El Tawil, Dalya, MD

Paul, Adam R., DO

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Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of PediatricsRectal Polyp with Atypical Lymphoid Infiltrate;Rectal Lymphoma or Rectal TonsilDalya El Tawil MDLVHN, dalya.eltawil@lvhn.orgAdam R. Paul DOLehigh Valley Health Network, Adam_R.Paul@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/pediatricsPart of the Pediatrics CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtEl Tawil, D., Paul, A. & Grau, J. (2014, October, 22). Rectal Polyp with Atypical Lymphoid Infiltrate; Rectal Lymphoma or Rectal Tonsil.Poster session presented at the NASPGHAN 2014 Annual Meeting and Postgraduate Course, Atlanta, GA.© 2014 Lehigh Valley Health Network References:1	 	Farris,	AB,	et	al.	The	rectal	tonsil:	a	reactive	lymphoid	proliferation	that	may	mimic	lymphomaAm	J	Surg	Pathol.	2008	Jul;32(7):1075-9.		2	 	Kojima	M,,	et	al.	Localized	lymphoid	hyperplasia	of	the	rectum	resembling	polypoid	mucosa-associated	lymphoid	tissue	lymphoma:	a	report	of	three	cases.	Pathol	Res	Pract	2005;	201:757–761.Discussion•		The	rectal	tonsil,	also	known	as	the	benign	lymphoid	polyp,	can	present	with	intermittent	rectal	bleeding	or	pain.•		On	endoscopy	it	is	usually	located	in	the	rectum	just	proximal	to	the	dentate	line.•		Its	histology	mimics	a	gastrointestinal	lymphoma,	which	is	the	most	common	extra	nodal	location	of	lymphoma.•		Diagnosis	of	rectal	lymphomas	require	supportive	immunohistochemical	staining	and	genotypic	studies.•		The	treatment	for	a	rectal	tonsil	is	local	excision.	•		Since	the	endoscopic	and	histologic	appearance	is	similar	to	rectal	lymphoma	it	is	critical	to	perform	further	testing	on	path	sections.Conclusions•		When	the	histology	of	a	polyp	is	suggestive	of	lymphoma,	it	is	important	to	include	rectal	tonsil	in	the	differential	diagnosis.	This	can	help	decrease	or	avoid	undue	familial	anxiety,	additional	medical	testing	and	referrals.Polyps	seen	on	endoscopy Section	of	excised	polyp	shows	a	large	asymmetric	germinal	centers	with	large	transformed	interfollicular	lymphocytes.Introduction•		Rectal	polyps	are	a	common	cause	of	rectal	bleeding.	•		In	most	instances,	rectal	polyps	are	benign	hamartomatous	juvenile	polyps.•		Though	the	finding	is	rare,	gastrointestinal	lymphomas	should	be	considered	when	polyps	contain	atypical	lymphoid	infiltrates.•		Rectal	tonsils	are	benign	localized	reactive	proliferations	of	lymphoid	tissue	not	commonly	reported	in	children.•		The	rectal	tonsil	appears	as	a	polyp	and	resembles	lymphoma	under	histological	examination.	Case Presentation•		6	year	old	previously	healthy	male	presents	with	4	weeks	of	hematochezia.	•		The	patient	underwent	EGD	&	colonoscopy	and	a	1	cm	pedunculated	polyp	in	the	distal	rectum	was	excised	by	snare	polypectomy	and	sent	for	pathology.	•		The	polyp	was	shown	to	have	atypical	lymphoid	infiltrate	involving	the	mucosa	and	the	submucosa	of	the	rectum.•		The	pathology	report	was	initially	consistent	with	rectal	lymphoma•		Immunophenotype	and	the	molecular	studies	then	were	performed	which	favored	reactive	lymphoid	hyperplasia	consistent	with	a	rectal	tonsil.	•		The	esophageal	biopsies	showed	a	slight	increase	in	eosinophils,	the	remainder	of	the	gastric,	duodenal,	colonic,	and	terminal	ileal	biopsies	showed	no	diagnostic	abnormalities.	Lehigh Valley Health Network, Allentown, PARectal Polyp with Atypical Lymphoid Infiltrate; Rectal Lymphoma or Rectal TonsilDalya El Tawil, MD, Adam Paul, DO, and Jillian Grau, MD

Rectal Polyp with Atypical Lymphoid Infiltrate; Rectal Lymphoma or Rectal Tonsil

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1118&context=pediatrics

Rectal Polyp with Atypical Lymphoid Infiltrate; Rectal Lymphoma or Rectal Tonsil

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