Solitary Rectal Ulcer Syndrome/Mucosal Prolapse



Solitary Rectal Ulcer Syndrome/Mucosal Prolapse


Julianne K. Purdy, MD





Key Facts


Clinical Issues



  • Rare; usually in young to middle-aged adults


  • Ulcer, polyp, erythema on anterior rectal wall


  • Rectal bleeding or straining with defecation


Microscopic Pathology



  • Fibromuscular obliteration of lamina propria, muscularis mucosa hypertrophy, & disorganization


  • Mild mucosal architectural distortion, reactive atypia, surface hyperplasia


Top Differential Diagnoses



  • Inflammatory bowel disease



    • Extensive chronic lamina propria inflammation


  • Rectal mucinous adenocarcinoma



    • Epithelium floating in irregular pools of mucin, cytologic atypia, desmoplasia


  • Adenoma, Peutz-Jeghers polyp, hyperplastic polyp



    • No fibromuscular obliteration of lamina propria; dysplasia (adenoma)







Hematoxylin & eosin shows polypoid ulcerated rectal mucosa with underlying fibromuscular proliferation in the lamina propria and serrated, branching, haphazardly arranged crypts image.






Hematoxylin & eosin shows hypertrophied, disorganized smooth muscle of the muscularis mucosa image, extending up into the lamina propria between crypts image.


TERMINOLOGY


Definitions



  • Solitary rectal ulcer syndrome (SRUS)



    • Chronic benign defecation disorder with histologic features of mucosal prolapse


ETIOLOGY/PATHOGENESIS


Contraction of Sphincter during Defecation



  • Excessive straining → compression of rectal wall, prolapse


  • Venous congestion, traction on submucosal vessels → poor blood flow → ischemia, ulceration


Direct Trauma

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Jul 6, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Solitary Rectal Ulcer Syndrome/Mucosal Prolapse

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