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OBJECTIVES The lack of risk profile data on changes in multiple polyps identified by a colonoscopy constrains the creation of evidence-based guidelines. Our study aimed to investigate the relationship between size, location and histology of multiple polyps and patients' characteristics in a large teaching hospital-based Chinese population. METHODS We conducted a large, case-control, retrospective analysis on polyps obtained from 8308 patients who presented at the Digestive Endoscopy Center, Changhai Hospital (Shanghai, China) from January 2013 to August 2015. In total 10572 polyps were analyzed, with risk factors extrapolated through chart reviews of patients' electronic medical records. RESULTS Single polyps were identified in 6843 (82.4%) patients while multiple polyps were found in 1465 (17.6%). A multivariate analysis indicated that men were more likely than women to have multiple polyps (P < 0.001). Compared with the single polyps group, the numbers of patients with multiple polyps increased significantly with age (P < 0.001). Multiple small (6-9 mm) non-advanced adenomas were more likely to be found than were diminutive (

PURPOSE OF REVIEW The goal of this review is to help providers recognize, diagnose and manage gastrointestinal (GI) polyposis syndromes. RECENT FINDINGS Intestinal polyps include a number of histological sub-types such as adenomas, serrated, hamartomas among others. Over a quarter of individuals undergoing screening colonoscopy are expected to have colonic adenomas. Although it is not uncommon for adults to have a few GI polyps in their lifetime, some individuals are found to have multiple polyps of varying histology throughout the GI tract. In these individuals, depending on polyp histology, number, location and size as well as extra-intestinal features and/or family history, a polyposis syndrome should be considered with appropriate testing and management. SUMMARY Diagnosis and management of polyposis syndromes has evolved with advent of multigene panel testing and new data on optimal surveillance strategies. Evidence-based recommendations and current practice guidelines for polyposis syndromes are reviewed here. Areas of uncertainty and future research are also highlighted.

Familial adenomatous polyposis (FAP) is an inherited disorder that typically presents with multiple polyps in the colon. These polyps become cancerous if not monitored in the early stages or if left untreated. For those with a family history of FAP, colonoscopy screenings begin in adolescence and continue throughout adulthood because polyps can arise at an early age. Colon cancer in untreated individuals develops before age 40 years. This topic warrants discussion to aid in the prompt recognition of symptom presentation. This article will address the development of FAP, its presentation, and potential treatment strategies that may be used by nurse practitioners.

This clinical case demonstrates the diagnostic value of capsule endoscopy for the detection of polyposis of gastro-intestinal tract (Peutz–Jeghers syndrome). We report the case of a 5-year-old male presenting with a chronic iron refractory iron deficiency anemia. Multiple polyps of the stomach and small intestine with an erosive and hemorrhagic component were identified by the method of capsule endoscopy.

Peutz-Jeghers syndrome (PJS) is characterized by scattered black pigmentations on fingers and lips and multiple polyps in the gastrointestinal tract. Patients with PJS often have severe complications secondary to multiple large polyps. Herein, we presented a young woman complicated with a large polyp in her colon without any clinical symptoms. We also emphasized the necessity of early diagnosis and treatment of multiple polyps in such patients.

Only 49 % of diminutive colorectal polyps are neoplastic, but a tiny percentage contains advanced histology. We aimed to determine the rate of advanced diminutive polyps and to evaluate the influence of age, gender, number, and localization. Patients undergoing a videocolonoscopy in October 2010 and April 2012 were collected prospectively. Subjects with polyps ≤5 mm in diameter were recruited into the study. The presence of a villous component of >25 % and a high degree of dysplasia were categorized as polyps with advanced histology. Two hundred eight diminutive polyps were identified in 102 patients. Twenty (9.6 %) diminutive polyps in 13 (12.74 %) patients showed advanced histology. The probability of having an advanced diminutive polyp was higher in patients who have more than one polyp or have polyps localized all along the colon or only to the distal part (p

Multiple intestinal lipomas (lipomatous polyposis) are quite rare, and they can be quite challenging to diagnose because this condition may be clinically confused with familial adenomatous polyposis with a suggestive family history. Herein, we present a case of lipomatous polyposis that was presented with abdominal pain and, in colonoscopy, had more than 100 polyps. The patient was admitted for surgery with diagnosis of familial polyposis. Resected colon specimen had multiple polyps ranging from 0.1 to 1.5 cm. Microscopically, the polyps were composed of mature adipose tissue with normal overlying mucosa. There were also increased fat cells in the submucosa of the colon adjacent to the polyps. Lipomatous polyposis rarely occurs and can be confused with familial polyposis. Polypectomy is a simple and cost-effective procedure to help in diagnosis and prevent a major surgery.

