A rare case of gastrointestinal bleeding: colonic ganglioneuroma

Ganglioneurosmas are hamartomatous tumors derived from the autonomic nervous system. Gastrointestinal tract proliferation of ganglioneuromas are uncommon, primarily occurring in the colon. It is estimated that there are fewer than 100 cases reported in the literature. Patients with solitary ganglioneuromas are often asymptomatic, but can present symptoms as constipation, abdominal pain, weight loss, obstruction or bleeding. Treatment involves endoscopic resection.

A 54-year-old woman with no significant medical history presents with a 2-hour history of rectal bleeding without associated abdominal pain and one episode of syncope. Upon arrival at the emergency department the patient is hypotensive with a hemoglobin level of 8,4 g/dL. After stabilizing and preparing the patient for a colonoscopy, the rectal bleeding resolves on its own.

During the colonoscopy, a subepithelial lesion approximately 18 mm in diameter is identified in the right colon, highlighting a central depressed area with irregular calibre and distribution of vessels. Then the patient is referred to an expert center. There, after reviewing the lesion and noting a pattern that could be suspicious for neoplasia with submucosal invasion, a full-thickness resection is performed [1] [2] [3] [4] [5].

The histology shows a benign mesenchymal proliferation with occasional ganglion cells without atypia and immunoreactivity to S100 protein. Being compatible with a colonic ganglioneuroma

There is no consensus regarding endoscopic follow-up, as there is a lack of data on the association of polypoid ganglioneuroma and colon cancer; besides these lesions tend not to recur.

Whereas ganglioneuromatous polyposis and diffuse ganglioneuromatosis may be associated with hereditary diseases (neurofibromatosis, multiple endocrine neoplasia 2B syndrome, and Cowden disease), solitaries polypoid ganglioneuromas are not typically associated with genetic syndromes.

• References

• 1 Agarwal S, Wang Y, Iyer PG, Leggett CL.. Incidental colonic ganglioneuroma on surveillance colonoscopy. ACG Case Rep J. 2022; 9 (1): e00727
• 2 Chan OTM, Haghighi P.. Hamartomatous polyps of the colon: ganglioneuromatous, stromal, and lipomatous. Arch Pathol Lab Med 2006; 130: 1561-6
• 3 Araia T, Yamada H, Edagawa T, Yoshida S, Maekura S, Nakachi K.. Endoscopic treatment of solitary colonic ganglioneuroma. Case reports in Gastroenterology 2020; 14: 34-38
• 4 Nehme C, Ghazaleh S, Patel D. et al. Incidental Ascending Colon Ganglioneuroma in the Setting of Hematochezia. Cureus 2020; 12 (7): e9447
• 5 Bahmad H.F., Trinh S., Qian L., Terp K., Alloush F., Elajami M.K., Kilinc E., Poppiti R.. Colonic Ganglioneuroma: A Combined Single-Institution Experience and Review of the Literature of Forty-Three Patients. Diseases 2023; 11: 69