Difference between revisions of "Solitary rectal ulcer"

From Libre Pathology
Jump to navigation Jump to search
Line 1: Line 1:
'''Solitary rectal ulcer''' is a benign disease of the colorectum.   
'''Solitary rectal ulcer''' is a benign disease of the [[colon|colo]][[rectum]].   


It is also known as ''solitary ulcer syndrome of the rectum'' (abbreviated ''SUS'') and ''solitary rectal ulcer syndrome''.
It is also known as ''solitary ulcer syndrome of the rectum'' (abbreviated ''SUS'') and ''solitary rectal ulcer syndrome''.
Line 6: Line 6:


==General==
==General==
*Clinically may be suspected to a malignancy - biopsied routinely.
*Clinically may be suspected to a [[colorectal carcinoma|malignancy]] - biopsied routinely.
*Mucosal ulceration.
*Mucosal ulceration.
*"Three-lies disease":<ref name=pmid18271667>{{cite journal |author=Crespo Pérez L, Moreira Vicente V, Redondo Verge C, López San Román A, Milicua Salamero JM |title=["The three-lies disease": solitary rectal ulcer syndrome] |language=Spanish; Castilian |journal=Rev Esp Enferm Dig |volume=99 |issue=11 |pages=663–6 |year=2007 |month=November |pmid=18271667 |doi= |url=http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=459864&TO=RVN&Eng=1}}</ref>  
*"Three-lies disease":<ref name=pmid18271667>{{cite journal |author=Crespo Pérez L, Moreira Vicente V, Redondo Verge C, López San Román A, Milicua Salamero JM |title=["The three-lies disease": solitary rectal ulcer syndrome] |language=Spanish; Castilian |journal=Rev Esp Enferm Dig |volume=99 |issue=11 |pages=663–6 |year=2007 |month=November |pmid=18271667 |doi= |url=http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=459864&TO=RVN&Eng=1}}</ref>  

Revision as of 23:18, 28 May 2015

Solitary rectal ulcer is a benign disease of the colorectum.

It is also known as solitary ulcer syndrome of the rectum (abbreviated SUS) and solitary rectal ulcer syndrome.

Mucosal prolapse syndrome may be used as a synonym; however, it encompasses other entities.[1]

General

  • Clinically may be suspected to a malignancy - biopsied routinely.
  • Mucosal ulceration.
  • "Three-lies disease":[2]
  1. May not be solitary.
  2. May not be rectal -- can be in left colon.
  3. May not be ulcerating -- non-ulcerated lesions: polypoid and/or erythematous.

Note: Each of the words in solitary rectal ulcer is a lie.

Epidemiology

  • Typically younger patients - average age of presentation ~30 years in one study.[3]
  • Rare.

Clinical presentation

  • Usually presents as BRBPR ~ 85% of cases.[3]
  • Abdominal pain present in approx. 1/3.[3]
    • May be very painful.

Treatment:

  • Usually conservative, i.e. non-surgical.
  • Resection - may be done for fear of malignancy.

Gross

  • Classically, anterior or anterolateral wall of the rectum.[2]

Microscopic

Features:[2][4]

  • Fibrosis of the lamina propria.
  • Thickened muscularis mucosa with abnormal extension to the lumen.
  • +/-Mucosa ulceration.
  • +/-Submucosal fibrosis.

DDx:

IHC

  • p53 -ve.
    • May be used to help exclude adenocarcinoma.

See also

References

  1. Abid, S.; Khawaja, A.; Bhimani, SA.; Ahmad, Z.; Hamid, S.; Jafri, W. (2012). "The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases.". BMC Gastroenterol 12: 72. doi:10.1186/1471-230X-12-72. PMID 22697798.
  2. 2.0 2.1 2.2 Crespo Pérez L, Moreira Vicente V, Redondo Verge C, López San Román A, Milicua Salamero JM (November 2007). "["The three-lies disease": solitary rectal ulcer syndrome"] (in Spanish; Castilian). Rev Esp Enferm Dig 99 (11): 663–6. PMID 18271667. http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=459864&TO=RVN&Eng=1.
  3. 3.0 3.1 3.2 Chong VH, Jalihal A (December 2006). "Solitary rectal ulcer syndrome: characteristics, outcomes and predictive profiles for persistent bleeding per rectum". Singapore Med J 47 (12): 1063–8. PMID 17139403. http://www.sma.org.sg/smj/4712/4712a7.pdf.
  4. Malik, AK.; Bhaskar, KV.; Kochhar, R.; Bhasin, DK.; Singh, K.; Mehta, SK.; Datta, BN. (Jul 1990). "Solitary ulcer syndrome of the rectum--a histopathologic characterisation of 33 biopsies.". Indian J Pathol Microbiol 33 (3): 216-20. PMID 2091997.