A 5-year-old child presented with a history of blood in the stools. On examination, there was a polypoid mass in the rectum, a biopsy of which showed as below. A most probable diagnosis is ?
In assessing the scenario of a 5-year-old child presenting with blood in the stools and a polypoid mass in the rectum, the biopsy results are crucial to narrowing down the diagnosis. Here’s how to determine the most probable diagnosis:
Symptom Analysis: The presence of blood in stools in a young child, coupled with the discovery of a polypoid mass, suggests a condition typically seen in pediatric patients.
Age Consideration: At 5 years old, conditions like juvenile polyps are common. Villous adenomas and serrated adenomas are more typical in older patients and have a higher risk of malignancy. Vascular malformations can cause bleeding but are less likely to present as a polypoid mass with a specific biopsy signature.
Diagnosis by Exclusion: Considering the age and presentation, juvenile polyps are the most common type of colorectal polyp in children, generally benign, and often cause painless rectal bleeding. This aligns with the child’s symptoms.
Villous adenoma: Usually presents in older individuals and is a type of precancerous lesion.
Vascular malformation: While it can cause bleeding, it wouldn’t typically present as a polyp without specific histological evidence.
Serrated adenoma: Characteristically appears in adults and has distinctive histology that doesn’t align with juvenile polyp presentation.
Histology: The biopsy results aid in identifying classic features of juvenile polyps, such as cystic glands and a loose stroma filled with inflammatory cells, typical of juvenile polyps.
Given these factors, the most probable diagnosis for this child is a Juvenile polyp.
