Colon
Other nonneoplastic
Colitis cystica profunda
Author: Raul S. Gonzalez, M.D.
Last author update: 14 April 2021
Last staff update: 12 October 2023
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: colitis cystica profunda
Table of Contents
Definition / general | Essential features | Terminology | Epidemiology | Sites | Pathophysiology | Clinical features | Radiology description | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Sample pathology report | Differential diagnosis | Board review style question #1 | Board review style answer #1Cite this page: Gonzalez RS. Colitis cystica profunda. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/coloncystitiscystica.html. Accessed December 20th, 2024.
Definition / general
- Reactive mucosal change characterized by submucosal mucin filled cysts lined by benign epithelium
Essential features
- Mucosal herniation into submucosa secondary to various forms of injury
- Bland histology distinguishes from a true invasive process
Terminology
- Also called colitis cystica polyposa or hamartomatous inverted polyp when presents as polypoid lesion
Epidemiology
- Uncommon; male predilection
Sites
- Can occur anywhere in GI tract, including stomach (gastritis cystica profunda) and small intestine (enteritis cystica profunda)
Pathophysiology
- Secondary to mucosal damage due to ulcerative colitis, Crohn's disease, radiation, diverticulitis or other inflammation / ulceration of bowel; mucus follows granulation tracts to involve large areas of bowel
Clinical features
- Stools contain blood or mucus; patients may have diarrhea or abdominal pain
Radiology description
- Can mimic a malignant process (Abdom Imaging 2007;32:239)
Case reports
- 41 year old woman with recurrence after 20 years (Chir Ital 2005;57:789)
- 42 year old man with diverticulitis (Am J Gastroenterol 2011;106:172)
- After radiation for bladder carcinoma (Arch Pathol Lab Med 1995;119:1170)
Treatment
- Patient education to avoid straining, high fiber diet with bulk laxatives, surgery for rectal prolapse
Gross description
- May appear as a polypoid or submucosal mass
Microscopic (histologic) description
- Either localized or diffuse; similar histology to colorectal polyps in Cowden syndrome although inverted
- Misplaced benign colonic epithelium forming cystic spaces filled with mucin and surrounded by lamina propria; mucin may extravasate into surrounding tissue
Microscopic (histologic) images
Contributed by Raul S. Gonzalez, M.D.
Colitis cystica profunda
Sample pathology report
- Rectum, mass, biopsy:
- Colitis cystica profunda
- Negative for dysplasia or malignancy.
Differential diagnosis
- Mucinous (colloid) carcinoma:
- Infiltrating, epithelium floats in mucin, glandular atypia, tumor desmoplasia, no hemorrhage or hemosiderin, no lamina propria
- Solitary rectal ulcer syndrome:
- May be indistinguishable in late cases of colitis cystica profunda
- Ulcerative colitis:
- No fibromuscular obliteration of lamina propria
Board review style question #1
A patient undergoes routine colonoscopy and is found to have a submucosal mass. A mucosal biopsy is unremarkable and surgery is performed. What is the best diagnosis?
- Colitis cystica profunda
- Mucinous adenocarcinoma
- Pneumatosis cystoides intestinalis
- Tubular adenoma with pseudoinvasion
Board review style answer #1
