1460 An Unusual Histopathology of Colonic Polyps

Abstract

INTRODUCTION: Sarcoidosis is a multi-system disorder most commonly known to involve lungs, eyes, skin and joints. Colonic involvement either in isolation or as a part of systemic disease has been reported in less than 20 cases. Here, we describe a patient who presented with abdominal pain, constipation, and weight loss and was found to have colonic sarcoidosis. CASE DESCRIPTION/METHODS: A 38-year-old woman presented with chronic left lower quadrant abdominal pain, constipation, and unintentional weight loss for a few months. Her past medical history significant for treated latent tuberculosis and uterine fibroids. She denied fever, diarrhea, melena or hematochezia. Physical exam revealed tenderness in the left lower quadrant and periumbilical region. Laboratory work up showed hemoglobin of 9.6 (11.7-14.9 g/dL). Her ACE levels were elevated at 120 (8-52 U/L). Chest xray showed scattered pulmonary nodules and bilateral hilar lymphadenopathy. CT scan demonstrated extensive porta hepatis, mesenteric, portocaval, retroperitoneal, and inguinal lymphadenopathy. Biopsy of inguinal lymph node showed granulomatous lymphadenitis but no malignancy. Acid fast bacilli and fungal stains were both negative. Further, colonoscopy revealed multiple sessile polyps in descending colon ranging between 2-8 mm (Figure 1), removed with excisional biopsy. Biopsy from the colon polyps revealed numerous non-caseating granulomas (Figure 2). She was diagnosed with multi-system symptomatic sarcoidosis and was started on prednisone with improvement of her symptoms. DISCUSSION: Gastrointestinal tract involvement by sarcoidosis is seen in less than 1% of cases, with stomach being the most commonly affected organ. Colonic sarcoidosis is extremely rare and has variable clinical presentation but abdominal pain is most commonly described. Endoscopic appearance is very nonspecific and includes polyps, mass like lesions, erosions, ulcers and focal nodularity. Diagnosis requires demonstration of non necrotizing granulomas in the involved organ, evidence of sarcoidosis in at least one other organ system and exclusion of other granulomatous disorders such as tuberculosis, fungal infections, inflammatory bowel disease and malignancy. While no therapy is warranted for inactive disease, steroids are the initial treatment of choice in symptomatic patients.