Fibromuscular Obliteration Research Articles

Verrucous gastritis-like lesion in intramucosal Helicobacter pylori-uninfected signet ring cell carcinoma with poorly differentiated adenocarcinoma

In Japan, accessible Helicobacter pylori (Hp) eradication therapy is associated with an increase in the prevalence of gastric cancers (GCs) in Hp uninfected stomachs. Signet ring cell carcinoma (SRCC) is the most common of these GCs. Intramucosal SRCC with poorly differentiated adenocarcinoma (PDA) occurring in Hp uninfected gastric mucosa is rare; furthermore, many Hp uninfected pure SRCCs exhibit discoloration and flat or slightly depressed lesions, and morphological elevation is relatively rare. We report a case of intramucosal SRCC with PDA with an elevated, verrucous gastritis-like lesion in a 57-year-old male patient. In the present case, the PDA area showed dense tumor cell growth and coexisting desmoplastic and fibrotic reactions. Histopathology and immunohistochemical staining identified extensive fibromuscular obliteration with smooth muscle bundles extending from the muscularis mucosa into the lamina propria. The patient underwent curative endoscopic submucosal dissection. The reporting and analysis of such rare cases may lead to a better understanding of the characteristics of advanced Hp uninfected GCs.

Clinical, Endoscopic, and Histologic Characteristics of Patients with Solitary Rectal Ulcer Syndrome at a Tertiary Care Center

Abstract Objective Solitary rectal ulcer syndrome (SRUS) is a chronic disorder of defecation presenting with bleed per rectum, mucorrhea, tenesmus, perianal discomfort, etc. We aim to report clinical, endoscopic, and histologic features of SRUS in patients who underwent either colonoscopy or sigmoidoscopy at our center. Materials and Methods We performed retrospective analysis of all patients diagnosed with SRUS on endoscopy and confirmed by histopathologic examination at our center between January 2010 and June 2022. Data retrieved included demographic details, clinical features along with endoscopic, and histopathological findings of SRUS patients. Results The study included 132 patients with SRUS with mean (± standard deviation) age of 45 (± 20.6) years and male to female ratio of 1.5:1. While most of the patients presented with a combination of symptoms, the most common clinical presentation was bleeding per rectum (82%). Rectal ulcers, either single or multiple, were the predominant findings on endoscopy followed by polypoidal lesions. Histology showed fibromuscular obliteration and crypt distortion in all patients. Biofeedback training, lifestyle changes, and sucralfate enema were successful in about 87% of the patients at the end of 6 weeks and about 76% at the end of 12 weeks with surgery for rectal prolapse being performed in two of our patients. Conclusion SRUS presents with a myriad of symptoms and requires a high index of suspicion by the treating physician(s). While the most common presenting symptom in our study was rectal bleed rectal bleed; ulcers, either solitary or multiple, ulcers, either solitary or multiple, were the commonest endoscopy findings. Endoscopic findings along with histopathology confirm the diagnosis.

Analysis of solitary rectal ulcer syndrome in 7 children

Objective: To analyze the clinical features, treatment and prognosis of solitary rectal ulcer syndrome (SRUS) in children. Methods: The clinical data of 7 children who were diagnosed with SRUS in Department of Gastroenterology in Guangzhou Women and Children' Medical Center from January 2019 to December 2021 were retrospectively analyzed. The clinical data including general demographics, clinical presentations, endoscopic and histologic features, treatment and outcome were extracted from hospital medical records. Results: The 7 patients were all males, and the age of onset was 6-12 years. The course before diagnosis was 2-36 months. The most common symptom was rectal bleeding (6 cases) and most common findings at initial colonoscopy were ulcer in 3 cases and protuberance in 4 cases, both located only in rectum. The intestinal histopathology of 5 cases showed characteristic fibromuscular obliteration of lamina propria. Five children were treated with mesalamine granules or suppositories, and 2 cases underwent local excision. The follow-up lasted for 5-24 months and found symptoms relieved in 5 cases, improved in 1 case, and no remission in 1 case. Colonoscopy after the treatment was performed in 5 children, among whom 2 cases achieved mucosal healing. Conclusions: SRUS in children is mainly presented with rectal bleeding, and has characteristic histological change of ulcer and protuberance in endoscopy. Pathology is crucial for diagnosis and differential diagnosis. Both the medical and surgical treatment are effective for SRUS.

