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Órgano Oficial del Instituto Nacional de Pediatría

2020, Number 5

Acta Pediatr Mex 2020; 41 (5)

Nodular lymphoid hyperplasia of the colon: a normal finding or an underestimated pathological condition?

Cadena-León JF, Sempértegui-Cárdenas PX, Ignorosa-Arellano KR, Toro-Monjaráz EM, Zárate-Mondragón FE, Cervantes-Bustamante R, Ramírez-Mayans JA

Language: Spanish
References: 55
Page: 215-221
PDF size: 216.68 Kb.


ABSTRACT

Nodular lymphoid hyperplasia (NLH) is defined as a cluster of ›10 extruding lymphoid nodules, for a long time this finding was considered normal in children, however it has been a commonly reported finding in patients with chronic abdominal pain, refractory constipation, unexplained anemia, digestive bleeding, chronic diarrhea and growth retardation. There is increasing evidence that associates with pathologies such as Helicobacter pylori infection, giardiasis, oxyuriasis, infectious colitis by amoeba or E.
coli; immunodeficiencies such as: common variable immunodeficiency, IgA deficiency, hypogammaglobulinemia, HIV; food allergy; inflammatory bowel disease and irritable bowel syndrome among others. NLH is diagnosed when the following histological criteria are observed: hyperplasic lymphoid follicles, mitotically active germinal centers with well-defined lymphocytes mantles, and lymphoid follicles localized in the mucosa or submucosa. The treatment is aimed at the underlying cause although this is not always possible to establish, so studies have been conducted with the use of empirical treatments based on elimination diets and salicylates. There is evidence of the risk of malignant transformation, which is why some authors consider carrying out serial studies although the duration and intervals between them have not been well defined. It is important that the health professional knows the guiding endoscopic findings of lymphoid nodular hyperplasia, their most related gastrointestinal symptoms, the etiologies in which can occur, and the recognized potential of malignization to provide a better diagnosis and, thereof, the treatment in the paediatric patient. The objective of this article is to provide current information regarding its definition, epidemiology, etiology, clinical manifestations, diagnosis and treatment.


REFERENCES

  1. Troncone R, Discepolo V. Colon in food allergy. J Pediatr Gastroenterol Nutr. 2009; 48(2):89-91. doi. 10.1097/ MPG.0b013e3181a15d1a

  2. Kuper C. Histopathology of mucosa associated lymphoid tissue. 2006; 34: 609-615. doi. 10.1080/01926230600867735

  3. Kunisawa J, et al. Mucosa-associated lymphoid tissues in the aerodigestive tract: their shared and divergent traits and their importance to the orchestration of the mucosal immune system. Curr Mol Med. 2005; 5:557-572. doi. 10.2174/1566524054863924

  4. Gurkan O, et al. Colonic lymphoid nodular hyperplasia in childhood: causes of familial Mediterranean fever need extra attention. J Pediatr Gastroenterol Nutr. 2013; 57: 817-21.

  5. Mansueto P, et al. Review article: intestinal lymphoid nodular hyperplasia in children – the relationship to food hypersensitivity. Aliment Pharmacol Ther. 2012; 35: 1000-9. doi: 10.1111/j.1365-2036.2012.05062.x.

  6. Zahmatkeshan M, et al. Etiology of lower gastrointestinal bleeding in children: a single center experience from southern Iran. Middle East J Dig Dis. 2012; 4 (4): 216-23.

  7. Tătăranu E, et al. Clinical, immunological and pathological profile of infants suffering from cow’s milk protein allergy. Rom J Morphol Embryol 2016; 57 (3): 1031-5.

  8. Albuquerque A. Nodular lymphoid hyperplasia in the gastrointestinal tract colon in adults: is it common? 1990; 36: 421-422. doi. 10.1016/s0016-5107(90)71092-9

  9. Silverio C, et al. Diagnósticos colonoscópicos más frecuentes en pediatría. Rev Cubana Pediatr. 2001; 73 (1): 28-33.

  10. Sempértegui P, et al. Validez diagnóstica de hallazgos colonoscópicos en hiperplasia nodular linfoide en niños. Revista de Gastroenterología de México 2019; 84 (Supl 2): 62-3.

