直肠良性淋巴滤泡性息肉15例的临床及内镜下表现分析

Clinical and endoscopic characteristics of 15 cases of rectal benign lymphoid polyps

摘要:

为了探讨直肠良性淋巴滤泡性息肉患者的临床症状以及病灶的内镜下表现，对2015年4月至2023年6月于山东第一医科大学第一附属医院内镜中心行内镜切除且术后病理确诊直肠良性淋巴滤泡性息肉的15例连续病例（16处病灶）进行了回顾性分析。结果显示：15例患者中，男6例、女9例，平均年龄52.6岁，8例因有临床症状行肠镜检查，其中7例为腹痛；16处病变均为黏膜下病变，单发14例、多发1例，直肠下段10处、中段6处，平均长径0.5 cm，14处呈规则的扁圆或半球形，11处表面黏膜颜色正常或灰白，8处表面见不同程度的毛细血管扩张，其中2处呈放射状扩张类似“车轴”样；10处病变内镜切除术前行超声内镜检查，其中4处起源于第3层，起源于第2层和第2+3层各3处，5处表现为均质的低回声光团，3处呈高回声，2处为混和回声。初步提示：直肠良性淋巴滤泡性息肉患者临床症状表现不特异，内镜下病灶表面可见“车轴”样扩张毛细血管，超声内镜下呈高回声或混和回声时可作为与直肠神经内分泌肿瘤鉴别的诊断依据。

Abstract:

To investigate the clinical symptoms and endoscopic features of rectal benign lymphoid polyps, a retrospective analysis was conducted on 15 consecutive cases (16 lesions) who underwent endoscopic resection at the First Affiliated Hospital of Shandong First Medical University between April 2015 and June 2023, with postoperative pathological confirmation of rectal benign lymphoid polyps. The results showed that among the 15 patients, 6 were male and 9 were female, with a mean age of 52.6 years. Colonoscopy was performed in 8 patients due to clinical symptoms, among whom 7 presented with abdominal pain. All 16 lesions were submucosal, including 14 solitary and 1 multiple. The lesions were located in the lower rectum (n=10) and mid-rectum (n=6), with a mean long diameter of 0.5 cm. Fourteen lesions exhibited regular shape as flat circles or hemispheres. The surface mucosa appeared normal or gray-white in 11 lesions, and varying degrees of capillary dilation were observed in 8 lesions, among which 2 exhibited prominent capillaries resembling a "wheel-shaped" pattern. Endoscopic ultrasonography (EUS) was performed in 10 lesions prior to endoscopic resection: 4 originated from the third layer, 3 from the second layer, and 3 from both the second and third layers. Five lesions appeared as homogeneous hypoechoic masses, 3 were hyperechoic, and 2 showed mixed echogenicity. Therefore, the clinical symptoms of rectal benign lymphoid polyps are non-specific. Endoscopically, the presence of "wheel-shaped" pattern of dilated capillaries may serve as a diagnostic clue. When EUS demonstrates hyperechoic or mixed echogenicity, it could aid in the differential diagnosis from rectal neuroendocrine neoplasms.