A case of mucosal prolapse syndrome complicated by well-differentiated tubular adenocarcinoma and high-grade adenoma after long-term follow-up by colonoscopy

This study included a 45-year-old woman. In 20XX, we performed colonoscopy (CS) on fresh bloody stools, and a diagnosis of rectal mucosal prolapse syndrome (MPS) was made. In 20XX+14 years, CS was reexamined because of fresh bloody stools, and a biopsy of the same site revealed well-differentiated tubular adenocarcinoma. The lesion was resected via endoscopic submucosal dissection (ESD) and histopathologically diagnosed as MPS with high-grade adenoma and well-differentiated tubular adenocarcinoma. The symptoms improved after ESD, and no recurrence was observed during the 18-month follow-up. We experienced a case of a well-differentiated tubular adenocarcinoma in MPS during the long-term follow-up of MPS. In this case, performing ESD was useful not only for cancer treatment but also in terms of therapeutic effects on symptoms. Although MPS is a chronic benign inflammatory disorder, characterized by rectal mucosal prolapse with fibromuscular obliteration, it is necessary to consider the possibility of the appearance of cancer during the follow-up of MPS.

S3380 Mucosal Prolapse Syndrome: Case Report and Literature Review

INTRODUCTION: Mucosal prolapse is a rare condition that consists of protrusion of the rectal mucosa through the anal sphincter. This condition comprises, solitary rectal ulcer syndrome, adenocarcinoma, hamartomas, inflammatory cloacogenic polyp, inflammatory myoglandular polyp, and proctitis cystica. It is prevalent among males (3:1) and typically found in the 4-6 decades of life, the patient presents with hematochezia, tenesmus, partial incontinence, constipation, or can be asymptomatic. Surface erosion of the mucosa can occur as well as inflammation, hemorrhage, and fibrosis. Histologic features are disruption of the muscular mucosal and fibromuscular repair on the lamina propia. CASE DESCRIPTION/METHODS: The patient is a 23 year old female with a medical history of sickle cell trait and family history of gastrointestinal cancer and polyps who presented to the outpatient clinic complaining of rectal bleeding accompanied by anemia. Skin tags and large external hemorrhoids were noted on digital rectal exam (DRE). A colonoscopy was then scheduled. This was later done revealing, but was limited due to the inability to advance the scope beyond 20 cm, with evidence of a large, indurated and ulcerated mass in the rectal area measuring approximately 4 cm. Additionally a circumferential, indurated lesion 8-10 cm from anal verge was found with multiple biopsies performed to rule out malignancy (Figure 1). The biopsy results showed fragmented hyperplastic colonic mucosa showing fibrosis and smooth muscle strands in the lamina propia, consistent with mucosal prolapse syndrome (Figure 2). The patient was then referred to colorectal surgery due to hemorrhoids and prolapsed polyps near the anal verge. A hemorrhoidectomy was performed shortly thereafter for symptomatic relief. DISCUSSION: Mucosal prolapse syndrome is the presenting sign of a variety of conditions, as the differential diagnosis is broad. Among almost all cases colonoscopy will allow for direct visualization and treatment of polyps and ulcerations. Biopsies will confirm the etiology in most of the cases. These conditions present with constipation, leading to spastic contraction, which ultimately leads to congestion. Histologically, there is an overlap with the findings seen among all the mentioned etiologies. Findings such as fibromuscular obliteration, glandular crypt abnormalities, and gland dilation are reported and mimicking of adenomas and adenocarcinomas. The primary purpose is to rule out malignancy and then establish surveillance.Figure 1.: Colonoscopy showing an indurated mass in the rectal area.Figure 2.: Fragmented hyperplastic colonic mucosa showing fibrosis and smooth muscle strands in the lamina propria.

