Resección mucosal endoscópica de hiperplasia linfoide reactiva de colon: Presentación de un caso / Endoscopic mucosal resection of reactive lymphoid hyperplasia of colon: One case presentation

La hiperplasia linfoide de colon es una patología gastrointestinal muy poco frecuente. Su tamaño y su forma macroscópica es variable. Se presenta un caso de hiperplasia linfoide reactiva en paciente femenina de 53 años de edad con aspecto macroscópico de una lesión polipoidea sésil tipo IIa ubicada en el ángulo hepático de colon la cual fue tratada con resección mucosal endoscópica. No había evidencia de lesión en otras áreas de la paciente y su evolución fue favorable.

Colon Lymphoid Hyperplasia is a rare gastrointestinal pathology. Its size and its macroscopic form is variable. We present a case of reactive Lymphoid Hyperplasia in a female patient of 53 years old with macroscopic appearance of a sessile polypoid lesion type IIa in the hepatic flexure of colon which was treated with Endoscopic mucosal resection. There was no evidence of the same pathology in other areas of the patient and the evolution of this patient has been favourable.

Utilidad de segunda biopsia de ganglio linfático con informe previo de hiperplasia linfoide reactiva en niños / Usefulness of second lymph node biopsy with a prior report of reactive lymphoid hyperplasia in pediatric patients

Introducción: En niños con ganglios linfáticos superficiales aumentados de tamaño se debe tener cuidado en definir quién requerirá biopsia. El objetivo de esta investigación fue analizar la utilidad de la biopsia de ganglio linfático superficial en el diagnóstico pediátrico. Métodos: De los informes histopatológicos de 364 biopsias de niños y adolescentes se consideró edad, sexo, tiempo de evolución de la adenomegalia, área anatómica, estudios de laboratorio y gabinete, y diagnósticos histopatológicos. Para el análisis estadístico se utilizaron pruebas estadísticas paramétricas y no paramétricas. Resultados: 211 pacientes masculinos (57.9 %) y 153 femeninos (42.0 %); el grupo entre uno y seis años representó 50.8 %, el tiempo promedio de evolución fue de cinco meses, el sitio anatómico predominante fue la región cervical. En 46.9 % se trató de hiperplasia linfoide reactiva seguida de neoplasias (24 %) y procesos granulomatosos (14.5 %); en 14.6 % se incluyeron infecciones diversas; en 95 pacientes con adenopatía en sitios de alarma, 29 eran oncológicos. El coeficiente de determinación de Spearman (R2 = 0.3485) indicó especificidad de patología en esas áreas, aunque la mayoría de los diagnósticos fue de ganglios en regiones diversas; prueba de Fisher con p < 0.0001. En 25 niños con hiperplasia linfoide reactiva en primer estudio, en segunda biopsia se estableció diagnóstico; la probabilidad binomial fue p = 0.0493, con 75 % de certeza y prueba de χ2 con p = 0.0512. Conclusiones: Los ganglios en regiones de alarma indican probabilidad para encontrar enfermedad; en crecimiento persistente con informe inicial de hiperplasia linfoide reactiva debe considerarse segunda biopsia pues existe probabilidad > 75 % de establecer la causa.

