Giant colonic polyps in pediatric patient with familial adenomatous polyposis

This article describes a 16-year-old girl with signs of malnutrition, rectal bleeding, hypoalbuminemia and anemia. At the age of 6 months she was operated on for hepatoblastoma. Last two years she has been followed by endocrinologist because of amenorrhea. Her family history was unremarkable. Esophagogastroduodenoscopy revealed multiple small gastric polyps. Colonoscopy showed a few polyps in rectum and hundreds of them  (3-25 mm in diameter) in sigmoid and descending colon. Giant colonic polyps at splenic flexure region prevented further passage of the scope. The diagnosis of FAP was established based on the endoscopy and pathology of colonic polyps removed by snare polypectomy. Extraintestinal manifestations of FAP have not been detected. The patient underwent prophylactic surgery (restorative proctocolectomy). The post-operative course was uneventful. In our knowledge, this is the first report of giant colonic polyps in a pediatric patient suffering from FAP. This clinical syndrome can be presented not only with different genetic backgrounds and diverse clinical pictures but also with intriguing endoscopic findings.