|Year : 2018 | Volume
| Issue : 2 | Page : 175-177
Umbilical polyp; an anomaly of omphalomesenteric duct remnant from birth in a 3-year-old male child: A case report and review of literature
Ifeoma Florence Ezejiofor1, Jideofor Okechukwu Ugwu2, Chinedu Onwuka Ndukwe1, Kingsley Chike Madubuike1, Nnamdi Sergius Ozor1
1 Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
2 Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
|Date of Web Publication||18-May-2018|
Ifeoma Florence Ezejiofor
Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State
Source of Support: None, Conflict of Interest: None
The umbilical polyp is a rare congenital lesion characterized by bright reddish round mass resulting from the persistence of omphalomesenteric duct enteric mucosa at the umbilicus. Umbilical tissue specimens are uncommonly received in the Histopathology Department of Nnamdi Azikiwe University Teaching Hospital. Approximately, one is seen out of every 300 samples received in this center. The aim of this article is to report a rare case of umbilical polyp which was present at birth in a 3-year-old male child who presented with umbilical ulcer with a bloody discharge on contact. This article is the first of its kind in Nigeria and therefore aims to create awareness of this rare condition among Nigerian histopathologists and to differentiate it from more common umbilical anomalies.
Keywords: Congenital lesion, male child, omphalomesenteric duct remnant, umbilical polyp
|How to cite this article:|
Ezejiofor IF, Ugwu JO, Ndukwe CO, Madubuike KC, Ozor NS. Umbilical polyp; an anomaly of omphalomesenteric duct remnant from birth in a 3-year-old male child: A case report and review of literature. Med J DY Patil Vidyapeeth 2018;11:175-7
|How to cite this URL:|
Ezejiofor IF, Ugwu JO, Ndukwe CO, Madubuike KC, Ozor NS. Umbilical polyp; an anomaly of omphalomesenteric duct remnant from birth in a 3-year-old male child: A case report and review of literature. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2022 Jun 25];11:175-7. Available from: https://www.mjdrdypv.org/text.asp?2018/11/2/175/232647
| Introduction|| |
Umbilical cord in intrauterine life contains paired umbilical arteries, umbilical vein, allantois (urachus) and omphalomesenteric duct (OMD) or vitelline duct (VD) which connects the yolk sac to the midgut. The OMD/VD obliterates by the 5–9th week of gestation while the urachus obliterates by the 4–5th months of gestation to become the median umbilical ligament. In the newborn, the umbilical cord typically separates within 3 weeks, leaving a dry, star-like central abdominal scar that forms the umbilicus.
Persistent or failure of involution of OMD result in spectrum of congenital anomalies ranging from umbilical polyp, Meckel's diverticulum (most commonly seen in 2%–3% of the population), patent VD/OMD, OMD cyst, and persistent congenital fibrous band extending from the umbilicus to the intestine. Umbilical polyp may be difficult to distinguish from an umbilical granuloma, but unlike granuloma, umbilical polyp is usually brighter red, usually slightly larger with diameter of 0.5–2 cm as oppose to 0.1–1 cm of granuloma and it does not respond to conservative treatment with topical silver nitrate.
| Case Report|| |
The patient is a 3-year-old boy, who presented earlier within the 1st year of life with a fleshy bright red umbilical mass. He is the first child in a monogamous setting who had complete immunization and was exclusively breastfed with a birth weight of 2.9 kg. He has been on and off the hospital with complaints of umbilical ulcer which started after detachment of the umbilical stump. This lesion started as a small umbilical nodule which discharges blood, especially on contact. There was no discharge of urine or fecal material. General physical examination showed anicteric, not pale and not dehydrated male child of 14.5 kg with respiratory rate of 32 cycles/min and pulse rate of 100 beats/min. Abdominal examination showed 0.5 cm umbilical nodule with a small ulcer at the apex and a fibrous cord extending backwards from the mass. A diagnosis of umbilical granuloma was made. Investigation done revealed pack cell volume of 35%, AA genotype and negative retroviral screening. Abdominal ultrasound scan shows no associated abnormality. He was managed repeatedly with silver nitrate ablation, but lesion reopens weeks later necessitating surgical intervention. The operation was excision and umbilicoplasty; the abdomen was not opened up. Intraoperative findings revealed a 0.5 cm diameter mass at umbilical cicatrix containing granulation tissue. The specimen was sent for histology. He was discharged home on satisfactory condition 5-day post up and currently on follow-up.
