Large Hyperplastic Colorectal Mass in a 25-Year-Old Intern Physician Suspicious for Inflammatory Cap Polyposis

This case study chronicles the identification and removal of a 40mm mobile, multilobulated, polypoid colorectal mass with ambiguous non-neoplastic inflammatory pathology. The initial pathology report identified "inflamed hyperplastic polyp with prolapse changes, ulcer, and granulation tissue," consistent with the rare disease "inflammatory cap polyposis." With few reported cases, cap polyposis is poorly described in the literature. In this case, colonoscopy did not identify additional masses, as is typical for cap polyposis, though a lone polyp does not exclude the diagnosis. The patient himself is the primary author of this case report, at the time of diagnosis, a 25-year-old male beginning his first year of emergency medicine residency. One year after excision, the patient underwent repeat colonoscopy, which demonstrated no recurrence of disease. With the patient having the medical expertise to recognize that the large size of the polyp was concerning for neoplasm, there was significant emotional distress between the initial identification of the mass on colonoscopy and the results of the first pathology report five days later. Even with the first pathology report being negative for malignancy, there was only marginal emotional relief until receiving the results of the final pathology report of the wholly excised mass, 15 days after initial identification of the mass.