MetroHealth Medical Center Cleveland, OH, United States
Sara Kamionkowski, DO, Sophie Trujillo, DO, Neethi Paranji, MD, Fnu Raja, MD, Taha Keskin, MD, Nisheet Waghray, MD MetroHealth Medical Center, Cleveland, OH
Introduction: Ganglioneuromas are rare tumors of the gastrointestinal (GI) tract. There are only about 50 cases of ganglioneuromas described in the colon. The clinical implications of colonic ganglioneuroma, risk of malignancy, and the need for colonoscopic surveillance remains unclear. We describe two cases of colonic ganglioneuromas with review of literature.
Case Description/Methods: Case 1 A 60-year-old female with a history of Turner’s syndrome presented for colonoscopy after a positive fecal immunochemical test. She denied any GI symptoms. Colonoscopy demonstrated a 4mm cecal polyp, one 8mm descending colon polyp, and a 6mm rectal polyp. Histopathology of the cecal polyp was consistent with a polypoid ganglioneuroma (Figure 1a and 1b), while the remaining polyps were adenomatous.
Case 2 A 49-year-old female with a history of breast and endometrial cancer presented for screening colonoscopy. She denied GI symptoms as well as family history of GI malignancy. Colonoscopy revealed a 2mm hepatic flexure polyp, a 6mm transverse colon polyp, and a sessile 2.5cm sigmoid colon polyp. Histopathology of the hepatic flexure and transverse colon polyps were consistent with ganglioneuroma (Figure 1c and 1d), while the sigmoid colon polyp was reported as a tubular-villous adenoma.
Discussion: Ganglioneuromas are benign tumors of undifferentiated neural crest cells often found in the retroperitoneum or posterior mediastinum. These tumors have a a predilection for the head, neck and adrenal glands. Ganglioneuromas are classified into three variants: polypoid ganglioneuromas, ganglioneuromatous polyposis, and diffuse ganglioneuromatosis. Polypoid ganglioneurmoas are the most common type of GI ganglioneuromas. They are small lesions measuring less than 2 cm and may be sessile or pedunculated. Histologically, the epithelium will show neural hyperplasia with collections of spindle ganglion cells, and may involve the lamina propria or extend transmurally. Polypoid ganglioneuromas are not associated with genetic disorders. Ganglioneuromatous polyposis has been associated with familial adenomatous polyposis, multiple endocrine neoplasia IIb, Cowden syndrome, and tuberous sclerosis. No guidelines exist on the management of ganglioneuromas. Treatment of colonic ganglioneuromas is based on the size, location, and associated complications. Our patients were treated with endoscopic resection with follow up based on current colorectal surveillance guidelines.
Figure: Figure 1: Clusters of ganglion cells and spindle cells in lamina propria; 200x magnification, H&E stain (A). Lamina propria expanded by eosinophilic spindle cells and stroma that separate the colonic crypts; 400x magnification, H&E stain (B). Representative of colon with ganglioneuroma with multiple fragments of colonic mucosa; 2x magnification, H&E stain (C). Colonic mucosa with luminal side simple columnar epithelium (black arrow), lamina propria, crypt glands (blue arrow), ganglion cells (red arrow), and stromal spindle cell proliferation; 20x magnification, H&E stain (D).
Disclosures: Sara Kamionkowski indicated no relevant financial relationships. Sophie Trujillo indicated no relevant financial relationships. Neethi Paranji indicated no relevant financial relationships. Fnu Raja indicated no relevant financial relationships. Taha Keskin indicated no relevant financial relationships. Nisheet Waghray indicated no relevant financial relationships.
Sara Kamionkowski, DO, Sophie Trujillo, DO, Neethi Paranji, MD, Fnu Raja, MD, Taha Keskin, MD, Nisheet Waghray, MD. P2264 - Colonic Ganglioneuromas Found on Surveillance Colonoscopies in Two Asymptomatic Women, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.