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. 2019 Mar 1;58(5):625-631.
doi: 10.2169/internalmedicine.1635-18. Epub 2018 Oct 17.

Rectal Lymphoid Follicle Aphthous Lesions Frequently Progress to Ulcerative Colitis with Proximal Extension

Ryohei Hayashi  1 , Yoshitaka Ueno  1 , Shinji Tanaka  1 , Masaki Wakai  2 , Junko Kumada  2 , Akira Fujita  2 , Motonobu Nomura  2 , Shiro Oka  2 , Masanori Ito  2 , Kazuaki Chayama  2
Affiliations

Rectal Lymphoid Follicle Aphthous Lesions Frequently Progress to Ulcerative Colitis with Proximal Extension

Ryohei Hayashi et al. Intern Med. .

Abstract

Objective Rectal lymphoid follicular aphthous (LFA) lesions are related to ulcerative colitis (UC) and can be initial lesions of UC. We investigated the clinical course and prognosis of rectal LFA lesions. Methods This is a retrospective analysis of the clinical records at a single center. Patients Thirteen consecutive cases with LFA lesions treated at Hiroshima University Hospital between 1998 and 2015 were evaluated. Another 49 consecutive cases with ulcerative proctitis treated in the same period were enrolled as the control group. The clinical course and prognosis of both groups were evaluated. Results The group with LFA lesions included 9 women and 4 men with a median age of 39.9 years (range, 21-70 years). A total of 11 cases progressed to typical UC at 5-51 months. Proximal extension of these typical UC lesions was observed in 7 (53.8%) cases, which was significantly higher than in the control group (10 cases, 20.8%). Three cases (5-year accumulation incidence rate, 27.3%) progressed to steroid-intractable UC, a significantly higher incidence than that of the control group (3 cases; 5-year accumulation incidence rate, 6.9%). Conclusion Rectal LFA lesions frequently progress to typical UC with proximal extension, some of which become intractable to corticosteroid treatment.

Keywords: aphthous lesions; proctitis; proximal extension; ulcerative colitis.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Endoscopic and histological findings of LFA lesions. a: Endoscopic findings of LFA showing lymphoid follicles with an elevated hemispherical appearance (like salmon caviar) restricted to the rectum. b, c: Chromoendoscopic findings of LFA showing dense granular deposits with erosion on the apex. d: Histological appearance of the biopsy specimen showing acute inflammatory cells in the lamina propria of the mucosa, superficial ulceration, crypt distortion, and large lymphoid follicular hyperplasias. LFA: lymphoid follicular aphtha
Figure 2.
Figure 2.
Progress to typical UC and the proximal extension of UC lesion in LFA cases. a, b: Proportion of cases with lesions that progressed to typical UC. In case 5, the lymphoid follicle with an elevated hemispherical appearance became flattened and typical of UC lesions after two months. c, d: The overall cumulative rate of proximal extension in the LFA group and the control (ulcerative proctitis) group. In case 9, proximal extension into the transverse colon was observed at 30 months after the diagnosis. LFA: lymphoid follicular aphtha, UC: ulcerative colitis
Figure 3.
Figure 3.
Steroid treatment for LFA lesions and ulcerative proctitis. a: The steroid-free survival rate of the LFA and control (ulcerative proctitis) groups. b: The overall cumulative steroid-intractable rate of the LFA and control groups. LFA: lymphoid follicular aphtha
Figure 4.
Figure 4.
Clinical flowchart of the LFA and control groups. LFA: lymphoid follicular aphtha
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