The serrated pathway has recently been proposed as a route for the development of colorectal cancer with microsatellite instability. Hyperplastic polyposis syndrome is a rare syndrome defined by the presence of numerous serrated polyps, with a high risk of developing into colorectal cancer. We present here a case of hyperplastic polyposis syndrome developing into colorectal cancer with microsatellite instability from a serrated polyp. BRAF mutation and the loss of MLH1 protein were observed in the colorectal cancer, but not in the other serrated polyps around the colorectal cancer, suggesting that colorectal cancer with microsatellite instability develops rapidly from a specific serrated polyp with distinct molecular properties.

Intestinal polyposis syndromes are characterized by the development of multiple polyps throughout the colorectum and the GI tract. They can be differentiated based on clinical characteristics, including age at onset, type, number, and histology of polyps, extraintestinal manifestations, and pattern of familial recurrence. However, there is phenotypic overlap among the different forms, and clinical examination may not be sufficient to obtain a diagnosis.

Summary Gastrointestinal polyps are common lesions that usually present singly or in small numbers. Although the term ‘multiple colorectal polyposis' was originally applied to patients carrying at least 100 large intestinal adenomas, it has subsequently become broadened to include patients carrying multiple polyps regardless of their nature. Most of the non-adenomatous polyposis syndromes are hereditary. They can be classified according to the dominant type of polyp, their distribution in the gastrointestinal tract and their potential for the development of gastrointestinal cancers. This review summarises their main clinical, genetic and histopathological features.

Collection of multiple resected proximal colon polyps >10 mm in size through a scope channel via aspiration following an endoscopic mucosal resection (EMR) is difficult; thus, polyps are currently all grasped at once using net forceps. However, the simultaneous collection by net forceps makes it difficult to identify the accurate locations of all resected polyps.1 Therefore, we aimed to investigate a novel technique to identify the accurate location of resected polyps using colored ring-threads.

Schistosomiasis polyps induced by Schistosoma mansoni and S. japonicum have been reported from pathological observations but this is not the case for colonic schistosomiasis infection by S. intercalatum which has always been associated with mild clinical presentations. We report the case of a 17-year-old man, native from Equatorial Guinea, with colonic polyposis associated with infection by S. intercalatum.

Cap polyposis (CP) is a rare disease that was first described by Williams et al.1 in 1985. It is characterized by multiple polyps with a mucoid and fibrinopurulent cap. Although the pathogenesis is unknown, the characteristic histological appearance is similar to that of mucosal prolapse syndrome (MPS). Endoscopically, it is difficult to distinguish the polyps of CP from inflammatory polyps and neoplasms. True neoplasms can be differentiated from non-neoplastic lesions by magnifying colonoscopy, but the changes in the mucosal surface of CP have not been investigated in detail. A case of CP that was treated successfully with conservative therapy, is described, as well as the findings obtained by magnifying colonoscopy.

Polyps of the intestines represent a considerable proportion of the practising pathologist's workload. There are many types of intestinal polyp and accurate histological assessment is imporant to ensure the accurate diagnosis and appropriate management of patients. Most polyps have a corresponding polyposis syndrome, the presence of multiple polyps. Some of these are well established and clearly defined in clinical, molecular and pathological terms, whilst other polyposis syndromes are less precisely characterized. The most important recent advances in our understanding of polyposis syndromes have come from molecular biological studies: these have considerable potential in the diagnosis and management of these syndromes. They also provide insights into the pathobiology of sporadic polyps and the pathogenesis of intestinal cancer.

Multiple lymphomatous polyposis is a rare form of gastrointestinal lymphoma characterized by the presence of multiple polyps throughout the length of the digestive tract. We present a typical case diagnosed by using an intestinal barium follow-through and CT scan which revealed gastric, ileac and colonic involvement as well as retroperitoneal adenopathy. We discuss the radiological differential diagnosis.

Objectives Serrated polyposis (hyperplastic polyposis) is characterized by multiple polyps with serrated architecture in the colorectum. While patients with serrated polyposis are known to be at increased risk of colorectal cancer (CRC) and possibly extracolonic cancers, cancer risks for their relatives have not been widely explored. The aim of this study was to estimate the risks of CRC and extracolonic cancers for relatives of patients with serrated polyposis.