3055 Solitary Rectal Ulcer Syndrome: A Rare Cause of Hematochezia

INTRODUCTION: Solitary rectal ulcer syndrome (SRUS) is an uncommon rectal disorder that may result in severe rectal bleeding. The term solitary rectal ulcer syndrome is a misnomer. Endoscopic findings in patients with SRUS can range from mucosal erythema alone to single or multiple ulcers and polypoid mass lesions. Here, we present a rare case of severe hematochezia occurring secondary to a solitary rectal ulcer. CASE DESCRIPTION/METHODS: The patient is a 37 year-old male with a medical history of alcohol abuse who presented to our emergency department complaining of three episodes of hematochezia accompanied by dizziness and lightheadedness that began the night prior. Notable workup in the emergency department included a complete blood count (CBC) showing a hemoglobin of 12.5 gm/dL. A fecal occult blood test was also done which returned positive. This was followed by a repeat CBC showing an acute drop in the hemoglobin to 9.8 gm/dL. The gastroenterology service was then consulted and performed a colonoscopy. This was done and showed a large cratered ulcer about two centimeters in size and a non-bleeding visible vessel noted approximately five centimeters from the anal verge (Figure 1). These were treated with BiCAP cautery and the three hemostatic clips. Biopsies were not taken given the high risk of bleeding and emergent nature of the procedure. After the procedure the patient remained hemodynamically stable with no further drops in hemoglobin. He was then discharged with follow up appointments for repeat colonoscopy. DISCUSSION: SRUS is an oftentimes-misdiagnosed condition. The prevalence of SRUS is not clear, but has an estimated incidence of 1 in 100,000 people per year. Its diagnosis can usually be accomplished through a combination of symptomatology, endoscopy, sigmoidoscopy, and the histologic finding of fibromuscular obliteration of the lamina propria. The pathogenesis if SRUS is not well known, but various factors contribute to its development. This includes straining, self-induced trauma, paradoxical contraction of puborectalis muscle and rectal prolapse, and intussusception. Treatment of SRUS is based on the symptoms and severity. Asymptomatic patient treatment options include dietary modification, patient education, and behavioral modification. Endoscopic treatment can be applied to control bleeding and allows the clinician to obtain a biopsy specimen. Surgical treatment is recommended for those who have full thickness and rectal prolapse.

A Case of Solitary Rectal Ulcer Syndrome in a 16-year-old Girl Presented with Iron Deficiency Anemia

Solitary rectal ulcer syndrome (SRUS) is a rare condition that is most commonly characterized by rectal pain and bleeding. It can be accompanied by diarrhea or constipation, tenesmus, and rectal prolapse. Considering its non-specific symptoms, it is often difficult to diagnose, particularly in children. The underlying etiology of SRUS is not fully understood; however, it may be secondary to ischemic changes in the rectum associated with paradoxical contraction of the pelvic floor and external anal sphincter muscles and rectal prolapse. The macroscopic appearance of the rectal lesion may vary from hyperemia to ulceration or a polypoid lesion that can mimic carcinoma, although the histological findings are characteristic, with fibromuscular obliteration of the lamina propria and disorientation of muscle fibers. We report an adolescent case of SRUS developed in a 16-year-old adolescent girl who presented with iron deficiency anemia. pISSN 2233-5250 / eISSN 2233-4580 http://dx.doi.org/10.15264/cpho.2016.23.1.53 Clin Pediatr Hematol Oncol 2016;23:53∼56

Solitary rectal ulcer syndrome: clinical, endoscopic, histological and anorectal manometry findings in north Indian patients.

