Year: 2025
Type: article
Study design: Case Report
Abstract: A 55-year-old male presented to the outpatient department with a 1-year history of intermittent diarrhea. The patient described loose stools occurring three to four times per day, predominantly in the mornings, without nocturnal symptoms. There was no blood or mucus in stools, abdominal pain, fever, weight loss, or history of antibiotic/medication use. The stools were non-oily, not bulky, and not associated with urgency or tenesmus. His medical history was unremarkable. Physical examination was within normal limits. Routine blood investigations, including complete blood count, liver and renal function tests, thyroid profile, and stool analysis, were normal. Given the chronicity of symptoms, a colonoscopy was performed. The colonoscopic examination revealed a single sessile polyp measuring approximately 1.2 cm in the cecum ([ Fig. 1 ]). No other mucosal abnormalities were noted throughout the colon. Endoscopic polypectomy ([ Fig. 2 ]) was performed, and the specimen was sent for histopathological examination. Microscopic evaluation revealed ganglion cells with neuronal spindle cells with wavy nuclei suggestive of ganglioneuroma ([ Fig. 3 ]). Immunohistochemical staining showed positive expression of S100 and synaptophysin, supporting the diagnosis ([ Figs. 4 ] and [ 5 ]). Following polypectomy, the patient reported complete resolution of diarrhea during follow-up visits. Fig. 1 Sessile polyp noted in the cecum. Fig. 2 Polypectomy of cecal polyp. Fig. 3 White arrow denoting ganglion cell (cells with abundant amphophilic cytoplasm, oval eccentric nuclei, and prominent nucleoli) with neuronal spindle cells with wavy nuclei. Fig. 4 White arrow denoting S100 immunostaining, highlighting both the ganglion cells and neuronal components (brown color). Fig. 5 Immunohistochemical staining showing positive expression of synaptophysin (brown color) denoted by a white arrow. In the present case, although the lesion was small and histologically nonsecretory, possible hypothesis for the resolution of diarrhea include: (1) polyp being an incidental finding with coincidental improvement of functional diarrhea, (2) local mucosal irritation or motility alteration caused by the lesion, (3) overlap with an irritable bowel syndrome-like presentation with symptomatic relief following intervention, (4) intermittent luminal flow alteration due to its location in the cecal fold, and (5) a potential neuromodulatory effect of polypectomy itself. While a direct causal relationship cannot be conclusively established, excision and histological confirmation remain clinically relevant for patient reassurance and accurate diagnosis. Publication History Article published online: 16 October 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/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
Source: Journal of Digestive Endoscopy
Authors: Bommanahalli S. Puneeth, Dheeraj Karanth
Institution: Manipal Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4415255526