  11. Iacono G, et al. Colonic lymphoid nodular hyperplasia in children: relationship to food hypersensitivity. Clin Gastroenterol Hepatol. 2007; 5: 361-66. https://doi. org/10.1016/j.cgh.2006.12.010

  12. Colon A, et al. Intestinal lymphonodular hyperplasia of childhood: patterns of presentation. J Clin Gastroenterol. 1991; 13: 163-66. doi. 10.1097/00004836-199104000-00009

  13. Ajdukiewicz A, et al. Nodular lymphoid hyperplasia with hypogammaglobulinaemia. Gut. 1972; 13: 589-595. doi. 10.1136/gut.13.8.589

  14. Hermans P, et al. Idiopathic late-onset immunoglobulin deficiency. Clinical observations in 50 patients. Am J Med. 1976; 61: 221-237. doi. 10.1016/0002-9343(76)90173-x

  15. Lai Ping SA, Mayer L. Gastrointestinal manifestations of primary immunodeficiency disorders. Semin Gastrointest Dis. 1997; 8: 22-32.

  16. Bästlein C, et al. Common variable immunodeficiency syndrome and nodular lymphoid hyperplasia in the small intestine. Endoscopy. 1988; 20: 272-75. doi. 10.1055/s2007-1018192

  17. Postgate A, et al. An unusual cause of diarrhea: diffuse intestinal nodular lymphoid hyperplasia in association with selective immunoglobulin A deficiency. Gastrointest Endosc. 2009; 70: 168-79. doi. 10.1016/j.gie.2009.03.004

  18. Joo M, et al. Nodular lymphoid hyperplasia and histologic changes mimicking celiac disease, collagenous sprue, and lymphocytic colitis in a patient with selective IgA deficiency. Pathol Res Pract. 2009; 205: 876-80. doi. 10.1016/j.prp.2009.02.005

  19. Webster A, et al. Nodular lymphoid hyperplasia of the bowel in primary hypogammaglobulinaemia: study of in vivo and in vitro lymphocyte function. Gut. 1977; 18: 364- 72. doi. 10.1136/gut.18.5.364

  20. Levendoglu H, Rosen Y. Nodular lymphoid hyperplasia of gut in HIV infection. Am J Gastroenterol. 1992; 87: 1200-2.

  21. Rubio A, et al. Clinical characteristics of a group of adults with nodular lymphoid hyperplasia: a single center experience. World J Gastroenterol. 2006; 12: 1945-48. doi. 10.3748/wjg.v12.i12.1945

  22. Canto J, et al. Nodular lymphoid hyperplasia of the intestine. Clinic-pathologic characteristics in 11 cases. Rev Invest Clin. 1990; 42: 198-203.

  23. Olmez S, et al. Diffuse nodular lymphoid hyperplasia of the small bowel associated with common variable immunodeficiency and giardiasis. Wien Klin Wochenschr. 2014; 126: 294-97. doi. 10.1007/s00508-014-0525-5

  24. Onbasi K, et al. Common variable immunodeficiency (CVID) presenting with malabsorption due to giardiasis. Turk J Gastroenterol. 2005; 16: 111-13.

  25. Baran B, et al. Nodular lymphoid hyperplasia of duodenum caused by giardiasis. Clin Gastroenterol Hepatol. 2013; 11: A22. doi. 10.1016/j.cgh.2012.12.019.

  26. Ward H, et al. Small intestinal nodular lymphoid hyperplasia in patients with giardiasis and normal serum immunoglobulins. Gut. 1983; 24: 120-6. doi. 10.1136/gut.24.2.120

  27. Hermans P, et al. Dysgammaglobulinemia associated with nodular lymphoid hyperplasia of the small intestine. Am J Med. 1966; 40: 78-89. doi. 10.1016/0002-9343(66)90189-6

  28. 28. Vestergaard H, et al. Association between intussusception and tonsil disease in childhood. Epidemiology. 2008; 19: 71-74. doi. 10.1097/EDE.0b013e31815c1dd3

  29. Coulibaly B, et al. Benign lymphoid polyposis: two diffuse cases leading to fatal intestinal ischemia in children. Pediatr Int. 2009; 51: 428-31. doi. 10.1111/j.1442- 200X.2009.02824.x

  30. Wakefield A, et al. The significance of ileocolonic lymphoid nodular hyperplasia in children with autistic spectrum disorder. Eur J Gastroenterol Hepatol. 2005; 17: 827-36.

  31. MacDonald T. The significance of ileocolonic lymphoid nodular hyperplasia in children with autistic spectrum disorder. Eur J Gastroenterol Hepatol. 2006; 18: 569-71.

