Colitis cystica profunda of the rectum: An unexpected operative finding

Abstract

Colitis cystic profunda is a rare entity benign condition of the colon and rectum that can mimic suspicious polyps or malignancy. The commonest sites of affectation are the rectum and the sigmoid colon but it can be unusually widely distributed in the colon. The aetiology of this condition is not fully elucidated and confident diagnosis can only be made on histological features. We hereby describe a patient who presented with significant rectal symptoms and an unexpected finding of a submucosal mucous cyst mimicking a suspicious rectal polyp and highlighted its significance and the review of the literature.

MRI Appearances Of Colitis Cystica Profunda: A Rare Benign Mimicker Of Colorectal Malignancy

“…2,7 CCP can present in a localised form with a polypoid lesion, or as a diffuse process involving a variable length of the rectal mucosa or colon, having predilection for male gender. 3,8,9 The etiology of this entity is not fully elucidated, but it has been described to have inflammatory/post traumatic origin with associations with a number of ulcerating diseases including inflammatory bowel disease, SRUS, diverticulosis, and infectious colitis. Features of CCP can overlap with carcinoid tumour, mucinous adenocarcinoma, pancreatic heterotopia or adenomatous polyps of the anorectal region (inverted/pseudo-invasion).…”

“…Features of CCP can overlap with carcinoid tumour, mucinous adenocarcinoma, pancreatic heterotopia or adenomatous polyps of the anorectal region (inverted/pseudo-invasion). 3,4,9 Patients may present with a variety of symptoms, the most common being constipation, bleeding per rectum, mucus discharge, and abdomen pain. 5 Colonoscopy shows polypoidal/sessile lesions enclosed within normal, edematous or inflamed mucosa and/or ulcerations.…”

“…2,6 MRI typically reveals cystic, non-infiltrative, submucosal lesions with thickening of levator ani muscles, some loss of perirectal fat tissue or nodules with high signals on T2 sequences due to mucoprotein content of the cysts. 3,8,9 Removal of lesions by colonoscopy, followed by histopathology, is the gold-standard for clinching the final diagnosis. Key histological features are obliteration of the lamina propria, muscle fibers extending upwards between the crypts with hypertrophied muscularis mucosae and glandular cryptic abnormalities.…”

“…CCP usually presents with nonspecific symptoms of mucorrhea, abdominal pain, rectal bleeding, tenesmus, and constipation; frequently misdiagnosed or confused with a malignancy, sometimes resulting in unnecessary interventions, be it surgical or pharmacological. 3,4 Our case illustrates the difficult diagnosis of this uncommon but problematic phenomenon, awareness of which is paramount for the concerning radiologists and clinicians. 5,6…”

“…1,2 Stark first described it in the colon of two autopsied cases of chronic dysentery and Vinchow was the one to name it 'colitis cystica polyposa'. [2][3][4][5][6] Rectum and the sigmoid colon are the commonest sites of affliction, but wide colonic distribution is also seen. 2 CCP has similar histological features as solitary rectal ulcer syndrome (SRUS) and the overlap between these conditions is not fully elucidated.…”