Galapagos NV (former study sponsor), and are now employees of Alfasigma S.p.A (current study sponsor).
MZ was an employee and shareholder of Galapagos NV (former study sponsor), and is now an employee of Alfasigma S.p.A (current study sponsor).

Introduction

The United Kingdom National Institute for Health and Care Excellence recommends Faecal Immunochemical Testing (FIT) for all patients presenting to primary care with symptoms suggestive of colorectal cancer. How use of this test varies across England is unknown, which this study aimed to quantify.

Aims & Methods

Routinely-collected primary care records (Clinical Practice Research Datalink Aurum) were used to assess variations in symptomatic FIT use in adults (≥18 years) between regions and over time in England from 2019 to 2023. Rates were calculated using the population registered to each primary care practice as the denominator, with analysis split by calendar year.
The first coded FIT test with a numerical result per patient each year was extracted from the primary care records. Rates of testing were calculated using Poisson regression, adjusted for other confounders. Results were described between groups, regions and years at the recommended threshold of ≥10 µgHb/g faeces (results above this threshold henceforth referred to as FIT10), describing the proportions likely to have a secondary care referral based on national guidance. Logistic regression was used to compare the impact of year, region, gender and age on the differences in FIT10.

Results

Between 01/01/2019 and 05/06/2023 there were 531,735 FIT results among 495,121 patients and a denominator population of 17,910,681. The number of completed FITs increased from 8,395 in 2019 to 237,708 in 2022 (the last complete year within the study), with a corresponding ~thirty-fold increase from 0.69 tests per 1000 person-years in 2019 (95%CI 0.68-0.71) to 19.57 per thousand person-years in 2022 (95%CI 19.50-19.65). There was large variation in testing between regions, with rates 3.6 times higher in the North East compared to the West Midlands (17.05 per thousand person-years, 95%CI 16.87-17.23 versus 4.72 per thousand person-years, 95%CI 4.67-4.76). These differences persisted to 2022, with less than half the rate in the West Midlands (11.32) compared to the North East (31.85 per thousand person-years).
20.4% of results were FIT10. Despite increased testing, the overall proportion FIT10 did not change over time. 51.7% of all tests FIT10 were in those over 70 years of age. The percentage FIT10 was lower in regions with higher rates of FIT testing, for example FIT10 ranged from 16.7% in the South West (rate of testing 14.62 per thousand person-years) to 25.3% in the South East (rate of testing 8.00 per thousand person-years). After adjusting for year, region, gender and age, this difference persisted (adjusted OR 0.57, 95%CI 0.55-0.58) comparing FIT10 in the South West to the South East. The difference in proportions FIT10 between regions showed some convergence over time, from a range of 16.6%-26.7% (10.1%) in 2021 to 15.8%-23.7% (7.9%) in 2023.

Conclusion

There has been a marked increase over time in the use of FIT for patients with symptoms in primary care, with large and persistent variations between regions of England. The overall proportion FIT10 has not decreased over time with increasing use, however there were large differences in FIT10 between regions that correlated with rates of testing. These regional differences persisted but reduced over time as testing rates increased nationally. It is likely that clinical pathway differences in the implementation of FIT over time and between regions explain the variations we have observed. If used as a guide to referral, such variation could lead to inequalities in colorectal investigation and diagnosis.

Clinical Case Summary

Leiomyomas are benign soft tissue neoplasms that arise from smooth muscle. They are uncommon in the colon. We report two cases of colonic sessile polyps that underwent polypectomy and histology showed leiomyoma.

The first patient previously had a history of polyps with tubular adenoma with low grade dysplasia. A repeat colonoscopy for polyp surveillance was done which found polyps in the ascending colon, and sigmoid. The sigmoid colon polyp was 4mm in size and removed via cold snare polypectomy (Figure 1).
The second patient had underlying non-alcoholic fatty liver disease cirrhosis and iron deficiency anaemia. Colonoscopy showed colonic polyps which were biopsied (Figure 2).

The histology of the first patient’s sigmoid colon polyp showed nodular spindle cell lesion centered in the submucosa/muscularis mucosa. The lesion was composed of spindle cells in fascicles with bland spindled nuclei and eosinophilic cytoplasm. Desmin and SMA stains were done and they were diffusely positive. CD117 stains were negative. DOG1 showed focal nonspecific staining in lesional cells. The overlying lamina propria also showed aggregates of foamy histiocytes and lymphoid aggregates. These were consistent with a leiomyoma.
The second patient’s histology also showed fascicles of spindle cells and immunohistochemistry stain showed positivity for SMA and desmin but negative for CD117 and DOG-1, consistent with leiomyoma.

As the polyps showed smooth margins endoscopically and has similar appearance to hyperplastic polyps, it was likely thought to have a hyperplastic component on top of leiomyoma, hence the patients are to be monitored and followed up for routine surveillance.

References

Miettinen M, Sobin LH, Am J Surg Pathol. 2001;25(11):1433