A case of multiple polyps originating in a skin tube for esophageal reconstruction was reported in this paper. A 62-year-old man received a subtotal esophagectomy for esophageal cancer in June 1978. A stomach tube was used for the reconstruction of his esophagus. Because of the paralysis of the bilateral recurrent nerve, laryngectomy and a resection of the remnant esophagus were carried out 3 months after the esophagectomy, and the skin tube with a D-P flap was used for reconstruction. 8 years after this operation, multiple polyps developed in the skin tube, and the number of polyps has gradually increased. Since a malignancy was suspected in some of these polyps from an endoscopic examination, tissue specimens taken in frequent biopsies have been examined histologically. However, no malignancy has been found. The histological finding showed an inflammatory squamous polyp without malignancy. Another report of polyps originating in a skin tube has not been seen so far. Because the long survival of patients with esophageal cancer after reconstruction with a skin tube is unlikely, a suficient observation of the skin tube may not be possible.

Medical records of dogs with colorectal polyps were retrospectively reviewed, and clinical presentation of inflammatory colorectal polyps in miniature dachshunds was evaluated. Of 33 dogs found to have colorectal polyps, miniature dachshunds were markedly over-represented with 16 dogs (48%), of which 12 (75%) were found to have inflammatory polyps. Multiple polyps localized between the rectum and the descending colon was the most common finding in miniature dachshunds with inflammatory polyps. Twenty dogs (80%) out of 25 miniature dachshunds with inflammatory colorectal polyps responded to immunosuppressive therapy using prednisolone and cyclosporine. The results of this study indicate that miniature dachshunds are predisposed to develop inflammatory colorectal multiple polyps, for which immunosuppressive therapy may be a treatment option.

The polyposis syndromes are characterized by the presence of multiple polyps affecting the intestinal lining. The adenomatous polyposes are associated with an elevated risk of gastrointestinal malignancy. The familial hamartomatous polyposes carry a risk of polyp-related complications and may also be associated with an increased risk of gastrointestinal cancers. The role of endoscopic screening and surveillance is described in detail for familial adenomatous polyposis, Peutz-Jeghers syndrome, and juvenile polyposis.

Intussusception of the appendix is a rare condition. We present the case of a 72-year-old woman with multiple polyps in the colon with an appendix completely intussuscepted into a polyp within the caecum. The clinical features, preoperative diagnosis, classification and treatment of this condition are discussed with reference to literature.

Various extraintestinal manifestations may occur in juvenile polyposis, but hereditary hemorrhagic telangiectasia has rarely been reported in this type of polyposis. The authors treated a 14-year-old girl with rectal bleeding and anemia who had multiple polyps of the colorectum. Large polyps were removed and histologically diagnosed as juvenile polyps. She was later diagnosed as having telangiectasia of the skin, and arteriovenous malformations in the lung and in the liver, all of which were compatible with the diagnosis of hereditary hemorrhagic telangiectasia. At age 32, she had multiple ulcers in the ileum and in the colon. The coexistence of juvenile polyposis and hereditary hemorrhagic telangiectasia may be a clue for the understanding of the histopathogenesis of juvenile polyposis.

Familial adenomatous polyposis (FAP) is an autosomal dominant condition caused by a mutation in the APC gene on chromosome 5. Those affected develop innumerable intestinal adenomas that inevitably progress to invasive adenocarcinoma if left untreated. In addition, the majority of patients affected also develop gastric polyps, primarily …

We describe an unusual complication of appendicovesicostomy—the development of multiple polyps in the appendiceal conduit—in a patient with spina bifida.

TO THE EDITOR: We read with great interest the article by Chey on a novel method, the channel occlusion technique, for retrieval of 5–8-mm polyps (1). After polypectomy, the snare sheath was pulled back into the working channel so that it was situated 3–4 cm from the distal tip of the colonoscope. The resected polyp was then suctioned and came to rest at the tip of the snare within the channel. After removal of the colonoscope, the snare sheath was advanced, pushing the resected polyp from the channel. Chey (1) concluded that this technique proved easy and quick without additional equipment, obtained a single tissue sample without searching a sample in a suction trap or bottle, and ensured good colonoscopic view during withdrawal of the colonoscope without obstructed view by retrieval devices or resected polyps. However, this technique remains to have problems in retrieval of multiple polyps in the proximal colon.

