Rectal polyp as presentation form of colitis cystica profunda

Abstract

A 63-year-old woman complained of rectal bleeding of hemorroidal type and spontaneous emission of mucus in the feces for 2 months. Laboratory tests, tumoral markers included, were normal. A colonoscopy was performed revealing a 2-cm polypoid lesion ( Fig. 1A) with a mucoid and gelatinous material ( Fig. 2) coming out of it. Cytology and biopsies were inconclusive. An endoscopic ultrasonogram showed a cystic anechoic 20-mm lesion filled with some non-solid materials located in the submucosal layer of the rectal wall (Fig. 1B), without adjacent adenopathies, and a hypertonic internal anal sphincter. Histology showed mucosal thickening with dilated glands and the presence of inflammatory infiltrates, muscular fibers, and congestive vessels in the muscularis propria, findings that can be seen in rectal prolapse. These results, in addition to endoscopic and ultrasonographic findings, established the diagnosis.

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.…”