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Difference between revisions of "Rectal prolapse"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Rectal_prolapse_-_intermed_mag.jpg | |||
| Width = | |||
| Caption = Fibromuscular hyperplasia as seen in rectal prolapse. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = fibromuscular hyperplasia: lamina propria fibrosis and lamina propria muscle, thick muscularis propria, submucosal fibrosis, +/-ischemic mucosal changes | |||
| Subtypes = | |||
| LMDDx = | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[rectum]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = women - multiparous & postmenopausal | |||
| Signs = "rectal mass" | |||
| Symptoms = | |||
| Prevalence = not common | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = rectal carcinoma (rarely) | |||
| Tx = surgery | |||
}} | |||
'''Rectal prolapse''' is a benign pathology of the [[rectum]], typically seen in women that are multiparous and postmenopausal. | |||
==General== | |||
*Usually close to the anal verge. | |||
*Rare forms can occasionally be confused with [[colorectal carcinoma|cancer]].<ref name=pmid19861563>{{cite journal |author=Brosens LA, Montgomery EA, Bhagavan BS, Offerhaus GJ, Giardiello FM |title=Mucosal prolapse syndrome presenting as rectal polyposis |journal=J. Clin. Pathol. |volume=62 |issue=11 |pages=1034–6 |year=2009 |month=November |pmid=19861563 |pmc=2853932 |doi=10.1136/jcp.2009.067801 |url=}}</ref> | |||
Epidemiology: | |||
*~90% women, postmenopausal and multiparous.<ref name=pmid22413077>{{Cite journal | last1 = Lee | first1 = S. | last2 = Kye | first2 = BH. | last3 = Kim | first3 = HJ. | last4 = Cho | first4 = HM. | last5 = Kim | first5 = JG. | title = Delorme's Procedure for Complete Rectal Prolapse: Does It Still Have It's Own Role? | journal = J Korean Soc Coloproctol | volume = 28 | issue = 1 | pages = 13-8 | month = Feb | year = 2012 | doi = 10.3393/jksc.2012.28.1.13 | PMID = 22413077 }}</ref> | |||
Treatment: | |||
*Surgical: | |||
**Delorme procedure = mucosa stripped. | |||
==Microscopic== | |||
Features:<ref name=pmid3234303>{{cite journal |author=Schneider A, Fritze C, Bosseckert H, Machnik G |title=[Primary clinical, endoscopic and histologic findings in solitary rectal ulcer] |language=German |journal=Dtsch Z Verdau Stoffwechselkr |volume=48 |issue=3-4 |pages=183–9 |year=1988 |pmid=3234303 |doi= |url=}}</ref> | |||
*"Fibromuscular hyperplasia" - '''key feature''': | |||
**Fibrosis (submucosa, lamina propria). | |||
**Muscularis mucosae is "too superficial" (muscle in the lamina propria). | |||
*Surface ulceration + inflammation ([[neutrophil]]s). | |||
**May show frank ischemic changes - see ''[[ischemic colitis]]''. | |||
*+/-Serration of epithelium at the surface. | |||
Notes: | |||
*'''Important negative''': no nuclear atypia. | |||
**May be seen if ischemic changes are present. | |||
===Images=== | |||
<gallery> | |||
Image:Rectal_prolapse_-_low_mag.jpg | Rectal prolapse - low mag. (WC/Nephon) | |||
Image:Rectal_prolapse_-_intermed_mag.jpg | Rectal prolapse - intermed. mag. (WC/Nephron) | |||
</gallery> | |||
==Sign out== | |||
<pre> | |||
Rectum, Excision: | |||
- Colorectal wall with mild chronic mucosal inflammation, | |||
and prominent submucosal fibrous tissue with dilated-appearing vessels. | |||
- NEGATIVE for dysplasia and NEGATIVE for malignancy. | |||
</pre> | |||
===Block letters=== | |||
<pre> | |||
RECTAL MUCOSA, DELORME PROCEDURE: | |||
- SUPERFICIAL RECTAL WALL WITH FIBROMUSCULAR HYPERPLASIA AND EDEMA. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
RECTAL MUCOSA, DELORME PROCEDURE: | |||
- SUPERFICIAL RECTAL WALL WITH FIBROMUSCULAR HYPERPLASIA, EDEMA, MILD INFLAMMATORY | |||
CHANGES, AND FOCAL REACTIVE CHANGES; | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
====Micro==== | |||
The sections show rectal mucosa, submucosa and a small amount of muscularis propria. The mucosa shows fibromuscular hyperplasia with thickening of the muscularis mucosae and mild lamina propria fibrosis. The submucosa is edematous. The small amount of muscularis propria is unremarkable. The epithelium matures normally to the surface. No significant nuclear atypia is identified. | |||
===Ischemic changes present=== | |||
<pre> | |||
RECTAL MUCOSA, DELORME PROCEDURE: | |||
- SUPERFICIAL RECTAL WALL WITH REACTIVE CHANGES, ISCHEMIC CHANGES AND FIBROMUSCULAR | |||
HYPERPLASIA, SEE COMMENT. | |||
- NEGATIVE FOR MALIGNANCY. | |||
COMMENT: | |||
The changes are compatible with prolapse (fibromuscular hyperplasia) and suggestive of | |||
concurrent ischemia (see microscopic). | |||
The mucosal reactive changes are marked. No definite dysplasia is identified; however, it | |||
is difficult to completely exclude. Follow-up is recommended. | |||
</pre> | |||
====Micro==== | |||
The sections show superficial rectal wall with ischemic changes (focal cryptitis, marked | |||
reactive epithelial changes, erosions, capillary congestion, goblet cell paucitity, | |||
epithelium with attenuated cytoplasm) and changes compatible with prolapse (fibromuscular | |||
hyperplasia). | |||
==See also== | |||
*[[Rectum]]. | |||
*[[Solitary rectal ulcer]]. | |||
*[[Prolapse]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Gastrointestinal pathology]] | |||
[[Category:Diagnosis]] | |||