Difference between revisions of "Solitary rectal ulcer"

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#redirect [[Colon#Solitary rectal ulcer]]
'''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.<ref name=pmid22697798>{{Cite journal  | last1 = Abid | first1 = S. | last2 = Khawaja | first2 = A. | last3 = Bhimani | first3 = SA. | last4 = Ahmad | first4 = Z. | last5 = Hamid | first5 = S. | last6 = Jafri | first6 = W. | title = The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases. | journal = BMC Gastroenterol | volume = 12 | issue =  | pages = 72 | month =  | year = 2012 | doi = 10.1186/1471-230X-12-72 | PMID = 22697798 }}</ref>
 
==General==
*Clinically may be suspected to a malignancy - biopsied routinely.
*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>
# May not be solitary.
# May not be rectal -- can be in left colon.
# 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.<ref name=pmid17139403>{{cite journal |author=Chong VH, Jalihal A |title=Solitary rectal ulcer syndrome: characteristics, outcomes and predictive profiles for persistent bleeding per rectum |journal=Singapore Med J |volume=47 |issue=12 |pages=1063–8 |year=2006 |month=December |pmid=17139403 |doi= |url=http://www.sma.org.sg/smj/4712/4712a7.pdf}}</ref>
*Rare.
 
===Clinical presentation===
*Usually presents as [[BRBPR]] ~ 85% of cases.<ref name=pmid17139403/>
*Abdominal pain present in approx. 1/3.<ref name=pmid17139403/>
**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.<ref name=pmid18271667/>
 
==Microscopic==
Features:<ref name=pmid18271667/><ref name=pmid2091997>{{Cite journal  | last1 = Malik | first1 = AK. | last2 = Bhaskar | first2 = KV. | last3 = Kochhar | first3 = R. | last4 = Bhasin | first4 = DK. | last5 = Singh | first5 = K. | last6 = Mehta | first6 = SK. | last7 = Datta | first7 = BN. | title = Solitary ulcer syndrome of the rectum--a histopathologic characterisation of 33 biopsies. | journal = Indian J Pathol Microbiol | volume = 33 | issue = 3 | pages = 216-20 | month = Jul | year = 1990 | doi =  | PMID = 2091997 }}</ref>
*Fibrosis of the lamina propria.
*Thickened muscularis mucosa with abnormal extension to the lumen.
*+/-Mucosa ulceration.
*+/-Submucosal fibrosis.
 
DDx:
*[[Inflammatory pseudopolyp]] (inflammatory polyp).
**Associated with [[inflammatory bowel disease]].
*[[Rectal prolapse]].
*Well-differentiated [[colonic adenocarcinoma|adenocarcinoma]].
 
==IHC==
*p53 -ve.
**May be used to help exclude adenocarcinoma.
 
==See also==
*[[Colon]].
*[[Rectum]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Rectum]].

Revision as of 23:11, 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.

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