Spindle cell proliferations of the sigmoid colon, rectum and anus: a review with emphasis on perineurioma

Abstract

A wide range of spindle cell proliferations are found uncommonly in the sigmoid colon, rectum and anus. They usually present as polyps, and include reactive lesions and benign and malignant neoplasms which may be primary or metastatic. They are less frequently described in the literature compared to those in the upper gastrointestinal tract, and may be underdiagnosed. The widespread use of sigmoidoscopy in symptomatic patients and bowel cancer screening programmes means that histopathologists must be aware of, and adopt a logical approach to, diagnosing spindle cell proliferations in biopsy and polypectomy specimens. This is particularly relevant given the strong association of some mesenchymal polyps with hereditary cancer syndromes. This review article will focus on perineurioma and the recent debate in relation to its overlap with fibroblastic polyp. The clinical, endoscopic, histological and immunohistochemical features of spindle cell proliferations which should be considered in the differential diagnosis of perineurioma will be discussed. There is also a brief reference to malignant spindle cell tumours of diagnostic importance.

A Solitary Sigmoid Perineurioma in an Otherwise Healthy 30-Year-Old Male

“…They are not typically known to be associated with gastrointestinal symptoms and are typically found incidentally on colonoscopy with a benign course [ 2 ] Histologically they are composed of bland spindle cells with ovoid nuclei in a whorling appearance. Nuclear pleomorphism, mitotic activity, and necrosis are often absent [ 3 ]. Immunohistochemistry is often strongly positive for glucose transporter-1 (GLUT-1), claudin-1, and less specifically for epithelial membrane antigen (EMA) [ 4 ].…”

Gastrointestinal Tactile Corpuscle-Like Bodies: Report of Two Cases and Review of the Literature

“…Wagner Meissner bodies are specialized sensory structures responsible for touch sensation. 1 These mechanoreceptors are typically distributed in nerve endings, especially in glabrous skin. 1 The gastrointestinal tract normally lacks these structures; however, Wills et al (2003) first described the so-called tactile corpuscle-like bodies in the colonic mucosa, resembling these structures 2 and causing potential diagnostic difficulties.…”

“…1 These mechanoreceptors are typically distributed in nerve endings, especially in glabrous skin. 1 The gastrointestinal tract normally lacks these structures; however, Wills et al (2003) first described the so-called tactile corpuscle-like bodies in the colonic mucosa, resembling these structures 2 and causing potential diagnostic difficulties. 1 Subsequently, few reports documented their existence in the gastrointestinal tract, mainly in the colorectal region and esophagus/gastroesophageal junction and rarely in the gastric mucosa.…”

“…1 The gastrointestinal tract normally lacks these structures; however, Wills et al (2003) first described the so-called tactile corpuscle-like bodies in the colonic mucosa, resembling these structures 2 and causing potential diagnostic difficulties. 1 Subsequently, few reports documented their existence in the gastrointestinal tract, mainly in the colorectal region and esophagus/gastroesophageal junction and rarely in the gastric mucosa. 3,4 Despite its incidental presentation and benign nature, pathologists should be aware of this diagnosis as it may be mistaken for granuloma, amyloidosis, or other gastrointestinal spindle cell proliferations, especially in the colon.…”

Intramucosal true perineurioma of the sigmoid: endoscopic and pathological features of an infrequent lesion

“…There were no complications in the postoperative period and the patient was discharged on the second day after surgery. A perineurioma is a rare benign peripheral nerve sheath tumor composed of cells resembling normal perineurium, with a reported incidence of 0.1 % -1.46 % [1,2]. Since their first description in 2004 by Eslami-Varzaneh, about 150 cases of perineurioma have been reported in the colorectum to date [1,3].…”