Ganglioneuroma Masquerading as Rectal Polyp: Clinical Significance and Literature Review

Ganglioneuroma (GN) of colon is a rare tumor of gastrointestinal (GI) tract. GNs of GI tract are usually confined to colon particularly rectum. GNs are usually found incidentally but can be associated with MEN IIb, von Recklinghausen’s neurofibromatosis or Cowden syndrome. A 21-year-old female with past medical history of bulimia, bipolar disorder and hypothyroidism, who presented with complaints of hematemesis and hematochezia. Her physical exam was unremarkable. She subsequently underwent an EGD and colonoscopy for further evaluation. EGD reveled mild gastritis. Colonoscopy revealed two 5 mm sessile polyps in the sigmoid colon and the rectum. Biopsy of the rectal polyp showed ganglioneuroma. This represents a case of polypoid ganglioneuromatosis. These polyps are endoscopically small sessile or pedunculated polyp indistinguishable from hyperplastic and adenomatous polyps. They are not associated with increased risk of colon cancer and don’t require additional screening. On the other hand, ganglioneuromatous polyposis and diffuse ganglioneuromatosis can be associated with increased risk of colon and other cancers, and may require further work up.