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December 30, 2019

Image challenge: an uncommon category of polyp lesion in a Western colon

What caused a worm-like polypoid lesion with a slightly edematous appearance and a drumstick-like tip to appear in a patient?
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Gastroenterology clinical image challenge:  An 87-year-old woman of European descent underwent ileocolonoscopy for workup of abdominal pain. In the ascending colon, a worm-like polypoid lesion appeared estimated at 12 mm with a slightly edematous appearance and a drumstick-like tip. After a change in patient positioning, the lesion was raised by gravitation, further highlighting the featureless glassy aspects in its head without evidence of adenomatous polyp quality (figure). Of interest, on further optic assessment of the narrow base concentric rings were visualized reminiscent of so-called Aurora rings otherwise characteristic for inverted colonic diverticula. However, although multiple inconspicuous diverticula were indeed present in the patient’s sigmoid colon, the patient proceeded to endoscopic resection under a specific working diagnosis.

What diagnosis might be suggested considering the unusual, however characteristic, endoscopic presentation?

To find out the diagnosis, read the full case in Gastroenterology.

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