{
 "topic": "Juvenile Polyp",
 "slug": "juvenile-polyp",
 "category_id": 15891,
 "passage_count": 14,
 "source_chars": 12519,
 "enough_material": true,
 "references": [
  {
   "title": "MedStudy Pediatrics Core 11th Edition 2024-2025",
   "author": null,
   "pages": [
    356
   ]
  },
  {
   "title": "Cover",
   "author": "Vitalsource Download",
   "pages": [
    5810,
    5811
   ]
  },
  {
   "title": "Algorithms in Pediatrics",
   "author": null,
   "pages": [
    660
   ]
  },
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    2425,
    2426
   ]
  },
  {
   "title": "Berkowitz's Pediatrics",
   "author": "Berkowitz, Carol D.;",
   "pages": [
    940
   ]
  },
  {
   "title": "Netters Pediatrics (Florin \u0422., Ludwig St.)",
   "author": null,
   "pages": [
    708
   ]
  },
  {
   "title": "Signs and Symptoms in Pediatrics",
   "author": "Henry M. Adam,Jane Meschan Foy",
   "pages": [
    424
   ]
  },
  {
   "title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "author": null,
   "pages": []
  }
 ],
 "passages": [
  {
   "source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 356",
   "text": "Inflammatory\u2014nonneoplastic with epithelial and inflammatory components + Hamartomatous\u2014polyps consisting of disorganized growth of tissue (This category includes solitary juve- nile polyps, juvenile polyposis, Peutz-Jeghers syn- drome, and PTEN syndromes.) * Adenomatous\u2014dysplastic polyps with malignant potential (This category includes familial adenoma- tous polyposis.) \u00b0 Mixed Most polyps are asymptomatic but can present with rectal bleeding. Colonoscopy is the best method to detect and biopsy polyps. Treatment consists of removal during colo- noscopy or surgical resection. JUVENILE POLYPS AND JUVENILE POLYPOSIS Juvenile polyps occur in ~ 1% of preschool children and account for the majority of all polyps in children. Juvenile polyps are benign inflammatory polyps, typically pedun- culated hamartomata. The classic presentation is a child 2-10 years of age (peak age = 3-4 years) who presents with intermittent, painless hematochezia with bowel move- ments. There are cases of older kids with these polyps,"
  },
  {
   "source": "Cover, p. 5811",
   "text": "The diagnostic criteria for juvenile polyposis syndrome (JPS) include the cumulative development of 5 or more colonic juvenile polyps; the presence of juvenile polyps in the stomach or small intestine (excluding other polyposis syndromes); or the presence of any juvenile polyp with a positive family history of JPS. JPS has four 4 presentations: JPS of infancy, juvenile polyposis coli, generalized JPS, and JPS-hereditary hemorrhagic telangiectasia (JPS-HHT) ( **Table 409-1** ). JPS of infancy is the most severe form of this disease, with juvenile polyps forming throughout the digestive tract. Infants present with rectal bleeding, chronic diarrhea, protein-losing enteropathy, failure to thrive, and decreased survival. This disorder can be associated with a microdeletion of the short arm of chromosome 10 deleting both the _PTEN_ and _BMPR1A_ genes known as 10q23 deletion syndrome. Juvenile polyposis coli has polyps limited to the large intestine, whereas those of generalized JPS can be found throughout the"
  },
  {
   "source": "Cover, p. 5810",
   "text": "Typical juvenile polyps can be seen in up to 2% of children under the age of 10 years. These lesions can present with painless rectal bleeding during defecation or can be identified visually as they prolapse through the anus. On occasion, colonic juvenile polyps can present with colic-like abdominal pain, diarrhea, or unexplained iron deficiency anemia. Juvenile polyps typically present from 2 to 4 years of age but can be found at any time during childhood or adolescence. Most juvenile polyps are solitary and are found in the rectosigmoid; however, up to half of children with juvenile polyps have more than 1 polyp, with the majority being in the left colon. Smaller polyps appear as flat sessile mucosal elevations that with time grow into mushroom-like pedunculated lesions. Juvenile or inflammatory polyps are classified as hamartomas. Pathology reveals an overgrowth of mature orderly epithelium with dilated mucus-filled glands, varying numbers of inflammatory cells, and surface ulceration. At times, the"
  },
  {
   "source": "Algorithms in Pediatrics, p. 660",
   "text": "Juvenile polyps are the most common intestinal polyps in children, accounting for almost 90% of colonic polyps in children. Around 20\u201325% of patients with juvenile polyps present with occult blood loss and anemia rather than visible bleeding. The majority of colonic polyps are sporadic and not associated with malignancy, but familial adenomatous polyposis and Peutz-Jeghers syndrome carry a risk of malignant transformation. When there are more than five polyps in the colon, multiple polyps throughout the GI tract or any number of juvenile polyps with a family history of juvenile polyps, it is known as juvenile polyposis syndrome, which carries a high malignant potential. **635** **sECTION 15:** Pediatric Surgery If the clinical history is strongly suggestive of the diagnosis of an intestinal polyp, but it is not felt on a per-rectal examination, then a colonoscopy under GA is essential. ## **Treatment**"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2425",
