Rectal tonsil: a rare cause of rectal bleeding

A rectal tonsil is a lymphoid follicular hyperplasia of the rectum and a rare cause of rectal bleeding. As it is a benign lesion of uncertain etiology [1] [2], treatment is reserved for symptomatic patients [2].

We present the case of a 21-year-old woman with normal bowel movements who presented with a history of rectal bleeding over a period of 4 months. Digital rectal examination revealed a rectal mass. Colonoscopy revealed circumferential granular involvement of the rectal mucosal surface ([Video 1]). Histology showed a dense lymphoid infiltrate and lymphatic follicles ([Fig. 1]).

Video 1 Colonoscopic appearance of a rectal tonsil before and after treatment with mesalazine.

Fig. 1 Rectal mucosa of a 21-year-old patient with a 4-month history of rectal bleeding. Lymphatic follicle with a prominent germinal center containing tingible body macrophages (H&E, × 10).

Infection [3] and lymphoma were excluded ([Fig. 2]) and a diagnosis of rectal tonsil was made [4]. Excellent clinical and endoscopic response was achieved after a 1-month course of rectal mesalazine administered twice daily ([Fig. 3]). Because the lesion is benign in nature, with transformation into lymphoma being the exception [4], treatment was discontinued. The patient continued asymptomatic at 3-month clinical follow-up.

Fig. 2 Rectal mucosa of the same patient. a Lymphatic follicle positive for CD20 (× 10); b lymphatic follicle with germinal center negative for Bcl2 ( × 10).

Fig. 3 Treatment with rectal mesalazine: appearance of the rectal mucosa before treatment (a) and after treatment (b).

Endoscopy_UCTN_Code_CCL_1AD_2AC

Publication History

Article published online:
12 May 2020

• References

• 1 Hong JB, Kim HW, Kang DH. et al. Rectal tonsil: A case report and literature review. World J Gastroenterol 2015; 21: 2563-2567
• 2 Trillo L, Arias M, Iglesias A. et al. Amígdala rectal o hiperplasia folicular linfoide del recto. Radiología 2014; 56: 370-373
• 3 Cramer SF, Romansky S, Hulbert B. et al. The rectal tonsil: a reaction to chlamydial infection?. Am J Surg Pathol 2009; 33: 483-485
• 4 Farris AB, Lauwers GY, Ferry JA. et al. The rectal tonsil: a reactive lymphoid proliferation that may mimic lymphoma. Am J Surg Pathol 2008; 32: 1075-1079