A 70-year-old woman was referred to our gastroenterology clinic for colon cancer screening. She denied abdominal pain, nausea, vomiting, heartburn, irregular bowel habits or hematochezia. She had undergone colonoscopy 10 years prior at an outside facility which according to her had been unremarkable. Her past medical history included migraine, hypertension, coronary artery disease and osteopenia. Her home medications included aspirin, hydrochlorothiazide, metoprolol, simvastatin, calcium, vitamin D and alendronate. Her family history was significant for stomach cancer in a sister, lung cancer in a brother and thyroid cancer in a daughter. She denied any family history of neurological tumors and cutaneous neurofibromas. She had a 40-pack-year smoking history, which she quit for 12 years. Physical examination revealed an overweight woman with a body mass index of 29. Her abdomen was soft with no tenderness or palpable masses. She did not have any skin lesions or pigmented/hypopigmented spots. Abdominal and neurological exams were within normal limits. Laboratory data revealed a hemoglobin level of 13.9 g/dl, a white blood cell count of 8,100/mul, a platelet count of 251,000/mul and a serum creatinine of 0.9 mg/dl. Basic metabolic panel, liver function tests and coagulation profile were within normal limits. Hepatitis serology was negative.
As part of routine screening, colonoscopy was performed up to the cecum. Findings included a 20-mm pedunculated polyp with a stalk measuring 0.6 cm in length and 0.4 cm in diameter in the ascending colon (fig. 1), and an 8-mm polyp in the transverse colon removed with polypectomy and a 3-mm polyp in the ascending colon removed with biopsy forceps. Other findings were diverticulosis of the entire colon and internal hemorrhoids. The 8-mm transverse colon polyp revealed tubular adenoma on histopathology, and the 3-mm ascending colon polyp revealed colonic mucosa. Histologically, the pedunculated ascending colon polyp revealed bland spindle cell proliferation in the submucosa (fig. 2, fig. 3). Immunohistochemical stains showed that the tumor cells were immunoreactive to S100 protein (fig. 4) and were non-reactive to CD117, SMA and desmin antibodies. These findings were consistent with a diagnosis of colonic submucosal neurofibroma. The patient continued to be followed up in our outpatient clinic. She remains asymptomatic without any systemic signs of neurofibromatosis even after 9 months of follow-up.