Background: "Rectal Tonsil" (RT) is a term used to describe prominent and localized lymphoid hyperplasia in the rectum. It is a rare phenomenon with unknown etiology, described only in a few cases, most of them include solitary polyp, and commonly present as rectal bleeding. The histological features include a lymphoid infiltrate in the lamina propria and submucosa, characterized by follicles with well-formed germinal centers.
Our case report demonstrates multiple rectal polyps in a young girl with rectal bleeding.
Case Report: A 4.5-year-old girl presents with a history of rectal bleeding for the past few months. Rectal examination revealed several sessile masses in the distal rectum. Ileo-Colonoscopy revealed 10 polyps, 0.5 cm to 2.5 cm in diameter, all in proximity to the anus up to 10 cm. Six polyps were removed and sent to pathological investigation.
The polyps were described as lymphoid polyps of the rectum, showing closely packed large hyperplastic follicles with germinal centers rich in tangible body macrophages. The follicles occupy the mucosa and submucosa. Immunohistology suggested lymphoid follicles.
A second colonoscopy revealed 4 mucosal nodules but no polyps. The nodules showed the same microscopic and histologic picture as the previous polyps.
Discussion: Rectal Tonsil (RT), is a benign, rare condition but should be distinguished from malignant lymphoma to prevent misdiagnosis and overtreatment. Some reports associated RT to Epstein-Barr virus. In this case multiple polyps were found and spontaneous regression of several polyps was demonstrated on a second colonoscopy.
Further investigation is required to determine Rectal Tonsil`s course, significance and etiology.
