A 15-year-old child was admitted to our hospital due to melena. Colonoscopic examination showed a huge and irregular surfaced polypoid lesion that is called type Yamada IV in the sigmoid colon at 22cm from anal verge. The polyp was removed successfully by colonoscope. The resected specimen was 36×23×18mm in size with marked lobulation and stalk. Histologic examination revealed both juvenile polyp and tubular adenoma with severe atypia. The resection margin was free from the adenoma.
Although the majority of colonic polyps in children are juvenile polyps, the presence of huge colonic adenoma with juvenile component in pediatric patients has also been reported by some authors. It is necessary to remove a huge colonic polyp in a child as soon as possible by colonoscope, especially that over 10 years of age.
We conclude that colonoscopic polypectomy is necessary in this case because the resected polyp was so huge (36mm in size) and histological findings revealed pre-cancerous potential.