Background Juvenile polyps, classified as hamartomatous lesions with neoplastic potential, are the most common gastrointestinal polyp of childhood. Risk factors for neoplasia include germline DNA mutations, a family history of juvenile polyps, and multiple polyps (≥3 or ≥5). Only a few large pediatric series (>100patients) of patients with juvenile polyps have been reported, with limited data about repeat surveillance colonoscopy and the incidence of neoplasia. The primary aim of this study was to identify a large cohort of children with one or more juvenile polyps for descriptive analysis of patient demographics, polyp number, location, repeat co1onoscopy, and neoplasia.

Familial adenomatous polyposis (FAP) is an autosomal-dominant disease with delayed expression, in which multiple polyps develop throughout the colon with a malignant potential of 100%. Genetic counselling and follow-up of patients at risk is essential for presymptomatic diagnosis. Prophylaxis of cancer arising from this condition would greatly improve if a genetic or a congenital phenotypic marker of gene carriers were available.

The term polyposis encompasses a heterogeneous group of gastrointestinal conditions which includes relatively well defined inherited syndromes, less well defined syndromes characterised by multiple polyps in the gut and acquired conditions such as inflammatory and lymphoid polyposis. There are three major inherited gastrointestinal polyposis syndromes which are, in order of prevalence, familial adenomatous polyposis (FAP, formerly called familial polyposis coli), Peutz-Jeghers polyposis (PJP) and juvenile polyposis (JP). It should be emphasised that, while the colon is the predominant site of involvement in FAP and JP, no part of the alimentary tract is immune from pathology in these syndromes: significant morbidity and mortality result from lesions both in the upper alimentary tract and outside the gut in all three conditions.

17 (DG) * * No change #18 (MC) * * * * Polyp at baseline increased size at 3 months. Removed #19 (LB) * * * ** * Polyp appeared at 3 months and was removed. Recurred at 12 months. No change still small at 24 months. To be followed. #20 (CK) ** Multiple polyps appeared at 3 months. Removed #22 (MZ) * * * * * * ** Polyp appeared at 3 months, increased in size at 12 months. Removed. Recurred at 24 months. To be followed. #24 (MW) * Removed after baseline

Inflammatory fibroid polyps are uncommon but well documented as solitary polyps occurring typically in the stomach or ileum. A Devon family has previously been reported in which a female in three successive generations has presented with multiple polyps requiring repeated surgery over a number of years. A further two female family members, both siblings from the 3rd generation, who required surgery for the same condition are now reported.

Excerpt Sulindac treatment has been reported to induce marked reductions in the number and size of adenomatous polyps in the rectal segment after subtotal colectomy (1). These findings were not con...

We have established a pre-operative diagnosis in four cases of non-secretory gastric carcinoid of the body and fundus presenting as multiple polyps in three patients, and a single polyp mass in the fourth patient. Clinical and endoscopic findings are not specific, and the pre-operative diagnosis was established by means of biopsy or polypectomy. We observed biochemical and histological differences between multiple and single carcinoids, which might indicate different mechanisms of carcinoid pathogenesis.

The combination of soft-tissue tumors, osteomas, and multiple polyps of the colon is known as Gardner's syndrome. Gardner in 1950 recognized this triad as a familial disease with a mendelian autosomal dominant inheritance. A case history of this entity is presented. It is generally accepted that the colonic polyposis in this disorder is similar in pathology and prognosis to that of classical familial polyposis. It is hoped that awareness of this syndrome with recognition of the external manifestations will lead to early diagnosis prior to the onset of carcinomatous changes in the polyps.

Summary 1.Five hundred completely asymptomatic males aged 17 to 25 years were subjected to proctosigmoidoscopy. 2.Eight (1.6 per cent) were found to have rectal polyps; 2 of these patients had multiple polyps; all polyps were benign. 3.The pertinent literature is reviewed and our findings compared. 4.Our findings lead us to urge strongly that proctosigmoidoscopy be in cluded in the complete physical examination of all patients.