At the histopathology department, a fragment of dark reddish soft to firm polypoidal tissue measuring 0.9 cm × 0.5 cm × 0.4 cm and weighing <10 g was received. Cut section revealed reddish-gray tissue. Histologic sections showed a benign lesion composed of intestinal mucosa containing numerous glands lined by cuboidal epithelium having mucin secreting cells (goblet cells). Present within the mucosa are few capillary blood vessels admixed with chronic inflammatory cells. This lesion is directly buried adjacent to the epidermis and upper part of the dermis [Figure 1]. Overall features are those of omphalomesenteric duct remnant and favors umbilical polyp.
|Figure 1: (a) The histology sections showing intestinal mucosa (double arrows) containing numerous glands with goblet cells buried within the skin tissue (single arrows). (b) Higher magnification|
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| Discussion|| |
Umbilical polyp is infrequently reported. Gaopande et al., of General Hospital India found only one umbilical polyp among 15 cases of umbilical lesions seen from the age 9 months to 45 years over a 24-month period. Moreover, over a 10-year period of study of 53 cases of all umbilical lesions reported by Pacilli et al. in Great Ormond Street Hospital, University College London, 13 cases of umbilical polyp were found in infant and children <7 years.
These lesions are not common histopathology diagnosis, and a histopathologist, especially in Nigeria, may not have seen one throughout his practice. Therefore, high index of suspicion is needed for recognition of these lesions. There has been no reported case of umbilical polyp in Nigeria following an extensive search in PubMed, Medline, and Google Scholar. Ameh et al. in Zaria, Northern Nigeria, studied 18 cases of OMD anomalies in children aged 11 days to 14 years over a 22-year period and found 12 cases of patent VDs, 3 Meckel's diverticulum, 2 umbilical sinus, and 1 case of vitelline cyst, and no umbilical polyp. OlaOlorun et al. in Ogbomoso Western Nigerian also reported one case of Patent OMD opening into the vermiform appendix.
Due to the rarity of this lesion, there is need to know about this condition and its likely differential diagnosis. The most frequent differential diagnosis is umbilical granuloma, but other differential diagnoses are endometriosis, persistent urachus, and omphalocele. Lack of response to ablative silver nitrate in this index case and larger diameter of the bright reddish mass with absent histologic features of proliferating capillaries admixed with fibroblasts support the diagnosis of umbilical polyp over granuloma. The absence of endometrial glands and/or stroma also ruled out endometriosis.
Clinical presentation of umbilical lesions depends on the age of the patient. In the newborn, delayed umbilical separation and omphalitis are common while in childhood and among adults, umbilical mass and umbilical discharge or wet umbilicus take precedence which was the features in this present case. Pacilli et al. reported a discharging polyp in all the 13 cases with associated bleeding in 9 cases as presented in the index case. OMD malformations are found with equal frequency among the sexes, although significantly greater incidence of symptoms is encountered in males as seen in this 3-year-old male child.
The histopathology of umbilical polyp shows remnants of enteric mucosa which is usually of small intestine or colonic type, but occasionally of gastric type in direct continuity with the adjacent epidermis [Figure 1]. Other variant, fibrous umbilical polyp; is a distinctive umbilical polyp devoid of any epithelial component.
The treatment of umbilical polyp show unresponsiveness to conservative management with repeated tropical silver nitrate ablation, ligation or use of alcoholic wipes. Simple surgical excision is adequate as done in this index case. A study by Pacilli et al. also show that surgical excision is adequate and that inspection and probing of the base of the polyp after its excision is not necessary. He performed exploration of the peritoneal cavity in 6 patients with umbilical polyp suspected to have an associated OMD anomaly, and none had OMD anomaly associated with it. The 7 children who did not undergo exploration of the abdominal cavity remained asymptomatic after 5.8 years of follow-up. An umbilical polyp can be present in the absence of other OMD anomalies. Exploration of the peritoneal cavity in children with an umbilical polyp does not seem to be necessary.
| Conclusion|| |
Umbilical polyp is a rare congenital lesion with wet bright reddish mass histological disposed as intestinal mucosa in direct continuity with adjacent skin which needs a high index of suspicious to be considered a possible diagnosis or differential diagnosis by histopathologists.
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