Incidental Finding of Colitis Cystica Profunda in Routine Colorectal Screening

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Colitis Cystica Profunda (CCP) is a rare, non-malignant condition characterized by cysts filled with mucus in the submucosa and muscularis mucosa layer, bordered by flattened epithelial cells of the colon. Recognizing CCP is crucial due to its potential to imitate well-differentiated rectal adenocarcinoma, possibly leading to unwarranted surgical resection. We report a case of CCP found during routine colonoscopy in a 48-year-old woman. Case Description/Methods: A 48-year-old woman with emphysema, generalized anxiety disorder, and latent tuberculosis (treated 16 years ago) was referred for her first colonoscopy for colorectal cancer screening. She was overweight (body mass index 29.41), an active smoker, and a cannabis user. Her family history included stomach cancer (maternal aunts and cousins died at ages 49 and 52 years-old). She denied symptoms or family history of colon cancer or inflammatory bowel disease. Her only medication was an albuterol inhaler. She had a robotic-assisted laparoscopic cholecystectomy 8 years prior. Her vital signs and physical exam were normal.The colonoscopy revealed a 2mm sessile polyp in the mid-rectum, 2 non-bleeding angiodysplasia lesions in the proximal ascending colon and recto-sigmoid colon, and small non-bleeding internal hemorrhoids. The patient went home without complications. Pathology report of the 2mm polyp showed CCP (submucosal herniation of mucosa), with no neoplastic component. The patient was asymptomatic during the follow-up visit after 3 weeks and was scheduled for a repeat colonoscopy in 3 years. Discussion: The pathophysiology of CCP involves congenital or acquired muscularis mucosa weakening from inflammation, infection, trauma, and ischemia. CCP can be classified as diffuse or localized. Endoscopic examination reveals polypoid lesions surrounded by normal, edematous, or ulcerated mucosa. Anorectal ultrasound shows a hypoechoic signal in the submucosal layers, without deeper infiltration. As CCP resembles rectal adenocarcinoma, early endoscopic submucosal dissection and biopsy are necessary for diagnosis and treatment. Management includes diet changes, biofeedback therapy, and medications like sucralfate and hydrocortisone enema. Surgery might be required for large lesions that cause obstructive symptoms, chronic hemorrhage, or rectal prolapse.

Volume

119

Issue

10

First Page

S2144

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