Click
on thumbnails to see full sized pictures.Gastrointestinal Pathology- Clinicopathologic Correlation in Mucosal Biopsy
Case #7 (question #10 and 11):
A 51 year-old woman with symptomatic internal hemorrhoids. Hemorrhoidectomy was performed. In addition to hemorrhoids, the surgeon felt there was an additional mass in the rectum and sections revealed the following. Representative images are illustrated below:
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Question No. 10. The Answer is: (A) Mucosal prolapse.
Discussion: The histologic features are consistent with mucosal prolapse / solitary rectal ulcer syndrome (SRUS). Note the features of bundles of smooth muscle and collagen extend into the lamina propria around crypts. The epithelium is focally hyperplastic in appearance, but features of neoplasia are not identified.
Question No. 11. The Answer is: (B) It is easily confused clinically with the ulcers of Crohn’s disease.
Discussion: Mucosal prolapse is easily confused clinically with the ulcers of Crohn’s disease or with ulcerative carcinoma because of the indurated tissue palpable around the ulcer. Contrary to the older name (solitary rectal ulcer syndrome), the lesions are often multiple and they may involve the sigmoid colon as well as the rectum. In addition, they more often have erosions rather than ulcers, or may have neither. The characteristic histologic finding is hypertrophy of the muscularis mucosa with bundles of smooth muscle and collagen extending high into the lamina propria around the crypts. The epithelium is often quite hyperplastic in appearance.