BACKGROUND: Physicians in daily practice frequently attend children who present an increase in lymph node size. Care should be taken to determine which children require biopsy. Our objective was to analyze the usefulness of the peripheral lymph node biopsy in pediatric diagnosis. METHODS: We reviewed histological reports of 364 lymph node biopsies. Variables were age, sex, lymphadenopathy evolution time, laboratory and imaging studies, and histopathology diagnoses. Parametric and nonparametric tests were used. RESULTS: There were 211 males (57.9 %) and 153 females (42.0 %), the 1- to 6-year age group included 50.8% of cases. Average disease-evolution time was 5 months, and the predominant anatomic site was the cervical region. Histological report was reactive lymphoid hyperplasia (RLH) in 46.9%, followed by neoplasms in (24%), and granulomas (14.5%). Other diagnoses and normal lymph nodes represented 14.6 %. Of the 95 patients with high-risk lymphadenopathy, 29 cases had oncological diagnoses. Spearman coefficient was R(2) = 0.3485. To obtain a specific diagnosis indicates the probability of disease in lymph nodes of risk areas. However, the majority of the diagnoses were obtained from lymph nodes in different areas (Fisher's test, p <0.001). In 25 children with RLH, the binominal probability of diagnosis in the second biopsy was p = 0.0493. There was a >75% chance for detecting disease. CONCLUSIONS: Peripheral lymph nodes in high-risk regions indicate probability relationship for determining disease. In persistent lymphadenopathy with an initial report of RLH, it is important to consider a second biopsy with high probability for obtaining a specific diagnosis.

A Case of Ocular Adnexal Benign Reactive Lymphoid Hyperplasia Recurred as Systemic Malignant Lymphoma

PURPOSE: We report a case of recurred systemic malignant lymphoma developed after the treatment for ocular adnexal benign reactive lymphoid hyperplasia. CASE SUMMARY: A 71-year-old female visited our hospital for right upper eyelid swelling and proptosis that had been progressing slowly for 4 years. Orbital computed tomography (CT) showed enlargement of the bellies of lateral and superior rectus muscles in the right orbit, but other abnormal findings were not detected in the systemic evaluation. Through incisional biopsy, benign reactive lymphoid hyperplasia was diagnosed on histopathologic examination. Upper eyelid swelling and proptosis resolved after radiation therapy. Fifty-one months after the treatment of benign reactive lymphoid hyperplasia, the patient visited our hospital again for a painful mass that had developed in the left neck. On neck CT, it showed enlargement of the left cervical lymph node and asymmetrical thickening of the left oropharyngeal wall. Systemic MALT lymphoma was confirmed, and radiation therapy was performed. According to neck CT, four months after radiation therapy, the enlargement and thickening resolved. CONCLUSIONS: Because there is a possibility of systemic malignant lymphoma after benign reactive lymphoid hyperplasia, continuous follow-up and repeated systemic evaluation should be required after treatment of ocular adnexal benign reactive lymphoid hyperplasia.

Orbital Lymphocytic Tumor Gradually Progressed to More Malignant Form during 4 Years

Primary lymphocytic tumor of the orbit is known as a relatively uncommon condition and difficult to diagnose in their types exactly even with microscopic examination. The authors experienced a reactive lymphoid hyperplasia patient, 42 years old male, which was progressed to atypical lymphoid hyperplasia during 4 years, confirmed by immunoperoxidase staining. In this case, steroid therapy was of no use and it shows resistance to combined chernotherapy.

Diagnosis of Idiopathic Inflammatory Pseudotumor of the Orbit

For an accurate diagnosis we analyzed 15 cases of clinically suspected idiopathic inflammatory pseudotumor(pseudotumor). The patients were 11 men and 4 women(mean age, 45.9 years). They were followed up for an average of 22 months. The final diagnosis was drawn collectively with clinical symptoms and signs, orbital computed tomography(CT), pathologic finding, and response to corticosteroids. In most instances the pathologic reading was reactive lymphoid hyperplasia(RLH). The final diagnosis was not constantly correlated with the pathologic reading; 5 were pseudotumor,6 RLH, and 4 undetermined. It could be concluded that the pseudotumor in the case which presented acute in flammatory symptoms and sings, involved the entire orbit in CT scan, or was cured by corticosteroid therapy. In the cases of no significant inflammatory sings it was difficult to differentiate pseudotumor from RLH with CT scan, pathologic finding, or response to corticosteroids. Although CT-guided fine needle biopsy often provides an insufficient specimen for pathologic diagnosis, it seems a useful diagnostic method, which is a simple and noninvasive technoque. At least the other orbital tumors or granulomatous lesions could be excluded by CT-guided fine needle biopsy.