Solitary rectal ulcer syndrome (SRUS) is a chronic, benign defecation disorder often related to excessive straining. SRUS is diagnosed on the basis of clinical symptoms, endoscopic and histological findings. All patients diagnosed with SRUS by colonoscopy and confirmed by histopathology from October 2012 to August 2014 in the Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, India, were included in the study. Out of 92 patients, thirty-four patients underwent anorectal manometry. Twenty age-matched healthy volunteers were also studied with anorectal manometry to serve as controls. Mean age of the group was 41 ± 19 years with age range of 10-82 years; males were 58 (63%) with male to female ratio of 1.7:1. Bleeding per rectum was present in 83%, constipation in 46.7%, abdominal pain in 27.2%, and diarrhea in 25% of the patients. On endoscopy, ulcerative lesions were seen in 83% patients of whom solitary and multiple lesions were present in 44% and 39%, respectively. Polypoidal lesions were reported in 17.4% whilst rectal polyps and erythematous mucosa were found in 5.4% and 2.2%, respectively. Histological examination revealed fibromuscular obliteration in 100% of patients, surface ulceration in 70.6% and crypt distortion in 20.65% of patients. Anal relaxation and balloon expulsion test was significantly abnormal in SRUS patients compared to healthy controls (53% vs. 20%, p < 0.01). Rectal bleeding was the most common symptom and ulcerative lesions the most common endoscopic finding. Fecal evaluation disorder was more prevalent inpatients with SRUS.

Coexistence of solitary rectal ulcer syndrome and ulcerative colitis: a case report and literature review.

Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease that is misdiagnosed as malignancy or inflammatory bowel disease because of similarities in clinical and endoscopic manifestations. Furthermore, SRUS with ulcerative colitis (UC) is extremely rare. To date, two cases have been reported in the medical literature. We report an additional case of SRUS with UC that was misdiagnosed as rectal cancer. A 61-year-old man was admitted to our hospital with rectal bleeding. Colonoscopy showed a well-demarcated, shallow, ulcerative lesion with polypoidal growth involving the entire circumference of the rectal lumen. Findings from imaging studies, including abdominal computed tomography (CT) and positron emission tomography (PET)/CT resembled those of rectal cancer. Surgical resection was performed because clinical symptoms persisted despite medical treatment and because occult rectal cancer could not be ruled out. Histopathological examination of the resected specimen revealed fibromuscular obliteration of the lamina propria and crypt abscesses, characteristics compatible with SRUS and UC.

Rectal mucosal prolapse syndrome as an unusual gastrointestinal manifestation of Sjögren's syndrome: a case report

IntroductionRectal mucosal prolapse syndrome, histologically characterized by fibromuscular obliteration in the lamina propria, hyperplastic glands and thickened muscularis mucosa, causes rectal bleeding. Sjögren's syndrome is an autoimmune exocrinopathy that chiefly destroys the salivary and lacrimal glands by lympho-plasmacytic infiltration. Although various gastrointestinal manifestations have been reported in patients with Sjögren's syndrome, there have not been to our knowledge any case reports to date of rectal mucosal prolapse syndrome in association with Sjögren's syndrome.Case presentationA 68-year-old Japanese woman with Sjögren's syndrome and long-term constipation consulted our hospital because of rectal bleeding. Because of dysphagia and xerostomia, she had consistently refused recommendations to take oral medicines including cathartics. Therefore, she frequently strained excessively during defecation. Colonoscopy and radiological examinations disclosed eroded flat protrusions of the rectum. Microscopic examination demonstrated inflamed mucosa with elongated tortuous glands and fibromuscular obliteration. Based on these findings, a diagnosis of rectal mucosal prolapse syndrome was made. Prohibition of straining during defecation and sulfasalazine suppository use were effective.ConclusionThis case highlights the importance of defecation control in patients with Sjögren's syndrome. In the case presented, rectal mucosal prolapse syndrome following long-term excessive straining during defecation caused rectal bleeding. Clinicians should consider rectal mucosal prolapse syndrome as a gastrointestinal manifestation of Sjögren's syndrome.