   "text": "Juvenile polyposis of infancy is characterized by early polyp formation (in patients younger than 2 years of age) and may be associated with protein- losing enteropathy, hypoproteinemia, anemia, failure to thrive, and intussusception. Early **endoscopic or surgical intervention** may be needed. ## **Peutz- Jeghers Syndrome** Peutz- Jeghers syndrome (PJS) is a rare autosomal dominant disorder \u223c (incidence: 1:120,000 total population) characterized by mucocutaneous pigmentation and extensive GI hamartomatous polyposis. Macular pigmented lesions may be dark brown to dark blue and are found primarily around the lips and oral mucosa, although these lesions may also be found on the hands, feet, or perineum (Fig. 393.2). Lesions can fade by puberty or adulthood, though buccal pigmentation can persist."
  },
  {
   "source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 356",
   "text": "ments. There are cases of older kids with these polyps, though not as common. There is usually not a history of a familial polyp syndrome, and there are typically <3-5 polyps. Solitary juvenile polyps of this type are not cancer prone. On the other hand, juvenile polyposis occurs when there are > 5 polyps, and these have a high, long- term risk of malignancy; affected individuals are 30x more likely to develop colorectal cancer. Juvenile polyposis coli (involving only the colon) refer to polyps that are distributed throughout the colon. If a family member has already been diagnosed with juvenile polyposis, any other member who has even a single juve- nile polyp is considered to also have juvenile polyposis. Most children with unexplained rectal bleeding get a colo- noscopy, It allows you to assess for the presence, number, \u00a9 2023 MedStudy\u2014Please Report Copyright Infringements to copyright@medstudy.com ##"
  },
  {
   "source": "Berkowitz's Pediatrics, p. 940",
   "text": "The diagnostic procedure of choice is technetium Tc 99m pertechnetate scanning. Juvenile polyps may occur in as many as 1% of children, with peak incidence from 2 to 5 years of age. The common clinical presentation is recurrent, painless bleeding with a small amount of blood on formed stool. Diarrhea and tenesmus can occur when the polyp is large and located in the left colon. Typical juvenile polyps are smooth, rounded, and red. Polyps of less than 1 cm are usually sessile; polyps larger than 1 cm have short or long stalks. Juvenile polyps are composed of normal but cystically dilated crypts embedded in an abundant lamina propria. Colonic mucosa adjacent to the large polyp has a distinguished, so-called chicken skin appearance. Colonoscopy is indicated due to the high incidence (almost 50%) of coexisting of the rectal polyps with polyps in the more proximal portions of the colon."
  },
  {
   "source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 708",
   "text": "from ileocecal valve, 2 inches long, most commonly presents around age 2 years, and boys are two times as likely to be affected). ## _Polyps_ Polyps are mucosal projections into the intestinal lumen caused by disordered epithelial growth. Various spontaneous and familial polyposis entities exist. Regardless of the specific underlying process, they are a source of bleeding (generally painless) secondary to mechanical irritation or wholesale shearing by passing fecal material. In contrast to adults, the vast majority of polyps in children are juvenile polyps. These non-neoplastic polyps are typically composed of many cystic, dilated glands; copious inflammation; and surface erosions, the last of which is the cause of bleeding. Juvenile polyps have a peak incidence from 2 to 6 years of age, represent more than 90% of all pediatric polyp diagnoses, and are found in about 1% of school-age children. ## _Vascular Abnormalities_"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2425",
   "text": "Diagnosis and therapy are best accomplished via **endoscopy** . Polyps may be visualized via ultrasound or cross- sectional imaging, but this provides no therapeutic advantage. Colonoscopy affords opportunity for biopsy, **polypectomy** by snare cautery, and visualization of synchronous lesions; up to 50% of children have one or more additional polyps, and approximately 20% may have more than five polyps. Retrieved polyps should be sent for histologic evaluation for definitive diagnosis. ## **Juvenile Polyposis Syndrome** Patients with juvenile polyposis syndrome (JPS) present with multiple juvenile polyps\u2014usually five or more\u2014but typically 50- 200 are present within the GI tract. The incidence of JPS is between 1:10,000 and 1:160,000. Polyps are most likely isolated to the colon (98%) but may be distributed throughout the GI tract. There is often a family history (20\u201350%) with an autosomal dominant pattern of variable penetrance. Alterations in transforming growth factor- \u03b2 pathways have been"
