An isolated colonic neurofibroma

A 52-year-old male with a past medical history of hypertension presented with a two-week history of mild right lower quadrant abdominal pain. He denied chronic nonsteroid anti-infl ammatory drug use, alcohol or tobacco abuse. No skin lesions or any areas of hypo/hyperpigmentation were noted. Abdominal exam revealed mild tenderness in the right lower quadrant. Laboratory data including serum sodium, potassium, creatinine and blood urea nitrogen were normal. Other normal tests included liver function tests, lipase and thyroid stimulating hormone levels. Urine analysis was negative. A colonoscopy was performed which showed three sessile 3 mm polyps in the splenic fl exure and proximal descending colon (Fig. 1). Polypectomy was performed and histology examination showed a thickened lamina propria arranged in a fascicular-like pattern wrapped around dispersed benign colonic glands. Immunohistochemical staining with S-100 confi rmed the diagnosis of colonic neurofi broma (Fig. 2). Isolated neurofi broma of the gastrointestinal tract was fi rst described in 1937, and remains a rare entity [1]. Since then, less than 20 such cases have been reported in the literature [2]. Clinical presentation ranges from incidental fi ndings on routine colonoscopy to massive lower gastrointestinal bleeding [2,3]. In spite of an increase in reporting of isolated colonic neurofi bromas (ICN) in the past decade, the etiology, pathogenesis, prognosis and treatment options for ICN remain unclear. In addition, there are no data on the need for follow-up colonoscopies and the appropriate intervals. Th is and other cases highlight the importance of close follow up and detailed skin exams in these patient populations to monitor for any signs of systemic neurofi bromatosis. It also raises the need for a consensus guideline on follow-up care in patients with ICN including intervals for surveillance colonoscopies.