The purpose of this study was to investigate if experienced readers differ when matching polyps shown by both CT colonography (CTC) and optical colonoscopy (OC) and to explore the reasons for discrepancy. Twenty-eight CTC cases with corresponding OC were presented to eight experienced CTC readers. Cases represented a broad spectrum of findings, not completely fulfilling typical matching criteria. In 21 cases there was a single polyp on CTC and OC; in seven there were multiple polyps. Agreement between readers for matching was analyzed. For the 21 single-polyp cases, the number of correct matches per reader varied from 13 to 19. Almost complete agreement between readers was observed in 15 cases (71%), but substantial discrepancy was found for the remaining six (29%) probably due to large perceived differences in polyp size between CT and OC. Readers were able to match between 27 (71%) and 35 (92%) of the 38 CTC detected polyps in the seven cases with multiple polyps. Experienced CTC readers agree to a considerable extent when matching polyps between CTC and subsequent OC, but non-negligible disagreement exists.

In 31 of 33 patients with polyps of the stomach who underwent gastroscopy and x-ray examination the polyps could be diagnosed roentgenologically. 11 patients had multiple polyps, which were in 8 cases hyperplastic polyps, in 3 "other polyps", whereas in 20 patients with solitary polyps 11 cases showed hyperplastic, in 5 cases adenomatous and in 4 cases "other" polyps. After x-ray analysis it can be stated that in our cases the premalignant adenomatous polyp always occurred solitary.

EIGHTY-FIVE consecutive cases of solitary and multiple adenomatous polyps of the gastrointestinal tract at the Boston City Hospital have been reviewed. Solitary polyps were noted in 58 and multiple polyps in 27 cases. The ratio of solitary to multiple polyps was 2:1. Males were affected twice as often as females. Most of the polyps became manifest after the age of forty (62 cases). Eleven cases were observed in children under ten years of age, of whom 9 had solitary and 2 multiple polyps in the rectum. Dixon1 has observed 2 infants, each eighteen months of age, afflicted with multiple polyposis. . . .

Multiple polyps of the gastric mucosa are described in a 6-year-old male Airedale and a 6-year-old male French Bulldog. The first dog suffered from chronic vomiting while the second vomited for only 5 days and exhibited signs of pyloric stenosis. Gastroscopic examination revealed broad, thick rolls in the Airedale's antral mucosa and radiographically the antral wall was rigid and normal peristalsis was absent. Radiographic examination of the French Bulldog revealed pyloric stenosis without passage of contrast material through the pyloric canal. In biopsy specimens from the Airedale there were long thin foveolae and slight cellular infiltrations. Multiple polyps of the gastric mucosa were found throughout the antrum at necropsy. The resected antrum of the French Bulldog had a villous growth pattern with adenomatous formations and inflammation.

Thirty-four patients with bilharzial granuloma of the gastro-intestinal tract were analysed. The commonest site was the rectosigmoid. Bilharzial ‘appendicitis’ was also common but the exact relation between bilharzial granuloma and acute inflammation remains unclear. Preoperative diagnosis of bilharzial granuloma is occasionally dificult and histological proof is necessary. Surgical treatment with polypectomy in the case of a solitary polyp and excision of the affected segment of bowel when there are multiple polyps are recommended, There is no evidence that the conditon is premalignant.

Five children (age 5–13 years) were subjected to colonoscopic polypectomy. Nine polyps were removed, five of them from proximal to sigmoid colon. One patient had multiple polyps removed at the same sitting. No complication was observed. Colonoscopic polypectomy is a simple and safe method of removing benign colonic polyps in children. It obviates the need for laparatomy and reduces the hospital stay.

The case is reported of n 10-year-old boy who had severe diarrhoea with blood and mucus for I year which was found to be due to bilharzial polyposis of the rectum and sigmoid colon. He was treated first with anti-bilharzial drugs. Later, because of multiple polyps and secondary infection, local surgical resection was performed.

Gastric polyps were found in 38 patients in a series of 2,420 consecutive double-contrast studies of the upper gastrointestinal tract. The resulting incidence of 1.6% is four times the highest figure previously reported. Single polyps were usually located in the antrum, multiple polyps in the body of fundus. Two-thirds were less than or equal to 10 mm in diameter; only one was larger than 20 mm. Endoscopy was performed in 17 cases and showed either normal or inflamed gastric mucosa with no evidence of neoplasia. It is likely that most gastric polyps are inflammatory or hyperplastic, while the biopsies showing normal mucosa may represent small submucosal tumors such as leiomyomas. This study demonstrates the high frequency and innocuous nature of small gastric polyps.

Three cases of familial polyposis coli with adenomatous polyps of the upper gastro-intestinal tract are reported. This association has not previously been described in Britain, probably because no special attempt has been made to detect polyps in these situations. A careful study of known cases of polyposis coli is required to establish the frequency and fate of associated gastric or small intestinal polyps, with particular reference to the risk of malignant degeneration and the possibility of prophylactic surgical measures.

