P1492 - A Rare Case of Intramucosal Neuroma

Umair Chishti, MD¹, Sultan Mahmood, MD², Muhammad Tahir, MD², Misbah Safdar, MD^3
1Bayhealth Hospital, Dover, DE; ²University at Buffalo Gastroenterology, Buffalo, NY; ³Nishtar Medical University, Dover, Punjab, Pakistan

Introduction: Mucosal Neuromas are rarely found in the colon. They appear as ill-defined polyps and are made of hyperplastic nerve fibers arranged irregularly. We present a rare case of intramucosal neuroma with isolated involvement of the transverse colon which is extremely rare.

Case Description/Methods: A 55 years old African American female with a past medical history of Diabetes Mellitus presented for the average risk screening colonoscopy. The patient denied any previous screening procedures. Also denied any high-risk signs and symptoms including weight loss, hematochezia, altered bowel habits. The patient did not have any personal or family history of malignancy. The patient underwent her colonoscopy and was found to have one 8mm polyp in the transverse colon which was removed using a cold snare polypectomy. The rest of the examination looked well including the retroflexion. The pathology results showed intramucosal colonic neuroma. The results were reviewed with the pathologist and discussed with the patient with conservative follow-up.






Discussion: Benign tumors of the nerve sheath are common in skin and soft tissues although involvement of the gastrointestinal tract is very rare. Neural masses in the colon can present as masses such as schwannomas or small colorectal polyp. These polyps include neuroma, granular cell tumor and ganglioneuromas. In recent years, intramucosal neural proliferation is also seen in the colon and appears as polyps at the time of endoscopy. These lesions lack ganglion cells and are referred to as neuromas although the presence of ganglion cells is characteristic for ganglioneuroma. However, these polyps are not known to be associated with NF1 or other inherited syndromes. (1) It is important to differentiate neuromas from GIST, which has characteristic immunoreactivity to C-Kit and CD-117. Our patient was found to be positive for S-100 protein and CD-117 negative.




Below Table 1 is a brief literature review of unusual polyps found in the colon.




1. JA. Gibson et. al, Mucosal Schwann Cell Hamartoma Clinicopathologic Study. 2009.




Figure: Figure 1 and 2

Polyp Type	Common site	Immunoreactivity and Clinical features
Mucosal Neuroma	Lips and Tongue, rarely GI tract	Associated with MEN 2B
GIST	Small Intestine and Stomach	S100 Positive, C-KIT, CD 177, Malignant
MSCH	Colorectal	S100 Positive, Benign
Schwannoma	Stomach	S100 Positive
Neurofibroma	Stomach and Small Intestine	S100 variable, Characteristic of NF-1
Ganglioneuroma	Colon and Rectum	S100 positive, Linked to NF-1 and Cowden Syndrome

Table: Table 1, GIST: Gastrointestinal Stromal Tumor, MEN-2B: Multiple Endocrine Neoplasia-2, NF-1: Neurofibromatosis 1, MSCH: Mucosal Schwann Cell Hamartoma


Disclosures:
Umair Chishti indicated no relevant financial relationships.
Sultan Mahmood indicated no relevant financial relationships.
Muhammad Tahir indicated no relevant financial relationships.
Misbah Safdar indicated no relevant financial relationships.


Umair Chishti, MD¹, Sultan Mahmood, MD², Muhammad Tahir, MD², Misbah Safdar, MD³. P1492 - A Rare Case of Intramucosal Neuroma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.