Localized Colitis Cystica Profunda Research Articles

A RARE PRESENTATION OF COLITIS CYSTICA PROFUNDA

A 51 yrs old women who underwent a screening colonoscopy. She has no significant gastrointestinal symptoms. Her past medical history was significant for Hypertension and she was treated with atenelol. She has a 1.2 cm pedunculated polyp in descending colon which was snared with standard setting. Histology of that polyp was 'mucus-containing cysts partially lined with colonic epithelium located in the submucosa is diagnostic of colitis cystica profunda'. In the colon the presence of histologically benign mucus-containing cysts partially lined with colonic epithelium located in the submucosa is diagnostic of colitis cystica profunda. Most instances of colitis cystica profunda are localized polypoid lesions located in the rectum. Diffuse or segmental colonic involvement may occur occasionally, usually in association with inflammatory bowel disease or diffuse colonic infections. Circumstantial evidence strongly suggests that colitis cystica profunda follows mucosal ulceration of varied etiologies and is probably due to submucosal entrapment of colonic glands following healing of ulceration. At the present time localized colitis cystica profunda is considered to be closely related to the solitary rectal ulcer syndrome, prolapsing mucosal folds in diverticular disease, and inflammatory cloacogenic polyp. All of these conditions are linked to mucosal prolapse and represent parts of the spectrum of what has recently been called the “mucosal prolapse syndrome.” Colitis cystica profunda has also been reported following radiation therapy and self-inflicted rectal trauma. There is also evidence that submucosal entrapment of colonic glandular tissue may be a complication of surgery due either to mechanical displacement of glandular tissue. In an early report six of nineteen patients with localized rectal colitis cystica profunda had previous rectal surgery.

Colitis cystica profunda: Imaging diagnosis and conservative treatment

Rectally localized colitis cystica profunda can simulate mucosecretory carcinoma. Because endoscopic examination and barium enema do not clarify the diagnosis, other diagnostic imaging methods such as transrectal ultrasonography, computerized tomography, or magnetic resonance imaging are needed. Transrectal ultrasonography identifies multiple cysts in the rectal submucosa, with areas of echorefringent fibrosis between cysts, and confirms the absence of lymph node involvement or invasion of the muscular layer. Findings with computerized tomography and magnetic resonance imaging have not previously been described for colitis cystica profunda. With computerized tomography, the lesion appears as a noninfiltrating entity in the submucosa, with loss of perirectal layers of fatty tissue and thickening of the levator ani muscle. With nuclear magnetic imaging, nodulations produce intense signals that increase in T2, illustrating the mucoprotein content of the cysts. The presence in surgical biopsy material of large, whole cysts confirms the diagnosis. Reeducation of bowel habits aimed at avoiding straining and a high-fiber diet together with bulk laxatives can lead to complete remission of lesions in 6 to 18 months.

Transrectal US in the diagnosis of localized colitis cystica profunda.

Colitis cystica profunda (CCP) mimicks rectal carcinoma, which makes distinguishing this benign lesion from the more common rectal neoplasm clinically and pathologically difficult. When transrectal ultrasound (US) was used in this case, three features of CCP were seen. There were multiple lesions, which did not penetrate beyond the submucosa. A large cystic component was seen, with a layer of uniform thickness in two of the three lesions. Non-solid contents and a lack of infiltration can be visualized at transrectal US, which helps diagnose CCP.

Protruded variants in solitary ulcer syndrome of the rectum.

A review of 21 patients with protruded lesions in solitary ulcer syndrome of the rectum confirmed by resection is presented. Symptoms were usually the passage of blood and mucus per rectum, alteration of bowel habit, anorectal pain and rectal prolapse. Solitary or multiple polypoid lesions were found within 15 cm of the anal margin and were usually sited anteriorly. Fifteen of the patients were men and 8 were women with a mean age of 37.1 years. The diagnosis was made on the basis of histopathology; 1) fibrous obliteration of muscle fibers, 2) reactive hyperplasia of the mucous membrane with villous configuration or mild pseudoinvasion. These changes have been observed in complete rectal prolapse, colonic intussusception, and localized colitis cystica profunda, suggesting a common pathogenesis. The histological findings were almost the same as in the ulcerative lesions of this syndrome except for remarkable regenerative hyperplastic changes such as a relatively high incidence of mucous cell proliferation, dilatation of glands and serrate change in the cases showing protrusion. In the pathogenesis, the occult mucosal prolapse in association with excessive straining may be of particular importance, so that the lesions might be termed mucosal prolapse syndrome of the rectum.

Adenocarcinoma and colitis cystica profunda in a radiation-induced colonic stricture

A case of adenocarcinoma of the rectum occurring 17 years after pelvic irradiation for squamous carcinoma of the cervix is reported. Earlier colonic resection had shown localized colitis cystica profunda in a radiation-induced colonic stricture. Colorectal cancer is an infrequent sequel to radiotherapy, which may occur many years after treatment of the primary tumor. Prolonged follow-up of these patients is essential.

Colitis cystica profunda occurring in a radiation-induced colonic stricture

Localized colitis cystica profunda developed in a fibrotic radiation-induced colonic stricture 17 years after pelvic radiation for squamous carcinoma of cervix. This uncommon pathologic entity must be distinguished from invasive adenocarcinoma of colon, and colonic radiation injury should be included with other conditions associated with colitis cystica profunda.

Localized colitis cystica profunda.

Radiologic reports of colitis cystica profunda are scarce, and on account of this most radiologists are unfamiliar with the radiologic appearance of the disease. In 10 cases the radiological appearance and clinical symptoms are described. In all cases the lesions were located in the rectum, and in the involved segments there were longitudinal, thickened mucosal folds and one or several polypoid lesions of various sizes, which strongly suggest the radiographic diagnosis of localized colitis cystica profunda.

Colitis cystica profunda.

Colitis cystica profunda is a benign disease of the colon. Its importance lies in differentiating it from mucus-producing adenocarcinoma. It has rarely been described in the surgical literature. A review of records of patients seen at the Mayo Clinic produced 66 clinical cases of localized colitis cystica profunda, and in 21 patients the diagnosis was confirmed histologically. Follow-up, which was available in all patients, ranged from 2 months to 29 years, with a mean follow-up of more than 8 years. The data suggest that local excision is the preferred initial therapy.

Adenomatous polyp with submucosal cysts.

A pedunculated adenomatous polyp of the descending colon containing benign glandular epithelium deep within the stalk is described. The submucosal cysts resemble colitis cystica profunda except that the lesion is confined to a solitary pedunculated polyp. Lesions of either localized colitis cystica profunda or adenomatous polyp with submucosal cysts have been misdiagnosed as adenocarcinoma. Attention to the cytologic details of the submucosal component should prevent this misinterpretation.