Long-term Prognosis of Localized Lymphoid Hyperplasia of the Rectum
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Background/Aims: Although localized lymphoid hyperplasia (LLH) of the rectum is occasionally observed, its clinical implications are unclear. This study aimed to investigate the clinical course and significance of LLH of the rectum. Methods: We identified 65 patients diagnosed with LLH of the rectum using a histopathologic examination and who received follow-up endoscopies between January 2009 and June 2015. Patients with a history of inflammatory bowel disease, lymphoma, familial adenomatous polyposis, or uncontrolled malignancy and patients who underwent scar biopsy after endoscopic resection or surgery were excluded. Endoscopic findings and clinical courses were analyzed. Results: During the median follow-up of 31 months (interquartile range, 19 to 40 months), 81.5% (53/65) of LLHs of the rectum were resolved. Clinically significant diseases, including ulcerative colitis (UC, n=5) and mucosa-associated lymphoid tissue (MALT) lymphoma (n=1), were diagnosed in 9.2% of patients (6/65). The other six patients showed no significant changes in the lesion (n=3) or a waxing and waning appearance (n=3). According to endoscopic findings, all of the 47 polypoid types showed resolution or waxing and waning patterns. Five of the 11 nodular types (45.5%) developed into UC. One of the seven submucosal tumor (SMT)-like types (14.3%) developed into MALT lymphoma. Conclusions: LLH of the rectum with persistent symptoms or the endoscopic appearance of the nodular or SMT-like type may lead to clinically significant disease. Risk stratification according to endoscopic findings and careful surveillance are required for these lesions.
Abstract
Background/Aims: Although localized lymphoid hyperplasia (LLH) of the rectum is occasionally observed, its clinical implications are unclear. This study aimed to investigate the clinical course and significance of LLH of the rectum. Methods: We identified 65 patients diagnosed with LLH of the rectum using a histopathologic examination and who received follow-up endoscopies between January 2009 and June 2015. Patients with a history of inflammatory bowel disease, lymphoma, familial adenomatous polyposis, or uncontrolled malignancy and patients who underwent scar biopsy after endoscopic resection or surgery were excluded. Endoscopic findings and clinical courses were analyzed. Results: During the median follow-up of 31 months (interquartile range, 19 to 40 months), 81.5% (53/65) of LLHs of the rectum were resolved. Clinically significant diseases, including ulcerative colitis (UC, n=5) and mucosa-associated lymphoid tissue (MALT) lymphoma (n=1), were diagnosed in 9.2% of patients (6/65). The other six patients showed no significant changes in the lesion (n=3) or a waxing and waning appearance (n=3). According to endoscopic findings, all of the 47 polypoid types showed resolution or waxing and waning patterns. Five of the 11 nodular types (45.5%) developed into UC. One of the seven submucosal tumor (SMT)-like types (14.3%) developed into MALT lymphoma. Conclusions: LLH of the rectum with persistent symptoms or the endoscopic appearance of the nodular or SMT-like type may lead to clinically significant disease. Risk stratification according to endoscopic findings and careful surveillance are required for these lesions.
참고문헌 (34)
- Riddell RH, "Atlas of tumor pathology: tumor of the intestine", pp.102~104 (2003), Armed Forces Institute of Pathology
- Ranchod M, "Lymphoid hyperplasia of the gastrointestinal tract : a study of 26 cases and review of the literature", Am J Surg Pathol, 2, pp.383~400 (1978)
- Kealy WF, "Colonic lymphoid-glandular complex(microbursa) : nature and morphology", J Clin Pathol, 29, pp.241~244 (1976)
- Cornes JS, "Benign lymphomas of the rectum and anal canal : a study of 100 cases", J Pathol Bacteriol, 82, pp.371~382 (1961)
- Kraehenbuhl JP, "Epithelial M cells : differentiation and function", Annu Rev Cell Dev Biol, 16, pp.301~332 (2000)
- Kojima M, "Localized lymphoid hyperplasia of the rectum resembling polypoid mucosa-associated lymphoid tissue lymphoma : a report of three cases", Pathol Res Pract, 201, pp.757~761 (2005)
- Kenney PJ, "The clinical significance of large lymphoid follicles of the colon", Radiology, 142, pp.41~46 (1982)