The chromosomes were studied in 7 polyps of the large bowel in a case of Gardner's syndrome. All tumours were histologically non-invasive. Four polyps had a normal diploid stemline and showed a predominantly hyperdiploid chromosome variation. Three polyps had heteroploid stemlines: two were pseudodiploid and one was hyperdiploid. The chromosomal difference between polyps of different size was merely quantitative. The same non-random karyotypic pattern was found in all polyps irrespective of size and histological grading.

Patients with polypoid adenomas of the stomach may be divided into two groups, those with solitary and those with multiple polyps. A series of twenty-three patients is reviewed with emphasis on clinical findings and management. There were four malignant polyps in the series indicating the need for careful observation and frequent surgery. Polyps over 2 cm. in diameter should be excised.

Experience with polyps in 27 children less than 13 years of age treated at the Ochsner Clinic during a period of 16 years has been reviewed in an effort to increase our knowledge of polypoid disease. Our study indicates that these polyps are usually pedunculated and may be single, multiple or diffuse. In our series 16 children had single polyps, nine multiple polyps and two diffuse polyposis. The commonest complaint was bright red blood in the stools. Pathologically, these polyps are benign adenomas with inflammatory changes. Malignant polyps in children are rare and none were found in our series. The true malignant potential of single or scattered polyps in children is unknown, but is probably not great. All polyps in children should be removed regardless of size, mainly because of the symptoms they produce and because of their possible but unproved malignant potentiality. A positive family history may be lacking in some cases of familial polyposis.

FAMILIAL or congenital polyposis is a disease of the colon and rectum characterized by multiple polyps which tend to become malignant. It is transmitted as a mendelian dominant characteristic and the heredofamilial malignant aspect has long been recognized. In 1942 we reported inArchives1a family of seven children, six of whom had polyposis of the colon. Now, a quarter of a century later, it seems appropriate to present a followup study of the same family. The summary of the original paper noted that of the six children with familial polyposis of the colon, three were males and three were females. The youngest was 10 and the oldest was 30 years of age. Malignant changes had developed in the polyps of the two oldest, both males, and both had died. No symptoms were exhibited by any of the siblings before the age of 23. The father of the children

Nowadays polyps in the gastrointestinal tract are usually removed under endoscopy, the method being highly effective and of low risk. Endoscopic removal, if necessary in several sessions, can be easily done even if there are multiple polyps of the colon. Altogether 69 polyps were removed from a 33-year-old woman, their microscopic appearance showing various degrees of proliferation. Complete removal of the polyp is of decisive importance, accomplished by enema wash-out. The diagnostic point of polypectomy lies in the histological assessment of the entire material which has been removed.

Excerpt It has been shown that in 10 per cent of cases of chronic ulcerative colitis multiple polyps of the large intestine develop eventually. This estimate is based on a statistical study of 693 ...

Although polyposis of the large intestine is generally considered a disease of children and young adults, there is little reference to the subject in pediatric literature. This, no doubt, is accounted for by the rarity of the condition, only a few cases in patients less than 14 years of age having been observed, and by the fact that the more refined proctoscopic and roentgenologic methods of diagnosis have not been generally employed. The subject of single and multiple polyps of the colon and rectum has received considerable attention from those interested in proctology and the clinical and surgical aspects of enterology. The present opinion seems to be that single polyps or polyps that occur in small numbers are of relatively common occurrence and differ from those making up the picture of generalized, disseminated polyposis which occurs relatively rarely. In 1895, von Port 1 reviewed fourteen cases of diffuse polyposis; in

The colon is a relatively frequent site for multiple polyps of the mucosa with and without chronic ulceration. The true polyp is composed of hyperplastic glandular mucous membrane projecting into the lumen of the bowel. In the literature are recorded cases of so-called pseudopolyposis lymphatica, 1 in which the mucosal projections are caused by underlying hyperplastic lymph follicles, but no cited instance has been found simulating the case to be reported, in which nodular polypoid projections into the colon were caused by a peculiar granulation tissue composed mostly of large mononuclear cells filled with what appears to be a specific infectious micro-organism. 2 It has not been possible to cultivate the bacillus associated with the lesion, but it is hoped that a record of the case may lead to an earlier recognition of the disease, so that its bacteriology may be studied with care. REPORT OF A CASE History and