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Nodular intestinal lymphoid hyperplasia, a rare entity. Surgical resection? Surveillance? a case report and a Literature Review

Pasquale Tammaro*, Maria Gaudiello, Alfredo D’Avino, Claudia Misso, Chiara Offi, Gianluca Benassai, Stefano Spiezia

The nodular intestinal lymphoid hyperplasia of the small bowel and colon is a rare condition characterized by the presence of one or multiple polypoid lesions. What is most important in the management of this disease is to understand whether or not to perform a surgical resection, which may be unnecessary. And this in light of the fact that there is no unanimous opinion on the carcinogenic potential of this lesion. The case presented by us concerns an ileocecal valve lesion, the preoperative characterization of which was not definitive. There are macroscopic and, above all, dimensional characteristics (during colonoscopy) that can help the clinician in the decision between surgery and conservative treatment. On the other hand, the precise pre-operative diagnosis is very complex. Therefore, taking charge remains difficult.

Our lesion was subjected to a surgical resection in the light of two considerations: 1) the suspicion of a syndromic nature of the pathology (the patient had two other rare lesions in anamnesis); 2) the fact that this lesion was enhancing on scintigraphy, together with the neighboring lymph nodes. The decision to perform a resection (for diagnostic purposes and in the suspicion of an underlying malignant lesion) should not be considered a mistake. In the absence of robust literature on the subject, the type of treatment must be chosen according to each individual case.