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Hyperplasie nodulaire lymphoïde du côlon: revue de la littérature à propos ďun cas observé chez ľadulte jeune

Nodular lymphoid hyperplasia of the colon: report of a case in a young adult and review of the literature

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Acta Endoscopica

Résumé

Nous rapportons ľobservation ďun homme de 23 ans hospitalisé pour rectorragies et présentant en colonoscopie de multiples formations nodulaires de petite taille étendues du rectum au côlon transverse. Les biopsies ont conclu à une hyperplasie nodulaire lymphoïde bénigne colique (HNLC). Ľexploration des autres segments du tube digestif ne montrait pas de telles anomalies; ľexploration de ľimmunité était normale et il n’existait pas de lambliase. ĽHNLC est classique chez ľenfant et parfois responsable de rectorragies. Chez ľadulte, sa fréquence est diversement appréciée selon le mode ďexploration, mais diminue avec ľâge. Ľaspect radiologique est celui de petites lacunes reposant sur une muqueuse normale et, en endoscopie, il s’agit souvent de petits nodules translucides. On peut dissocier cette affection en 3 cadres: a) ľHNLC isolée, exacerbation du nombre et de la taille des follicules normaux et prédominant sur le côlon droit; b) ľHNLC associée à une hyperplasie lymphoïde nodulaire du grêle avec parfois hypogammaglobulinémie et lambliase; c) et une forme caractérisée par la plus grande taille des nodules, de siège préférentiellement rectosigmoïdien et fréquemment associée ďemblée ou secondairement à une colite ulcéreuse. Ľabstention thérapeutique semble être la règle sous couvert ďune surveillance endoscopique.

Summary

The authors report the case of a 23-year-old man who complained of rectal bleeding; colonoscopy showed multiple tiny nodules extending from the rectum to the transverse colon. Biopsy established the diagnosis of colonic nodular lymphoid hyperplasia (CNLH). Examination of the whole gastro-intestinal tract did not reveal same features; there was no immunologic deficiency and no giardiasis. CNLH is common in childhood and may cause rectal bleeding. In adult its frequency depends on the diagnosis procedure (X-rays or colonoscopy) and decreases with age. Radiologic appearance is well known: multiple small nodular filling defects with normal overlying mucosa and endoscopy shows tiny and smooth nodules. We describe three clinical features: a) the most common CNLH corresponds to a number and size increase of normal follicles that are located on the right colon; b) CNLH associated with nodular lymphoid hyperplasia of the small bowel with sometimes hypogamma globulinemia and giardiasis; c) and the last clinical picture is characterized by a larger size of the follicles, a predominantly location in the rectosigmoid colon and a frequent association with ulcerative colitis. No treatment is to be recommended, but an endoscopic follow-up only.

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Authors and Affiliations

  1. Service ďHépato-Gastroentérologie, Centre Régional de Transfusion Sanguine. C.H.U. Pontchaillou, France

    J. L. Raoul, J. F. Bretagne, J. Lucas & J. Gastard

  2. Laboratoire ďAnatomie Pathologique, Centre Régional de Transfusion Sanguine. C.H.U. Pontchaillou, France

    M. P. Ramée

  3. Centre Régional de Transfusion Sanguine. C.H.U. Pontchaillou, Rennes, France

    N. Genetet

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  1. J. L. Raoul
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  4. J. Lucas
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  5. N. Genetet
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Raoul, J.L., Bretagne, J.F., Ramée, M.P. et al. Hyperplasie nodulaire lymphoïde du côlon: revue de la littérature à propos ďun cas observé chez ľadulte jeune. Acta Endosc 17, 211–216 (1987). https://doi.org/10.1007/BF02968813

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