Dermatologica 150: 111-115 (1975)
Umbilical Polyp: a Report of Two Cases N o sratollah H ejazi Departments of Dermatology, Wayne State University School of Medicine and Detroit General Hospital, Detroit, Mich.
Key Words. Umbilical polyp • Omphalomesenteric duct • Vitelline cyst • Meckel’s diverticulum Abstract. Two cases with umbilical polyp are reported. This rare malformation arises from remnants of the omphalomesenteric duct and may be clinically mistaken for a gran uloma pyogenicum or other benign or malignant umbilical neoplasms. Histologically umbilical polyp shows branching glandular structures lined by intestinal mucosa in con nection with the surface of the skin. When the umbilical polyp is not associated with any other types of underlying abnormalities, it may be treated by a simple surgical excision.
Umbilical polyp is a rare malformation of the skin that can easily be mistaken clinically for a granuloma pyogenicum, a pigmented nevus, or other benign or malignant umbilical neoplasms. Under normal conditions the omphalomesenteric duct disappears from the embryo after a few weeks. Persistence of all or part of this structure may give rise to a variety of anom alies including umbilical enteric fistula, umbilical sinus, vitelline cyst, Meckel’s diverticulum, congenital band, and umbilical polyp. This study concerns the clinical data and histological findings of two cases with umbili cal polyps. Case Reports
Received: January 20, 1975; accepted: January 31, 1975.
Downloaded by: King's College London 137.73.144.138 - 3/7/2018 5:41:12 AM
Case I. A 13-year-old white boy was seen because of a slowly growing and occasionally bleeding growth of the umbilicus for the past 2 years. Physical examination revealed a
112
H ejazi
Fig. 1. Dilated tubular structures embedded in a fibrovascular stroma in several areas opening into the surface of the lesion. HE. x 30.
5-mm raised, flesh-colored nodule with superficial erosion over the center of the umbilicus. The lesion was diagnosed as granuloma pyogenicum and was surgically excised under local anesthesia. There was no evidence of connection of the growth with underlying tissues. Histologic examination showed several branching glandular structures extending from the surface of the epidermis down into the corium. These structures were lined by a layer of high columnar intestinal mucous secreting epithelial cells (fig. 1). The mucinous material in these cells was PAS-positive and reacted strongly with alcian blue and aldehyde fuchsin (fig. 2). In addition, the corium also showed extensive proliferation of capillary blood vessels and diffuse chronic inflammatory cell infiltrate.
Downloaded by: King's College London 137.73.144.138 - 3/7/2018 5:41:12 AM
Case 2. An 11-ycar-old white boy was seen for a small nodular umbilical lesion present since birth. Examination showed a 1-cm, soft, nontendcrand skin-colored nodular growth. There was no definite evidence of central depression or opening into the surface. The lesion was freely movable and showed no attachment to the underlying tissue. The growth, diagnosed as a pigmented nevus, was surgically excised. Microscopic examination showed numerous branching ductal epithelia extending from the surface of the epidermis down into the corium (fig. 3). In the corium were also numerous newly thin-walled capillary blood vessels and a moderately heavy infiltrate of lymphocytes and eosinophils.
Umbilical Polyp: A Report of Two Cases
113
Fig. 2. The high columnar cells lining the lumina of tubular structures contain PASpositive and alcian blue-reactive material giving the color reaction of sialomucin. Alcian bluc-PAS. x 400.
The omphalomesenteric duct communicates between the mid gut and the yolk sac of the embryo. This duct is usually obliterated and disappears dur ing the 7th week of embryonic life. The remnant of the omphalomesenteric duct, anywhere along its embryonic course from skin to the intestine, may give rise to formation of polyps, sinuses, or cysts with or without connection
Downloaded by: King's College London 137.73.144.138 - 3/7/2018 5:41:12 AM
Comment
114
H ejazi
Fig. 3. Tubular structures are lined by a layer of intestinal mucosal epithelium. The fibrous stroma also shows diffuse inflammatory cell infiltrate. HE. x 180.
Downloaded by: King's College London 137.73.144.138 - 3/7/2018 5:41:12 AM
to the intestine or the surface of the skin [1,2]. Nix and Y o u n g [5] classified the failure of obstruction or persistence of the omphalomesenteric duct into the following categories: (A) completely patent omphalomesenteric duct (umbilical enteric fistula); (B) partially patent omphalomesenteric duct: (1) peripheral portion (umbilical sinus), (2) intermediate portion (vitelline cyst), (3) enteric portion (Meckel’s diverticulum); (C) mucosa remnant at the umbilicus (umbilical polyp), and (D) congenital band (obliterated omphalo mesenteric duct). Meckel’s diverticulum is the most common complication and umbilical enteric fistula is very rare. The umbilical polyp is also a relatively rare con dition which becomes manifest in newborns or early in childhood. Clinically, it could be mistaken for a granuloma pyogenicum, urachus remnant, foreign body granuloma, or a pigmented nevus. T hompson [7] suggested that 0.5% of patients with known diverticula had associated an umbilical polyp. S teck and H e l w ig [6] described 40 cases of omphalomesenteric duct remnant, of which 19 had only an umbilical polyp and 12 of these were associated with an underlying cyst, sinus, and fistula or a combination of sinus and cyst.