  32. Jass J. The intestinal lesion of autistic spectrum disorder. Eur J Gastroenterol Hepatol. 2005; 1: 821-22.

  33. Schwart D, et al. Diffuse nodular lymphoid hyperplasia of the colon: polyposis syndrome or normal variant? Gastrointest Endosc. 2003; 58: 630-32. doi. 10.1067/ S0016-5107(03)01969-2

  34. Smith M, Blackstone M. Colonic lymphoid nodules: another cause of the red ring sign. Gastrointest Endosc. 1991; 37: 206-8. doi. 10.1016/S0016-5107(91)70692-5

  35. Straub R, et al. Variable endoscopic appearance of colonic lymphoid tissue. J Clin Gastroenterol. 1994; 19: 158-64. doi. 10.1097/00004836-199409000-00018

  36. Molaei M, et al. Nodular lymphoid hyperplasia in common variable immunodeficiency syndrome mimicking familial adenomatous polyposis on endoscopy. Indian J Pathol Microbiol. 2009; 52: 530-33. doi. 10.4103/0377-4929.56152

  37. Bayraktar Y, et al. The findings of capsule endoscopy in patients with common variable immunodeficiency syndrome. Hepatogastroenterlogy. 2007; 54: 1034-37.

  38. Shiff A, et al. Nodular lymphoid hyperplasia in a defunctionalized colon. Gastrointest Endosc. 1973; 19: 144-45. doi. 10.1016/s0016-5107(73)73985-7

  39. Leonidas J, et al. Roentgen appearance of the excluded colon after colostomy for infantile Hirschsprung’s disease. Am J Roentgenol Radium Ther Nucl Med. 1971; 112: 116-22.

  40. Rambaud J, et al. Diffuse follicular lymphoid hyperplasia of the small intestine without primary immunoglobulin deficiency. Am J Med. 1982; 73 (1): 125-32. doi. 10.1016/0002- 9343(82)90938-x

  41. Washington K, et al. Gastrointestinal pathology in patients with common variable immunodeficiency and X-linked agammaglobulinemia. Am J Surg Pathol. 1996; 20: 1240-52. doi. 10.1097/00000478-199610000-00010

  42. Albuquerque A. Nodular lymphoid hyperplasia in the gastrointestinal tract in adult patients: A review. World J Gastrointest Endosc 2014; 6 (11): 534-40 doi. 10.4253/ wjge.v6.i11.534

  43. Bharadhwaj G, Triadafilopoulos G. Endoscopic appearances of colonic lymphoid nodules: new faces of an old histopathological entity. Am J Gastroenterol. 1995; 90: 946-950.

  44. Laufer I, deSA D. Lymphoid follicular pattern: a normal feature of the pediatric colon. American Journal of Roentgenology. 1978; 130: 51-55. doi. 10.2214/ajr.130.1.51

  45. Tomita S, et al. Diffuse nodular lymphoid hyperplasia of the large bowel without hypogammaglobulinemia or malabsorption syndrome: a case report and literature review. Int J Surg Pathol. 2002; 10: 297-302. doi. 10.1177/106689690201000411

  46. Ranchod M, et al. Lymphoid hyperplasia of the gastrointestinal tract. A study of 26 cases and review of the literature. Am J Surg Pathol. 1978; 2: 383-400. doi: 10.1097/00000478-197812000-00005

  47. Luzi G, et al. Duodenal pathology and clinicalimmunological implications in common variable immunodeficiency patients. Am J Gastroenterol. 2003; 98: 118-21. doi: 10.1111/j.1572-0241.2003.07159.x

  48. Ament M, Rubin C. Relation of giardiasis to abnormal intestinal structure and function in gastrointestinal immunodeficiency syndromes. Gastroenterology. 1972; 62: 216-26.

  49. Chiaramonte C, Glick S. Nodular lymphoid hyperplasia of the small bowel complicated by jejunal lymphoma in a patient with common variable immune deficiency syndrome. AJR Am J Roentgenol. 1994; 163: 1118-19. doi: 10.2214/ ajr.163.5.7976886

  50. Ryan J. Premalignant conditions of the small intestine. Semin Gastrointest Dis. 1996; 7: 88-93.

  51. 51. Schaefer P, Friedman A. Nodular lymphoid hyperplasia of the small intestine with Burkitt’s lymphoma and dysgammaglobulinemia. Gastrointest Radiol. 1981; 6: 325-328. doi.10.1007/BF01890278.

  52. Monsanto P, et al. Intestinal nodular lymphoid hyperplasia and extraintestinal lymphoma a rare association. Acta Gastroenterol Belg. 2012; 75: 260-62.

  53. Jonsson O, et al. Resolution of nodular lymphoid hyperplasia of the gastrointestinal tract following chemotherapy for extraintestinal lymphoma. Dig Dis Sci. 2002; 47: 2463-65. doi. 10.1023/a:1020547723325

  54. Rubio C. Nonprotruding colorectal neoplasms: epidemiologic viewpoint. World J Surg. 2000; 24: 1098-1105. doi. 10.1007/s002680010147

  55. Lucarelli S, et al. Intestinal lymphoid nodular hyperplasia in children: the relationship to food allergy. Pediatr Allergy Immunol. 2015; 26 (1): 18-24. doi 10.1111/pai.12328.




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