- Glick SN, "Colonic lymphoid follicles associated with colonic neoplasms", Radiology, 168, pp.603~607 (1988)
- Rambaud JC, "Diffuse follicular lymphoid hyperplasia of the small intestine without primary immunoglobulin deficiency", Am J Med, 73, pp.125~132 (1982)
- Chiaramonte C, "Nodular lymphoid hyperplasia of the small bowel complicated by jejunal lymphoma in a patient with common variable immune deficiency syndrome", AJR Am J Roentgenol, 163, pp.1118~1119 (1994)
- Ryan JC, "Premalignant conditions of the small intestine", Semin Gastrointest Dis, 7, pp.88~93 (1996)
- Castellano G, "Malignant lymphoma of jejunum with common variable hypogammaglobulinemia and diffuse nodular hyperplasia of the small intestine. A case study and literature review", J Clin Gastroenterol, 15, pp.128~135 (1992)
- Harris M, "High-grade non-Hodgkin’s lymphoma complicating polypoid nodular lymphoid hyperplasia and multiple lymphomatous polyposis of the intestine", Histopathology, 15, pp.339~350 (1989)
- Kahn LB, "Nodular lymphoid hyperplasia of the small bowel associated with primary small bowel reticulum cell lymphoma", Cancer, 33, pp.837~844 (1974)
- Lamers CB, "Jejunal lymphoma in a patient with primary adult-onset hypogammaglobulinemia and nodular lymphoid hyperplasia of the small intestine", Dig Dis Sci, 25, pp.553~557 (1980)
- Aguilar FP, "Jejunal malignant lymphoma in a patient with adult-onset hypo-gamma-globulinemia and nodular lymphoid hyperplasia of the small bowel", Am J Gastroenterol, 82, pp.472~475 (1987)
- Gonzalez-Vitale JC, "Immunoblastic lymphoma of small intestine complicating late-onset immunodeficiency", Cancer, 49, pp.445~449 (1982)
- Durham JC, "Common variable hypogammaglobulinemia complicated by an unusual T-suppressor", cytotoxic cell lymphoma, 1987, pp.59, 271~276
- Matuchansky C, "Nodular lymphoid hyperplasia of the small bowel associated with primary jejunal malignant lymphoma. Evidence favoring a cytogenetic relationship", Gastroenterology, 78, pp.1587~1592 (1980)
- Schaefer PS, "Nodular lymphoid hyperplasia of the small intestine with Burkitt’s lymphoma and dysgammaglobulinemia", Gastrointest Radiol, 6, pp.325~328 (1981)
- Bayraktar Y, "The findings of capsule endoscopy in patients with common variable immunodeficiency syndrome", Hepatogastroenterology, 54, pp.1034~1037 (2007)
- Hong JB, "Rectal tonsil : a case report and literature review", World J Gastroenterol, 21, pp.2563~2567 (2015)
- Schwartz DC, "Diffuse nodular lymphoid hyperplasia of the colon: polyposis syndrome or normal variant?", Gastrointest Endosc, 58, pp.630~632 (2003)
- Garg V, "Diffuse nodular lymphoid hyperplasia of intestine in selective IgG 2 subclass deficiency, autoimmune thyroiditis, and autoimmune hemolytic anemia : case report and literature review", J Gastrointestin Liver Dis, 21, pp.431~434 (2012)
- Farris AB, "The rectal tonsil : a reactive lymphoid proliferation that may mimic lymphoma", Am J Surg Pathol, 32, pp.1075~1079 (2008)
- Kojima M, "Localized lymphoid hyperplasia of the rectum representing progressive transformation of the germinal center : a report of two cases", APMIS, 115, pp.1432~1436 (2007)
- Eire PF, "The rectal tonsil in children : a reactive lymphoid proliferation that may mimic a lymphoma", Indian J Gastroenterol, 30, pp.282~283 (2011)
- Homan M, "Rectal tonsil", J Pediatr Gastroenterol Nutr, 54, pp.575~ (2012)
- Grube-Pagola P, "Rectal tonsil associated with Epstein-Barr virus", Endoscopy, 44(Suppl 2 UCTN), pp.E388~E389 (2012)
- Kojima M, "Histological variety of localized lymphoid hyperplasia of the large intestine : histopathological, immunohistochemical and genotypic findings of 16 cases", J Clin Exp Hematop, 49, pp.15~21 (2009)
- de Lange KM, "Understanding inflammatory bowel disease via immunogenetics", J Autoimmun, 64, pp.91~100 (2015)
- Lok KH, "Epidemiology and clinical characteristics of ulcerative colitis in Chinese population : experience from a single center in Hong Kong", J Gastroenterol Hepatol, 23, pp.406~410 (2008)
- Ng SC, "Incidence and phenotype of inflammatory bowel disease based on results from the Asiapacific Crohn’s and colitis epidemiology study", Gastroenterology, 145, pp.158~165 (2013)
- Masanori Takehara, "Twin Rectal Tonsils Mimicking Carcinoid or Mucosa-Associated Lymphoid Tissue Lymphoma", Clinical Endoscopy, 50(5), pp.500~503 (2017), 대한소화기내시경학회