Umbilical Polyp: a Report of Two Cases
115
It appears that the association of umbilical polyp and sinus are more common than others. A purely umbilical polyp is generally regarded as a harmless embryologic defect, but when associated with other abnormalities may produce more complicated features such as fecal fistula, infected cyst or large herniation of the intestinal wall through the umbilical orifice [3], In complicated types the possibility of sinus, fistula, and diverticula could be ruled out on the basis of the presence of an opening in the mucosal mass, histologic findings and X-ray studies after intralesional introduction or oral administration of a dye or opaque material. When a simple and uncompli cated umbilical polyp is present surgical excision of the lesion is usually adequate for treatment.
References 1 B enson, C.D.: Pediatric surgery, vol. 1, p. 558 (Year Book, Chicago 1962). 2 C ullen, T.S.: Embryology, anatomy and diseases of the umbilicus together with urachus. (Saunders, Philadelphia 1916). 3 K ling , S .: Patent omphalomesenteric duct. A surgical emergency. Archs Surg. 96: 545-548 (1968). 4 Moore, T.C. Omphalomesenteric duct anomalies. Surgery Gynec. Obstet. 103: 569 (1956). 5 N ix, T.E., jr. and Young , J.C .: Congenital umbilical anomalies. Archs Derm. 90: 160-165 (1964). 6 Steck , W.D. and H elwig , E.B.: Cutaneous remnant of the omphalomesenteric duct. Archs Derm. 90: 463-470 (1969). 7 T homson, J.E .: Perforated peptic ulcer in Meckel's diverticulum. Ann. Surg. 105: 44 (1937).
Street, Box 360, Monroe, M I 48161 (USA)
Downloaded by: King's College London 137.73.144.138 - 3/7/2018 5:41:12 AM
N osratollah H ejazi, MD, Pinkus Dermatopathology Laboratory, 415 South Monroe
Umbilical Polyp: a Report of Two Cases N o sratollah H ejazi Departments of Dermatology, Wayne State University School of Medicine and Detroit General Hospital, Detroit, Mich.
Key Words. Umbilical polyp • Omphalomesenteric duct • Vitelline cyst • Meckel’s diverticulum Abstract. Two cases with umbilical polyp are reported. This rare malformation arises from remnants of the omphalomesenteric duct and may be clinically mistaken for a gran uloma pyogenicum or other benign or malignant umbilical neoplasms. Histologically umbilical polyp shows branching glandular structures lined by intestinal mucosa in con nection with the surface of the skin. When the umbilical polyp is not associated with any other types of underlying abnormalities, it may be treated by a simple surgical excision.
Umbilical polyp is a rare malformation of the skin that can easily be mistaken clinically for a granuloma pyogenicum, a pigmented nevus, or other benign or malignant umbilical neoplasms. Under normal conditions the omphalomesenteric duct disappears from the embryo after a few weeks. Persistence of all or part of this structure may give rise to a variety of anom alies including umbilical enteric fistula, umbilical sinus, vitelline cyst, Meckel’s diverticulum, congenital band, and umbilical polyp. This study concerns the clinical data and histological findings of two cases with umbili cal polyps. Case Reports
Received: January 20, 1975; accepted: January 31, 1975.
Downloaded by: King's College London 137.73.144.138 - 3/7/2018 5:41:12 AM
Case I. A 13-year-old white boy was seen because of a slowly growing and occasionally bleeding growth of the umbilicus for the past 2 years. Physical examination revealed a
112
H ejazi
Fig. 1. Dilated tubular structures embedded in a fibrovascular stroma in several areas opening into the surface of the lesion. HE. x 30.
5-mm raised, flesh-colored nodule with superficial erosion over the center of the umbilicus. The lesion was diagnosed as granuloma pyogenicum and was surgically excised under local anesthesia. There was no evidence of connection of the growth with underlying tissues. Histologic examination showed several branching glandular structures extending from the surface of the epidermis down into the corium. These structures were lined by a layer of high columnar intestinal mucous secreting epithelial cells (fig. 1). The mucinous material in these cells was PAS-positive and reacted strongly with alcian blue and aldehyde fuchsin (fig. 2). In addition, the corium also showed extensive proliferation of capillary blood vessels and diffuse chronic inflammatory cell infiltrate.