Solitary rectal ulcer syndrome: A clinicopathological study of 13 cases

Background/Aims:Solitary rectal ulcer syndrome (SRUS) is a rare disorder that has a wide spectrum of clinical presentation and variable endoscopic findings. To further characterize the clinical and pathological features, a retrospective, hospital-based clinicopathological study was conducted.Materials and Methods:All cases of SRUS diagnosed at Farwania Hospital, Kuwait, between 2002 and 2007 were retrieved from the computerized filing system. The histological slides were reviewed by two authors to confirm the diagnosis. Immunohistochemical stain for smooth muscle actin (SMA) was performed. The clinical files were reviewed for clinical features and endoscopic findings.Results:Thirteen cases were identified: 8 males and 5 females. The age range was 15–85. Rectal bleeding, constipation, and abdominal pain were the most common presenting symptoms and were seen, either alone or in various combinations, in 12 of the 13 cases. Rectal ulceration was the most common endoscopic finding, being seen in 9 of the 13 cases; 3 of these cases had multiple ulcerations. Two patients had rectal polyps, with one of them having multiple polyps. The histological examination revealed surface serration, fibromuscular obliteration of the lamina propria, and crypts' distortion in all the cases. Seven of the cases had diamond crypts. Ectatic mucosal vessels were a common finding. Positivity for SMA in the lamina propria was seen in all examined cases.Conclusion:SRUS is a rare disorder and only 13 cases were diagnosed in Farwania hospital over a 6-year period. The clinical presentation of our patients was variable. The presence of polyps and multiple ulcerations on endoscopy is further evidence that SRUS is a misnomer. Surface serration, fibromuscular obliteration, and crypts' distortion are the most characteristic features. The presence of diamond crypts is an additional diagnostic feature.

What histologic features best differentiate Crohnʼs disease from ulcerative colitis?

