Colitis Cystica Profunda.

HomeRadioGraphicsVol. 43, No. 12 Next Cases from the Cooky JarFree AccessColitis Cystica ProfundaAnisha Bhagwanani , Ciléin Kearns, Antariksh Vijan, Maria Lucia Brun-VergaraAnisha Bhagwanani , Ciléin Kearns, Antariksh Vijan, Maria Lucia Brun-VergaraAuthor AffiliationsFrom the Department of Radiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Portsmouth Rd, Frimley, Camberley GU16 7UJ, England (A.B.); Department of Radiology, Wellington Regional Hospital, Te Whatu Ora, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India (A.V.); and Department of Radiology, Division of Radiation Oncology and Medical Physics, The Ottawa Hospital, Ottawa, Ontario, Canada (M.L.B.V.).Address correspondence to A.B. (email: [email protected]).Anisha Bhagwanani Ciléin KearnsAntariksh VijanMaria Lucia Brun-VergaraPublished Online:Nov 16 2023https://doi.org/10.1148/rg.230184MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Colitis cystica profunda is an uncommon benign disease characterized by mucin-filled cysts in the rectal submucosa (Fig 1). The most widely accepted cause is chronic prolapse that results in inflammation and mucosal ulceration, with subsequent epithelialization and formation of rectal submucosal cysts (2) (Fig 2). Colitis cystica profunda is associated with solitary rectal ulcer syndrome, an entity that also includes mucosal prolapse syndrome (4) and that has a reported incidence of one per 100 000 persons per year (4). The term solitary is a misnomer because a single ulcer is present in only 20% of cases, while multiple ulcers are present in 40%, and other cases can show polypoid masses or no ulcer at all (5). Characteristic histopathologic features include replacement of the lamina propria by fibroblasts and displacement of mucosal glands into the submucosa, resulting in mucin cyst formation (2). Imaging plays an important role in detecting commonly associated structural and functional abnormalities including rectal prolapse, intussusception, and dyssynergia (2).Figure 1. Colitis cystica profunda in a 49-year-old woman with rectal prolapse. Sagittal (A) and axial (B) MR images demonstrate mucin-filled cysts within the rectal submucosa (arrows). Colonoscopic image (C) demonstrates evidence of submucosal lesions. Such patients typically present with symptoms such as rectal bleeding, external prolapse (surgical photograph in D), and mucous discharge and have a long-standing history of obstructive defecation (1).Figure 1. Download as PowerPointFigure 2. Medical illustration depicts the most widely accepted explanation of the pathogenesis of submucosal cysts in colitis cystica profunda. Chronic prolapse results in mucosa herniating into the submucosa, where epithelium-lined mucous cysts then form. When large, these cysts bulge against the mucosa and can create surface irregularity that may be clinically misinterpreted as colorectal malignancy (3). (Reprinted, with permission, from Ciléin Kearns, Artibiotics, Copyright © 2023.)Figure 2. Download as PowerPointDisclosures of conflicts of interest.—C.K. Editorial board member of RadioGraphics. M.L.B.V. Travel stipend from RSNA for 2022 Annual Meeting, travel award from RSNA for Building Connections Across the Americas session. All other authors have disclosed no relevant relationships.References1. Abdelatty MA, Halligan S, El Sayed RF, Plumb AAO. Solitary rectal ulcer syndrome (SRUS): observational case series findings on MR defecography. Eur Radiol 2021;31(11):8597–8605. Crossref, Medline, Google Scholar2. Inan N, Arslan AS, Akansel G, Anik Y, Gürbüz Y, Tugay M. Colitis cystica profunda: MRI appearance. Abdom Imaging 2007;32(2):239–242. Crossref, Medline, Google Scholar3. Hulsmans FJH, Tio TL, Reeders JW, Tytgat GN. Transrectal US in the diagnosis of localized colitis cystica profunda. Radiology 1991;181(1):201–203. Link, Google Scholar4. Tjandra JJ, Fazio VW, Church JM, Lavery IC, Oakley JR, Milsom JW. Clinical conundrum of solitary rectal ulcer. Dis Colon Rectum 1992;35(3):227–234. Crossref, Medline, Google Scholar5. Kuijpers HC, Schreve RH, ten Cate Hoedemakers H. Diagnosis of functional disorders of defecation causing the solitary rectal ulcer syndrome. Dis Colon Rectum 1986;29(2):126–129. Crossref, Medline, Google ScholarArticle HistoryReceived: July 2 2023Accepted: July 5 2023Published online: Nov 16 2023 FiguresReferencesRelatedDetailsRecommended Articles MR Defecating Proctography with Emphasis on Posterior Compartment DisordersRadioGraphics2022Volume: 43Issue: 1Gastrointestinal Manifestations of Immunodeficiency: Imaging SpectrumRadioGraphics2022Volume: 42Issue: 3pp. 759-777Role of Multimodality Imaging in Gastroesophageal Reflux Disease and Its Complications, with Clinical and Pathologic CorrelationRadioGraphics2020Volume: 40Issue: 1pp. 44-71Imaging of Malignant Minor Salivary Gland Tumors of the Head and NeckRadioGraphics2020Volume: 41Issue: 1pp. 175-191Eosinophilic Disorders of the Gastrointestinal Tract and Associated Abdominal Viscera: Imaging Findings and DiagnosisRadioGraphics2022Volume: 42Issue: 4pp. 1081-1102See More RSNA Education Exhibits Don't Trust Your Gut: Diagnostic Pearls In Eosinophilic And Other Autoimmune Entities Of The GI Luminal TractDigital Posters2021Rectal and Perirectal Conditions: To Rectal Adenocarcinoma... and Beyond!Digital Posters2019Colorectal Cancer Mimics: A Lineup of the "Usual Suspects" with Radiologic-Pathologic InterrogationDigital Posters2019 RSNA Case Collection Clostridioides difficile colitisRSNA Case Collection2020Sigmoid diverticulitis with colouterine fistulaRSNA Case Collection2021Rectal EndometriosisRSNA Case Collection2021 Vol. 43, No. 12 Metrics Altmetric Score PDF download