Uncommon Mass of the Rectum: Colitis Cystica Profunda

Abstract

A 29-year-old woman was admitted to our hospital complaining of abdominal distention for one year, and occasionally experienced mild pain in the left lower abdomen. There was no antecedent or associated colonic disease. Physical examination didn’t reveal any abnormality. All results of her hematological and biochemical tests were normal, including erythrocyte sedimentation rate, C-reactive protein, and carcinoma-embryonic antigen. Her abdominal CT scan revealed uneven thickening of the left anterior-lateral wall of the rectum without the loss of perirectal fatty tissue and multiple cystic masses associated with scattered calcification in the transition zone between the rectum and sigmoid (Figure A & B: oblique reconstructed images). There was no lymphadenopathy in the abdomen. Two colonoscopies showed multiple smooth sub mucosal masses ranging from 1.0cm x1.5cm to 2.0x2.5cm in size (Figure C). An endoscopic ultra-sonogram depicted a cystic mixedechoic lesion without adjacent adenopathies (Figure D). The initial endoscopic biopsies were inconclusive. Endoscopy macrobiopsys were performed, and a mucoid and gelatinous material came out of it (Figure E & F). Macro biopsy specimen showed cystic lesion filled with muslin in the muscular is mucosa, and cystic wall was coated with columnar epithelium and inflammatory infiltrate (Figure G). The final diagnosis is colitis cystica profunda (CCP). The patient was recommended to high-fiber diet and regular lifestyle, and she remained well at the 1-year follow-up of endoscopy.