DIAGNOSTIC CHALLENGES IN A RARE CASE OF POLYPOID LYMPHANGIECTASIA WITH HIGH-GRADE VILLOUS ADENOMA

Intestinal lymphangiectasia is a rare protein-losing gastroenteropathy cahracterized by impaired drainage of lymph from small intestine associated with dilation of the intestinal lymphatic channels. This leads to inappropriate loss of lymph into the gastrointestinal tract causing hypoproteinemia, edema, lymphocytopenia, hypogammaglobulinemia, and immunologic dysfunction. Herein, we present a case of a 55-year-old male presenting with bleeding per rectum and straining during defecation since 5 days. On colonoscopy, a pedunculated and ulcerated polypoidal mass was found in the sigmoid colon. Upon histopathological examination of the excised mass, a diagnosis of polypoidal lymphangiectasia with co-existing high-grade villous adenoma was conferred upon. Our case report describes a rare entity at an uncommon location. It also highlights the importance of histopathological examination in arriving at the final diagnosis as intestinal lymphangiectasia has a broad list of differential diagnosis and also as our case had co-existing high-grade villous adenoma