The differential diagnosis between untreated ulcerative colitis (UC) and Crohn’s disease (CD) in resected specimens is usually not difficult. UC is a diffuse, continuous mucosal disease that begins in the rectum and spreads variably to the proximal colon. The disease is worse distally. The ileum is not involved. Granulomas, fissures, and transmural lymphoid aggregates are not present. CD shows segmental distribution with variable disease severity (worse proximal) and variable rectal involvement. The ileum is involved in up to 40% of the patients. Granulomas, unrelated to mucin or foreign bodies, and fissures may be present. Fibromuscular obliteration and nerve fiber hyperplasia in the submucosa and transmural lymphoid aggregates are common. In specimens from patients operated on for severe (fulminant) colitis, a definite diagnosis can be difficult because of overlapping features. These cases are classified as “colitis of uncertain type — etiology” (indeterminate colitis).1 The differential diagnosis between UC and CD is important in these patients because an ileal pouch anal anastomosis is often recommended. In CD this type of operation may be less appropriate. Transmural lymphoid aggregates (specificity: 90%; positive predictive value: 62%), granulomas in the subserosa, and submucosal nerve fiber hyperplasia with ganglionitis all favor CD.2 The endoscopic biopsy diagnosis of UC and CD remains a problem. Many features useful for the diagnosis when surgical resection specimens are available are not present or are nonspecific when only the mucosa and superficial submucosa are available. Additionally, medical treatment changes the typical disease patterns. The two diseases share features and neither disease has a pathognomonic finding present in every case of the one and absent in every case of the other. The relative absence of discriminating features can partly be solved by analysis of multiple endoscopic biopsies from different areas of the colon and ileum.3 This allows conclusions about the distribution of the disease, the focal nature of inflammation in the same area, and the presence of areas of sparing. Discontinuous disease is a major indicator that the underlying condition is unlikely UC.4 Stepwise biopsies also provide information about the variability of the disease (UC is worse distally). Ileal involvement favors CD. Ileitis in UC is present only when active total disease involves the ileocecal valve in continuity with distal disease. Full colonoscopic biopsy series provide a correct diagnosis in 64% of cases for CD and 74% for UC, increasing to 96% with the addition of clinical information. (5) The clinical presentation can be atypical and a precise diagnosis remains difficult in early-onset disease (2–6 weeks after the first symptoms), in children, especially young children below the age of 12, and in patients with associated liver disease (hepatitis, primary sclerosing cholangitis).1 These patients can be classified temporarily as colitis, type unclassified (IBDU). The microscopic criteria applicable to endoscopic biopsy specimens for the distinction of inflammatory bowel disease (IBD) from other forms of colitis and of CD from UC include a combination of architectural and inflammatory features and other lesions. Architectural abnormalities are crypt distortion (nonparallel, variable diameter, cystic), crypt branching, crypt shortening, decreased crypt density, and irregular mucosal surface. Inflammatory features are transmucosal increase in lamina propria cellularity (basal plasmacytosis accumulation of lymphocytes and plasma cells between the bases of crypt and the muscularis mucosae or close to the muscularis mucosae) and neutrophils. Neutrophils are mainly an indicator of disease activity. Other lesions include a change in epithelial mucin content, abnormalities of the muscularis mucosae, and metaplasia (pseudopyloric metaplasia in the ileum and Paneth cell metaplasia in the colon). Abnormal architecture and basal plasmacytosis distinguish between chronic idiopathic IBD (present) and other causes of colitis (absent). In this regard, diverticular disease associated colitis is a differential diagnostic problem.6,7 These features may not be present at the initial onset of the disease. Plasmacytosis increased from 38% in biopsies obtained 1–15 days following onset of symptoms to 89% in biopsies obtained after 121–300 days. Architectural abnormalities increased from 0%–78%.8 Metaplasia occurs mainly in longstanding disease. After recovery with or without treatment, basal plasmacytosis and architectural abnormalities may decrease. Repeat endoscopy with biopsy and comparative study From the Department of Pathobiology, University Hospital, Leuven, Belgium. Copyright © 2008 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1002/ibd.20598 Published online in Wiley InterScience (www.interscience.wiley.com).

Cap polyposis: a rare colorectal disease

Results Initially, in several endoscopic sessions a complete polypectomy was intended. Since the disease was only temporarily responsive to antiphlogistics and abdominal symptoms worsened, a left hemicolectomy including part of the rectum had to be performed. Examination of the resected gut and of biopsies showed typical histological features of cap polyposis: sessile polyps with elongated crypts and a granulation tissue 'cap' near to the surface of the partly ulcerated mucosa. The epithelium of the crypts had saw-tooth configurations like in hyperplastic polyps without evidence of adenomatous changes. In the lamina propria signs of fibromuscular obliteration were found: moderate hyperplasia of smooth muscle fibers and mild fibrosis. Between the polyps the mucosa was normal.

Prolapsing Mucosal Polyps in the Sigmoid Colon: Presenting with Chronic Abdominal Cramping Pain and Colonic Obstruction

Colorectal polypoid lesions are classified as either neoplastic or non-neoplastic, and the differentiation between the two lesions is important for clinical practice, however, this is not easy in some rare cases. Cases of colonic prolapsing mucosal polyps are rare. They are often, but not always, associated with diverticular disease and present with abdominal pain, obstructive symptoms or bleeding. On colonoscopic examination, the lesions are characterized by multiple polyps or elevated patches with smooth and bright red colored surface. The histological features include: glandular crypt abnormalities, fibromuscular obliteration of the lamina propria, and thickened and splayed muscularis mucosa. We report herein a case of sigmoid colonic prolapsing mucosal polyps presenting with acute lower abdominal cramping pain and colonic obstruction who was diagnosed based on colonoscopy and endosonography findings and treated with conservative management.

