Gastrointestinal lymphoid pseudotumoral hyperplasia: report of four pediatric cases.

(l" Table 1, l" Fig. 1 ± 3) with lymphoid pseudotumoral hyperplasia (LPH), two with an atypical localization (diffuse dis− ease). The lesion diameters varied from 7 to 30 mm. In our patients, the treatment was: con− servative (patient 1), surgery (patient 2), corticosteroids (patient 3), and a milk− free diet (patient 4). Complete remission of lesions and/or clinical improvement were seen in all cases. In the three clini− cally managed cases, there were no changes during the follow−up (6 years for patient 2, 4 years for patient 3, and 6 months for patient 4). Lymphoid nodular hyperplasia (LNH) is a common, nonpathologic finding in chil− dren [1]. The ileum and colon are com− monly affected [1,2]. An atypical form is the pseudotumoral presentation, defined as a tumoral presentation of LNH asso− ciated with inflammatory mesenteric lymph nodes [1,2]. The imperative differ− ential diagnosis is low−grade lymphoma. In such cases, a diagnosis of malignancy is based on morphologic and immuno− phenotypic (histologic) features with mo− lecular evidence of clonality [3]. LPH and LNH are similar, differing only in their endoscopic appearance. LNH ap− pears as micronodules 1 ±2 mm in size, of a whitish−rose color, surrounded by nor− mal mucosa [1]. In LPH, the micronodular endoscopic appearance is absent, giving a misleading picture of tumor [2] ± as was observed in our cases. It is very important to take a large number of biopsies (some− times macrobiopsies) to establish the di− agnosis [2, 4]. The physiopathology is not completely understood, but probably re− flects an unspecific exacerbated lymphoid response to various stimuli (e. g., infec− tions, allergies, immunodeficiency, auto− immunity) [1, 2], which were identified in three−quarters of our patients. There is no consensus about treatment, which is reserved for patients with severe symptoms. Treatments include surgery and hydrostatic barium enema (in the case of intestinal obstruction or intussus− ception), or the use of corticosteroids (with previous histologic confirmation of LPH) [2,5]. Due to its rarity, the natural history, and the increased risk of malig− nant transformation, many aspects such as clinical and endoscopic features and treatment follow−up remain uncertain. Endoscopy_UCTN_Code_CCL_1AD_2AC