Downloaded by: King's College London 137.73.144.138 - 3/7/2018 5:41:12 AM
Case 2. An 11-ycar-old white boy was seen for a small nodular umbilical lesion present since birth. Examination showed a 1-cm, soft, nontendcrand skin-colored nodular growth. There was no definite evidence of central depression or opening into the surface. The lesion was freely movable and showed no attachment to the underlying tissue. The growth, diagnosed as a pigmented nevus, was surgically excised. Microscopic examination showed numerous branching ductal epithelia extending from the surface of the epidermis down into the corium (fig. 3). In the corium were also numerous newly thin-walled capillary blood vessels and a moderately heavy infiltrate of lymphocytes and eosinophils.
Umbilical Polyp: A Report of Two Cases
113
Fig. 2. The high columnar cells lining the lumina of tubular structures contain PASpositive and alcian blue-reactive material giving the color reaction of sialomucin. Alcian bluc-PAS. x 400.
The omphalomesenteric duct communicates between the mid gut and the yolk sac of the embryo. This duct is usually obliterated and disappears dur ing the 7th week of embryonic life. The remnant of the omphalomesenteric duct, anywhere along its embryonic course from skin to the intestine, may give rise to formation of polyps, sinuses, or cysts with or without connection
Downloaded by: King's College London 137.73.144.138 - 3/7/2018 5:41:12 AM
Comment
114
H ejazi
Fig. 3. Tubular structures are lined by a layer of intestinal mucosal epithelium. The fibrous stroma also shows diffuse inflammatory cell infiltrate. HE. x 180.
Downloaded by: King's College London 137.73.144.138 - 3/7/2018 5:41:12 AM
to the intestine or the surface of the skin [1,2]. Nix and Y o u n g [5] classified the failure of obstruction or persistence of the omphalomesenteric duct into the following categories: (A) completely patent omphalomesenteric duct (umbilical enteric fistula); (B) partially patent omphalomesenteric duct: (1) peripheral portion (umbilical sinus), (2) intermediate portion (vitelline cyst), (3) enteric portion (Meckel’s diverticulum); (C) mucosa remnant at the umbilicus (umbilical polyp), and (D) congenital band (obliterated omphalo mesenteric duct). Meckel’s diverticulum is the most common complication and umbilical enteric fistula is very rare. The umbilical polyp is also a relatively rare con dition which becomes manifest in newborns or early in childhood. Clinically, it could be mistaken for a granuloma pyogenicum, urachus remnant, foreign body granuloma, or a pigmented nevus. T hompson [7] suggested that 0.5% of patients with known diverticula had associated an umbilical polyp. S teck and H e l w ig [6] described 40 cases of omphalomesenteric duct remnant, of which 19 had only an umbilical polyp and 12 of these were associated with an underlying cyst, sinus, and fistula or a combination of sinus and cyst.
Umbilical Polyp: a Report of Two Cases
115
It appears that the association of umbilical polyp and sinus are more common than others. A purely umbilical polyp is generally regarded as a harmless embryologic defect, but when associated with other abnormalities may produce more complicated features such as fecal fistula, infected cyst or large herniation of the intestinal wall through the umbilical orifice [3], In complicated types the possibility of sinus, fistula, and diverticula could be ruled out on the basis of the presence of an opening in the mucosal mass, histologic findings and X-ray studies after intralesional introduction or oral administration of a dye or opaque material. When a simple and uncompli cated umbilical polyp is present surgical excision of the lesion is usually adequate for treatment.
References 1 B enson, C.D.: Pediatric surgery, vol. 1, p. 558 (Year Book, Chicago 1962). 2 C ullen, T.S.: Embryology, anatomy and diseases of the umbilicus together with urachus. (Saunders, Philadelphia 1916). 3 K ling , S .: Patent omphalomesenteric duct. A surgical emergency. Archs Surg. 96: 545-548 (1968). 4 Moore, T.C. Omphalomesenteric duct anomalies. Surgery Gynec. Obstet. 103: 569 (1956). 5 N ix, T.E., jr. and Young , J.C .: Congenital umbilical anomalies. Archs Derm. 90: 160-165 (1964). 6 Steck , W.D. and H elwig , E.B.: Cutaneous remnant of the omphalomesenteric duct. Archs Derm. 90: 463-470 (1969). 7 T homson, J.E .: Perforated peptic ulcer in Meckel's diverticulum. Ann. Surg. 105: 44 (1937).
Street, Box 360, Monroe, M I 48161 (USA)
Downloaded by: King's College London 137.73.144.138 - 3/7/2018 5:41:12 AM
N osratollah H ejazi, MD, Pinkus Dermatopathology Laboratory, 415 South Monroe
