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A Rare Case of Diffuse Nodular Lymphoid Hyperplasia With Rectal Involvement
James R Pellegrini1, Jose Russe Russe1, Jonathan Arias1
1Internal Medicine, Nassau University Medical Center, East Meadow, USA.
Cureus
|June 6, 2022
Summary
Nodular lymphoid hyperplasia (NLH) is rare in the rectum, but this case highlights its potential link to malignancy. Early detection and monitoring are crucial for patients with rectal NLH.
Area of Science:
- Gastroenterology
- Pathology
- Oncology
Background:
- Nodular lymphoid hyperplasia (NLH) typically affects the intestinal wall's lamina propria and superficial submucosa.
- Gastric and rectal involvement with NLH is uncommon, with few documented cases of diffuse rectal lymphomatous polyposis.
Observation:
- A 39-year-old morbidly obese female presented with intermittent hematochezia.
- Colonoscopy revealed diffuse nodularity in the sigmoid colon and rectal mucosa.
- Rectal biopsies showed chronic inflammation, lymphoid hyperplasia, and focal ulceration, with immunohistochemistry confirming reactive lymphoid hyperplasia (RLH).
Findings:
- The patient's rectal biopsies indicated reactive lymphoid hyperplasia, a condition that can be a risk factor for lymphomas.
- While NLH itself is benign, its presence necessitates consideration of potential underlying or concurrent malignancy.
Implications:
- NLH, particularly in the rectum, warrants careful monitoring due to its association with intestinal and extraintestinal lymphomas.
- Regular surveillance using capsule endoscopy, small bowel series, and colonoscopy is vital for detecting new lesions and managing potential malignant transformation.
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