Benign or Malignant? Rectal Lymphoid Polyp, Report of a Case Taiji Akamatsu 1 , Tadashi shirai 1 , Kotaro Yamaguchi 1 , seiichi Furuta 1 , Tsutomu Katsuyama 2 1The Second Department of Internal Medicine, Shinshu University, School of Medicine 2Central Clinical Laboratories Shinshu Univertsity Hospital pp.313-319
Published Date 1986/3/25
DOI https://doi.org/10.11477/mf.1403110163
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 A 68 year-old woman was admitted to Shinshu University Hospital complaining of bloody stool in August 1982. Digital examination revealed a walnutsized tumor on the posterior wall of the rectum. Barium enema study showed a hemispherical, partially lobulated, protruded lesion with a smooth surface measuring approximately 40×30mm in width and 18mm in height. Endoscopically the tumor was covered by apparently nomal rectal mucosa with a shallow erosion in its vertex. These findings led to a clinical diagnosis of submucosal tumor in the rectum. Biopsy specimens revealed that the mucosa was slightly atrophic, but the lamina propria showed a marked infiltration by lymphocytic cells. The pathological diagnosis was “benign inflammatory polyp”. To obtain materials sufficient for making a conclusive pathological diagnosis, endoscopic partial resection was carried out by employing high-frequency waves. The histological findings, however, were essentially similar to those of the former specimens. A local excision was performed in January 1983.

 The tumor had a broad base and artificial ulceration. Histologically, it was covered by atrophic rectal mucosa except for the partial ulceration. Lymphocytes and plasma cells infiltrated estensively to the lamina propria and submucosa. Furthermore, lymphocytic cells massively infiltrated to the muscularis propria as well as to the adventitial region. The lymph follicle was sparsely presented. The infiltrating lymphocytic cells were relatively mature and mitotic figures were absent except in a geminal center.

 Largeness and massive infiltration of the muscularis propria were controversial points in diagnosing whether, in this case, the tumor was a benign lymphoid polyp or malignant lymphoma. There were various discussions about the distinction between benign lymhoid polyp and malignantl ymphoma.

 The patient is still alive and well three years after surgery.

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