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CC BY 4.0 · Endoscopy 2025; 57(S 01): E475-E476
DOI: 10.1055/a-2584-1349
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An unusual camellia-shaped lesion in a female with diarrhea: beauty is only skin deep

Authors

  • Yi Lu  ‡

    1   Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (Ringgold ID: RIN373651)
    2   Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
    3   Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University,, Guangzhou, China

  • Jiachen Sun  ‡

    1   Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (Ringgold ID: RIN373651)
    2   Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
    3   Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University,, Guangzhou, China

  • Weihao Deng

    2   Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
    3   Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University,, Guangzhou, China
    4   Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

  • Jiancong Hu 

    1   Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (Ringgold ID: RIN373651)
    3   Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University,, Guangzhou, China
    2   Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

Supported by: The program of Guangdong Provincial Clinical Research Center for Digestive Diseases 2020B1111170004
Supported by: The Sixth Affiliated Hospital of Sun Yat-Sen University Clinical Research-“1010” Program 1010PY(2022)-16
Supported by: National Key Clinical Discipline
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A 40-year-old woman was admitted due to chronic diarrhea for 6 months. Her laboratory tests revealed anemia (hemoglobin 104 g/L) and positive for fecal occult blood test. Enhanced chest and abdominal computed tomography scans demonstrated multiple enlarged lymph nodes at the root of the mesentery ([Fig. 1], yellow arrows), with the largest measuring 17 mm in short-axis, splenomegaly, and pulmonary nodules. Gastroscopy showed nonatrophic chronic gastritis and fundic gland polyps. Colonoscopy identified multiple camellia-shaped lesions in the terminal ileum ([Fig. 2] a), and magnified endoscopy (ME) with narrow-band imaging (NBI) showed opaque micro-elevation with superficial, thin branch-like vessels ([Fig. 2] b). Multiple small, flat lesions were diffusely distributed throughout the entire colon ([Fig. 2] c), resembling nodular lymphoid hyperplasia [1], but with a distinctive feature: the lesions exhibited not only a reddish outline but also a reddish central area ([Fig. 2] d). In the lower rectum, multiple slightly elevated lesions were observed ([Fig. 2] e), and ME-NBI again revealed opaque micro-elevations with superficial, thin branch-like vessels ([Fig. 2] f, [Video 1]). The biopsy pathology showed nodular lymphoid hyperplasia in the intestinal mucosa, with nuclei appearing round or irregular ([Fig. 3] a, b). Immunohistochemistry results showed positive for CD20 ([Fig. 3] c), CD21 (indicating follicular dendritic cells, [Fig. 3] d), CD10 ([Fig. 3] e), and Bcl-6 ([Fig. 3] f), while CD3 and Bcl-2 were negative, and Ki-67 was positive in 30% of cells; CD43 showed partial positive. Further B-cell clonality assessment detected a monoclonal rearrangement. The patient was ultimately diagnosed with follicular lymphoma (grade 3A, Ann Arbor stage IVA, FLIPI-2 score 3, and high risk), and underwent chemotherapy. This case highlights the striking endoscopic appearance of intestinal follicular lymphoma, underscoring the importance of recognizing such lesions, despite their potentially deceptive benign appearance.

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Fig. 1 Enhanced computed tomography scans demonstrated multiple enlarged lymph nodes at the root of the mesentery.
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Fig. 2 Colonoscopy images of the lesions: a multiple camellia-shaped lesions in the terminal ileum; b ME-NBI showed opaque micro-elevation with superficial, thin branch-like vessels; c the entire colon was diffusely distributed with multiple small, flat lesions; d the lesions resembling nodular lymphoid hyperplasia, but with a distinctive feature: the lesions exhibited not only a reddish outline but also a reddish central area; e multiple slightly elevated lesions were observed in the lower rectum; f ME-NBI revealed opaque micro-elevations with superficial, thin branch-like vessels. Abbreviation: ME-NBI, magnified endoscopy with narrow-band imaging.
Zoom
Fig. 3 Pathology images of the lesions (terminal ileum): a, b nodular lymphoid hyperplasia in the intestinal mucosa, with nuclei appearing round or irregular; c immunohistochemistry results CD20 (+); d CD21 (+) in follicular dendritic cells; e CD10 (+), f Bcl-6 (+).
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Colonoscopy images of an unusual camellia-shaped lesion in a woman with diarrhea.Video 1


 

Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Jiancong Hu, MD
Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University
26 Yuancun Erheng Road
Guangzhou 510655
P. R. China   

Publication History

Article published online:
22 May 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Zoom
Fig. 1 Enhanced computed tomography scans demonstrated multiple enlarged lymph nodes at the root of the mesentery.
Zoom
Fig. 2 Colonoscopy images of the lesions: a multiple camellia-shaped lesions in the terminal ileum; b ME-NBI showed opaque micro-elevation with superficial, thin branch-like vessels; c the entire colon was diffusely distributed with multiple small, flat lesions; d the lesions resembling nodular lymphoid hyperplasia, but with a distinctive feature: the lesions exhibited not only a reddish outline but also a reddish central area; e multiple slightly elevated lesions were observed in the lower rectum; f ME-NBI revealed opaque micro-elevations with superficial, thin branch-like vessels. Abbreviation: ME-NBI, magnified endoscopy with narrow-band imaging.
Zoom
Fig. 3 Pathology images of the lesions (terminal ileum): a, b nodular lymphoid hyperplasia in the intestinal mucosa, with nuclei appearing round or irregular; c immunohistochemistry results CD20 (+); d CD21 (+) in follicular dendritic cells; e CD10 (+), f Bcl-6 (+).