Colon non tumor
Non-neoplastic, non-congenital lesions
Solitary rectal ulcer syndrome

Author: Raul S. Gonzalez, M.D. (see Authors page)

Revised: 9 January 2017, last major update October 2013

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed search: solitary rectal ulcer syndrome

Cite this page: Solitary rectal ulcer syndrome. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/colonsolitaryrectalyulcer.html. Accessed June 22nd, 2017.
Definition / general
  • Solitary or multiple ulcerated or polypoid lesions 4 - 10 cm from anal margin
Terminology
  • Also called mucosal prolapse syndrome (may be a better term since not necessarily solitary, ulcerated or rectal)
Epidemiology
  • Uncommon (incidence of 1 per 100K per year)
  • Usually third and fourth decade
  • More common in women
  • Rarely in children (Pediatrics 2002;110:e79)
Sites
  • Usually in rectosigmoid colon
Etiology
  • Abnormal function of anal and pelvic floor musculature during defecation, causing rectal mucosal prolapse or intussusception
Clinical features
Treatment
  • High fiber diet, laxatives, topical steroids
  • Possibly resection
Gross description
  • Well demarcated irregular ulcer(s) on rectal wall
  • Also polypoid, rough, erythematous lesions
  • Mucosal thickening
Gross images

Images hosted on other servers:

Thickened prolapsed mucosa with surface erosion (fig 1)

Microscopic (histologic) description
  • Superficial mucosal ulceration and villiform change
  • Crypt hyperplasia and elongation with focal dilation (some glands diamond shaped)
  • Fibromuscular hyperplasia of lamina propria
  • Thickened muscularis mucosae with splayed fibers
  • Ectatic capillaries
  • Minimal inflammation
  • May have inflammatory pseudomembranes
  • Late changes resemble colitis cystica profunda
Microscopic (histologic) images

Images hosted on other servers:

Crypt hyperplasia (fig 2)

Haphazardly arranged benign colonic crypts

Distorted diamond shaped glands

Differential diagnosis