Rectal tonsil: a rare cause of rectal bleeding

A rectal tonsil is a lymphoid follicular hyperplasia of the rectum and a rare cause of rectal bleeding. As it is a benign lesion of uncertain etiology [1] [2], treatment is reserved for symptomatic patients [2].

We present the case of a 21-year-old woman with normal bowel movements who presented with a history of rectal bleeding over a period of 4 months. Digital rectal examination revealed a rectal mass. Colonoscopy revealed circumferential granular involvement of the rectal mucosal surface ([Video 1]). Histology showed a dense lymphoid infiltrate and lymphatic follicles ([Fig. 1]).

Video 1 Colonoscopic appearance of a rectal tonsil before and after treatment with mesalazine.

Fig. 1 Rectal mucosa of a 21-year-old patient with a 4-month history of rectal bleeding. Lymphatic follicle with a prominent germinal center containing tingible body macrophages (H&E, × 10).

Infection [3] and lymphoma were excluded ([Fig. 2]) and a diagnosis of rectal tonsil was made [4]. Excellent clinical and endoscopic response was achieved after a 1-month course of rectal mesalazine administered twice daily ([Fig. 3]). Because the lesion is benign in nature, with transformation into lymphoma being the exception [4], treatment was discontinued. The patient continued asymptomatic at 3-month clinical follow-up.

Fig. 2 Rectal mucosa of the same patient. a Lymphatic follicle positive for CD20 (× 10); b lymphatic follicle with germinal center negative for Bcl2 ( × 10).

Fig. 3 Treatment with rectal mesalazine: appearance of the rectal mucosa before treatment (a) and after treatment (b).

Endoscopy_UCTN_Code_CCL_1AD_2AC

Competing interests

The authors declare that they have no conflict of interest.

Acknowledgments

We acknowledge Prof. Dr. Carolina Olano (Hospital de Clínicas Uruguay) for her dedication and support in the publication of this E-Video.

• References

• 1 Hong JB, Kim HW, Kang DH. et al. Rectal tonsil: A case report and literature review. World J Gastroenterol 2015; 21: 2563-2567
• 2 Trillo L, Arias M, Iglesias A. et al. Amígdala rectal o hiperplasia folicular linfoide del recto. Radiología 2014; 56: 370-373
• 3 Cramer SF, Romansky S, Hulbert B. et al. The rectal tonsil: a reaction to chlamydial infection?. Am J Surg Pathol 2009; 33: 483-485
• 4 Farris AB, Lauwers GY, Ferry JA. et al. The rectal tonsil: a reactive lymphoid proliferation that may mimic lymphoma. Am J Surg Pathol 2008; 32: 1075-1079

Publication History

Article published online:
12 May 2020