Inflammatory Bowel Disease-Pathology

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Slide 69.   Solitary Rectal Ulcer (Mucosal Prolapse)

The alterations associated with mucosal prolapse (itself related in some cases to chronic mucosal ischemia) may mimic the changes of chronic quiescent colitis.  The presence of mucosal fibrosis and crypt architecture distortion are common features between these two processes, but the added feature of a splayed, duplicated muscularis mucosae that penetrates and divides the lamina propria, as highlighted in the smooth muscle actin immunostain (insert) is a feature that is characteristic of prolapse.  Hamartomatous changes in colonic mucosa may resemble prolapse, but tend to present in the setting of multiple polyps (Cowden’s disease), or involvement of sites other than those usually associated with prolapse (anterior rectal wall, mucosa adjacent to diverticular ostia)

DuBoulay CE, Fairbrother J, Isaacson PG: Mucosal prolapse syndrome – a unifying concept for solitary ulcer syndrome and related disorders.  J Clin Pathol 1983; 36:1264-1268.

Levine DS, Surawicz CM, Ajer TN, et al.: Diffuse excess mucosal collagen in rectal biopsies facilitates differential diagnosis of solitary rectal ulcer syndrome from other inflammatory bowel diseases.  Dig Dis Sci 1988; 33:1345-1352.

Saul SH, Christie Sollenberger L: Solitary rectal ulcer syndrome: its clinical and pathological underdiagnosis.  Am J Surg Pathol 1985; 9:411-421.

Carlson GJ, Nivatvongs S, Snover DC: Colorectal polyps in Cowden’s disease (multiple hamartoma syndrome).  Am J Surg Pathol 1984; 8:763-770.