Solitary Rectal Ulcer Syndrome in Childhood: A Rare, Benign, and Probably Misdiagnosed Cause of Rectal Bleeding. Report of Three Cases

Solitary rectal ulcer syndrome is an uncommon and often underdiagnosed condition that usually presents with hematochezia, mucous discharge, and tenesmus. Its etiology is unknown but it seems related to excessive straining with defecation. Prolonged efforts force the anterior rectal mucosa into the anal canal with strangulation and appearance of congestion, edema, and ulceration. Histologic findings (fibromuscular obliteration of lamina propria and disorientation of muscle fibers) are characteristic, which helps to differentiate these lesions from other rectal entities. Although solitary rectal ulcer syndrome is rarely reported in children, it must be suspected in patients with rectal discharge of blood and mucus and previous disorders of evacuation. We present three children (aged 9, 10, and 14 years) with solitary rectal ulcer syndrome that had presented with rectal bleeding. A careful inquiry about evacuation habits and a high index of suspicion in children presenting with hematochezia helps to diagnose this possibly unrecognized or misdiagnosed entity in children. Endoscopy and histologic examination confirms this condition.

The Value of Myenteric Plexitis to Predict Early Postoperative Crohn’s Disease Recurrence

Early ileocolonoscopy allows detection of recurrence after surgically induced remission of Crohn's disease (CD). Unequivocal histologic markers predicting recurrence have not been identified. We assessed the predictive value of neural lesions for early endoscopic CD recurrence and long-term reintervention risk. Ileocolonic resection specimens from 59 patients with CD and 21 control patients were histologically scored for typical inflammatory bowel disease lesions, neural hypertrophy, and presence and severity of inflamed ganglia and nerve bundles. Endoscopic recurrence was determined at 3 months in all patients and at 1 year in 32 patients as part of 2 prospective clinical trials. Myenteric plexitis of the proximal resection margin was present in 32 patients with CD (54%) in absence of surrounding inflammation. Patients with this feature had a higher endoscopic recurrence (Rutgeerts score >/=2) at 3 months (75% vs 41%; odds ratio, 4.36; 95% confidence interval, 1.44-13.23; P = .008) and at 1 year (93% vs 59%; odds ratio, 9.80; 95% confidence interval, 1.04-92.70; P = .041) and had a trend toward an earlier reintervention (mean, 7.00 vs 5.30 years; P = .174). The severity of myenteric plexitis in the proximal resection margin correlated with the severity of endoscopic recurrence at 3 months (r = 0.334, P = .010) and 1 year (r = 0.560, P = .001). Myenteric plexitis was the only consistent predictor of endoscopic recurrence. The presence of myenteric plexitis in proximal margins of ileocolonic resection specimens is predictive of early endoscopic CD recurrence.

Jumbo biopsy is useful for the diagnosis of colonic prolapsing mucosal polyps with diverticulosis

We report here a case of multiple prolapsing mucosal polyps with diverticulosis in the sigmoid colon. A 52-year-old man was admitted to our hospital because of bloody diarrhea. Colonoscopy and barium enema showed multiple diverticula, markedly thickened mucosal folds and polypoid lesions with mucus on the top of them in the sigmoid colon. Endoscopic ultrasonography showed thickening of the mucosal and submucosal layers. Several endoscopic biopsy specimens were taken from the polypoid lesions. Histological examination revealed only chronic inflammatory cell infiltration. In order to obtain a definite diagnosis, we performed endoscopic jumbo biopsy for the polypoid lesions after obtaining informed consent. Histological examination revealed marked lymphocyte infiltration, hemosiderin deposits and fibromuscular obliteration in the lamina propria, features similar to those of mucosal prolapsing syndrome. After anti-diarrhetic treatment, clinical findings were improved. Thus, jumbo biopsy is useful for diagnosis and treatment of prolapsing mucosal polyps.

