S3757 An Uncommon Cause of a Rectal Polyp: Pyogenic Granuloma in the Rectum

Introduction: Pyogenic granuloma (PG), or lobular capillary hemangioma, is a benign vascular lesion usually affecting the skin or oral mucosa. Gastrointestinal (GI) presentations are rare, with fewer than 50 cases reported and only 6 involving the rectum. PG typically appears as a friable, red, hypervascular lesion that can mimic neoplastic or inflammatory polyps. It is now believed to arise from local trauma or irritation, rather than infection. Due to its rarity, diagnosis often relies on histopathology. This case is further distinguished by the patient’s underlying hereditary hemochromatosis with homozygous HFE C282Y mutation, a genetic profile that may affect vascular response and mucosal healing. Case Description/Methods: A 77-year-old man with normocytic anemia, metastatic prostate cancer, and hereditary hemochromatosis (C282Y homozygous) was referred for surveillance colonoscopy. His prior colonoscopy, 6 years earlier, showed a benign polyp and thrombosed hemorrhoids. Current colonoscopy showed normal mucosa throughout the colon. A 1–3 mm sessile polyp in the cecum was removed with cold forceps, and a 3–6 mm sessile polyp in the transverse colon was removed via cold snare. In the rectum, a 15 mm semi-pedunculated polyp located just proximal to the dentate line was resected with hot snare. It appeared hypervascular but was nonbleeding. Histology revealed lobular clusters of capillaries lined by endothelial cells with granulation tissue and neutrophilic infiltrate, consistent with PG. Discussion: Rectal PG is extremely rare. Most GI PGs present with bleeding, but this lesion was asymptomatic and incidentally discovered. The hypervascular appearance may resemble adenomas or even malignancy, underscoring the need for histologic diagnosis. This case is unique due to the patient’s homozygous HFE C282Y mutation. Iron overload from hemochromatosis may contribute to oxidative stress, tissue injury, and altered healing, potentially predisposing to abnormal vascular lesions such as PG. To our knowledge, this is the first reported case of rectal PG in a patient with this genetic background. This report highlights the importance of recognizing rare benign lesions during colonoscopy and considering systemic or genetic factors in mucosal pathology.