S2220 A Rare Case of Intramucosal Neuroma

Abstract

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. Table 1 is a brief literature review of unusual polyps found in the colon.Table 1.: GIST: Gastrointestinal Stromal Tumor, MEN-2B: Multiple Endocrine Neoplasia-2, NF-1: Neurofibromatosis 1, MSCH: Mucosal Schwann Cell HamartomaFigure 1.: Demonstration video: please scan the QR code with your mobile phone camera and click the link.