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Lymphonodular hyperplasia of the colon as a pathologic finding in children with lower gastrointestinal bleeding
Insights
Lymphonodular hyperplasia of the colon (LNHC) is a common finding in children with rectal bleeding. This condition, characterized by enlarged lymphoid follicles, may be a source of bleeding in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Pathology
Background:
- Gastrointestinal bleeding in children is a significant concern.
- The role of lymphonodular hyperplasia of the colon (LNHC) in pediatric hematochezia is not well understood.
Purpose of the Study:
- To investigate the prevalence and significance of LNHC in children presenting with hematochezia.
- To characterize the endoscopic and histologic features of LNHC in this pediatric population.
Main Methods:
- Retrospective review of 95 children (2-48 months) with hematochezia.
- Proctosigmoidoscopy performed on 65 children, with biopsy of LNHC lesions.
- Comparison of biopsy findings with age-matched controls and children with colitis.
Main Results:
- LNHC was identified in 31% (20/65) of children undergoing proctosigmoidoscopy, with no other bleeding source found.
- LNHC was most prominent in the distal colon and rectum, showing friability and ulceration.
- Biopsies revealed increased lymphoid follicles, mucosal inflammation, epithelial thinning, and ulceration overlying enlarged follicles.
Conclusions:
- LNHC is a frequent finding in children evaluated for lower gastrointestinal bleeding.
- The endoscopic and histologic features suggest LNHC is an abnormal finding and a potential source of rectal bleeding in children.
Abstract:
The serious implication of gastrointestinal blood loss in children is well recognized; however, the significance of lymphonodular hyperplasia of the colon (LNHC) as a pathologic finding in this group of children is unclear. We reviewed the records of 95 children, ages 2-48 months, who were referred to our clinic with a history of hematochezia. Proctosigmoidoscopy was performed on 65 of them. Twenty children (31%) examined proctosigmoidoscopically were found to have LNHC, with no other identified source of bleeding. Clinical histories, endoscopic findings, and colonic biopsy specimens from the LNHC group were examined. Clinical presentation of patients in this group was not distinctive. LNHC was most prominent in the distal colon and rectum and was endoscopically characterized by friability (13/20) and ulceration (3/20). Characteristics of biopsy specimens from children with LNHC were than compared with tissue obtained from an age-matched control population and children with colitis. Biopsy specimens from children with LNHC contained increased numbers of lymphoid follicles and larger follicles than those from the control group. Specimens also contained mucosal inflammation and epithelial thinning and ulceration overlying enlarged follicles. We conclude that LNHC is a frequent proctosigmoidoscopic finding in children evaluated for lower gastrointestinal bleeding. The endoscopic and histologic appearance of these lesions would suggest that LNHC is not a normal finding and represents a potential source of rectal bleeding in children.