Published in:
26-05-2022 | Image of the Month
Colitis Cystica Profunda: A Rare Mimicker of Colorectal Neoplasia
Published in: Digestive Diseases and Sciences | Issue 7/2022
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A 58-year-old man presented with diarrhea. An incidental rectal mass was discovered, demonstrating endoscopic, sonographic (Fig. 1), magnetic resonance imaging (MRI; Fig. 2), and cytopathologic findings of colitis cystica profunda (CCP), a benign lesion of the colon and rectum [1, 2]; malignancy could not be definitively ruled out, so the patient underwent surgical resection, with histopathology confirming CCP (Fig. 3). Our case highlights the importance of considering CCP in the differential diagnosis of rectal masses that mimic malignancy [3]. Surgical resection removes the mass along with diagnostic uncertainty, but shared decision-making is needed prior to proceeding with a major surgery with associated morbidity and mortality for a benign cause.
Fig. 1
Endoscopic rectal ultrasound demonstrating a hypoechoic, submucosal lesion containing anechoic cystic foci, without clear involvement of the muscularis propria
Fig. 2
a Sagittal T2-weighted MRI image showing a mass with central multilocular cystic areas confined within the rectal wall and deep into the muscularis mucosa (arrows); b sagittal T1-weighted fat-saturated post-contrast MRI image of the lesion demonstrating only peripheral enhancement (arrows)
Fig. 3
Histopathology (hematoxylin and eosin staining) following resection of the rectal mass, revealing a mucin-filled cyst bordered by atrophic colonic mucosa and colonic mucinous epithelium, with evidence of surrounding fibrosis, without evidence of dysplasia or malignancy
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