Colonic lipoma with florid vascular proliferation and nodule‐aggregating appearance related to repeated intussusception

A unique case of repeatedly intussuscepted colonic lipoma mimicking an epithelial tumor in a 50-year-old man is reported. The tumor was located in the ascending colon and was approximately 5 cm in diameter. Colonoscopic and barium-enema examinations suggested a huge epithelial tumor because of its nodule-aggregating appearance. In contrast, computed tomography examination showed a fatty element in the core of the lesion. The biopsy specimens suggested a primary angiomatous lesion because of its pronounced vascular proliferation. Because the presumed diagnoses based on the examinations were different, the preoperative diagnosis was not confirmed. The tumor was composed of intramural lipoma with a multiple polypoid mucosa overlay. This lesion was unique in that the lipoma appeared to be within the muscularis propria and the multiple polypoid appearance of its covering mucosa. The mucosal changes including florid vascular proliferation, fibromuscular obliteration and epithelial regeneration suggested a reparative process, with ischemic damage due to the effects of intussusception being the most likely event. It should be kept in mind that even a simple lipoma can have a unique appearance reminiscent of epithelial tumor when it repeatedly experiences intussusception.

Prolapsing mucosal polyps: an underrecognized form of colonic polyp--a clinicopathological study of 15 cases.

Prolapsing intestinal mucosa occurs in many forms throughout the GI tract. We describe 15 patients with polypoid masses in the sigmoid colon and histological features of mucosal prolapse. Fifteen patients with colon polyps demonstrating endoscopic and histological features of mucosal prolapse were retrospectively identified from our database. Twelve patients presented with signs and symptoms that were nonspecific, but consistent with mucosal prolapse, such as occult or gross intestinal bleeding and lower abdominal pain. Three patients were asymptomatic. The polyps occurred in the sigmoid colon, usually in association with diverticular disease, and appeared more often in men. Endoscopically, the polyps appeared to be well-circumscribed, hyperemic masses that contrasted sharply with normal-appearing adjacent mucosa. Histological features include glandular crypt abnormalities, fibromuscular obliteration of the lamina propria, and thickened and splayed muscularis mucosa. Prolapsing mucosal polyps of the colon are histologically similar to other mucosal prolapsing conditions in the GI tract, such as the solitary rectal ulcer syndrome, inflammatory cloacogenic polyps, inflammatory "cap" polyps, and gastric antral vascular ectasia, and should therefore be designated as part of the "mucosal prolapse syndrome."

Prolapsing mucosal polyps: an underrecognized form of colonic polyp—a clinicopathological study of 15 cases

OBJECTIVE: Prolapsing intestinal mucosa occurs in many forms throughout the GI tract. We describe 15 patients with polypoid masses in the sigmoid colon and histological features of mucosal prolapse. METHODS: Fifteen patients with colon polyps demonstrating endoscopic and histological features of mucosal prolapse were retrospectively identified from our database. RESULTS: Twelve patients presented with signs and symptoms that were nonspecific, but consistent with mucosal prolapse, such as occult or gross intestinal bleeding and lower abdominal pain. Three patients were asymptomatic. The polyps occurred in the sigmoid colon, usually in association with diverticular disease, and appeared more often in men. Endoscopically, the polyps appeared to be well-circumscribed, hyperemic masses that contrasted sharply with normal-appearing adjacent mucosa. Histological features include glandular crypt abnormalities, fibromuscular obliteration of the lamina propria, and thickened and splayed muscularis mucosa. CONCLUSIONS: Prolapsing mucosal polyps of the colon are histologically similar to other mucosal prolapsing conditions in the GI tract, such as the solitary rectal ulcer syndrome, inflammatory cloacogenic polyps, inflammatory “cap” polyps, and gastric antral vascular ectasia, and should therefore be designated as part of the “mucosal prolapse syndrome.”