  },
  {
   "source": "Signs and Symptoms in Pediatrics, p. 424",
   "text": "Adenomatous polyps may produce rectal bleeding as early as infancy, but they are managed diff erently from juvenile polyps. Juvenile polyps are benign infl ammatory lesions that do not cause later complications. Adenomatous polyps, conversely, are premalignant tumors, which may transform into a malignancy over an average period of 10 years.[3] Familial polyposis and Gardner syndrome are associated with adenomatous polyps. Juvenile polyposis coli (JPC) is suggested by the presence of 5 to 10 juvenile polyps; 10 or more polyps is considered diagnostic. JPC, which occurs in about 10% of patients who have colonic polyps, is associated with anemia, right-colon polyps, and adenomas.[3]"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2426",
   "text": "APC, adenomatous polyposis coli; AV, arteriovenous; CHRPE, congenital hypertrophy of the retinal pigment epithelium; GI, gastrointestinal; PTEN, phosphatase and tensin homolog. ![](/tmp/pdf-images/pdf-2426-03.png) **----- Start of picture text -----**<br> A B C<br>**----- End of picture text -----**<br> Fig. 393.1 Representative histologic sections of commonly found polyps in pediatric patients. A, Juvenile polyp. Cystically dilated and irregular colonic crypts within an inflamed, expanded stroma. B, Peutz- Jeghers polyp. Small bowel with large arborizing bundles of smooth muscle and otherwise normal epithelial component. C, Adenomatous polyp. Enlarged, hyperchromatic, and stratified nuclei confined to a tubular configuration. _(Images courtesy Dr. Thomas Plesec, Cleveland Clinic.)_"
  },
  {
   "source": "Algorithms in Pediatrics, p. 660",
   "text": "- Laparotomy with reduction or bowel resection. ## **RECTal aND COlONIC pOlyps** Juvenile inflammatory polyps are the most common cause of bleeding in children older than 2 years of age. Most polyps are solitary juvenile polyps located in the rectum, hence are palpable during a digital rectal examination by an experienced pediatric surgeon. They present as painless, dropwise perrectal bleeding after defecation. They may be pedunculated and can protrude from the anus. Occasionally, the connecting stalk may get broken leading to incessant bleeding, so even a per-rectal examination has to be done with great care. If polyps are multiple, then a more sinister disease has to be explained to the relatives. The final diagnosis will of course be made after a histopathological confirmation of the type of polyp."
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Juvenile Polyps Older infants and children can develop either single or multiple retention polyps. Usually, the polyps occur in the lower portion of the colon and can often be palpated on rectal examination. Polyps bleed, but they rarely cause massive hemorrhage. They may intermittently prolapse at the anus or on occasion come free and be passed as a fecal mass associated with bleeding. Colonic polyps may be lead points for intussusception. Usually, however, polyps are asymptomatic except for the associated bleeding. These are not premalignant lesions, and they tend to be self-limiting ( Fig. 116.18 ) although they can be easily removed by colonoscopy. Meckel Diverticulum"
  },
  {
   "source": "Practical Algorithms in Pediatric Gastroenterology (Ron Shaoul), p. 61",
   "text": "\u2014 **\ufffd** GI polyps may occur in isolation or as part of a genetic syndrome. Polyps may be classified into 2 major groups: (1) hamartomatous and other non-neoplastic polyps and (2) adenomatous polyps which are neoplastic. A hamartoma is defined as a benign tumor composed of a disorganized overgrowth of mature cells and tissues normally present at the affected site, often with one element predominating. An adenoma is defined as a benign tumor of epithelial tissue composed of glands and/or glandular elements. In pediatrics, isolated juvenile polyps are common and account for the vast majority (>90%) of all polyps. The peak incidence of juvenile polyps is at the age of 2\u20136 years. Children usually present with recurrent painless rectal bleeding. Often, these polyps will auto-amputate, and bleeding will stop spontaneously. However, if bleeding continues, endoscopic evaluation and removal is indicated. Histologically, juvenile polyps demonstrate an excess of lamina propria including dense inflammatory infiltration"
  }
 ]
}