Colitis cystica profunda

Colon nontumor
Nonneoplastic, noncongenital lesions
Colitis cystica profunda

Topic Completed: 1 August 2013

Revised: 9 January 2019, last major update August 2013

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Cite this page: Gonzalez R. Colitis cystica profunda. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/coloncystitiscystica.html. Accessed October 21st, 2019.

Definition / general

Reactive mucosal change characterized by submucosal mucin filled cysts lined by benign epithelium

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 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)

Radiology images

Images hosted on other servers:

Barium imaging shows filling defect

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

Clinical images

Images hosted on other servers:

Submucosal abnormality

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

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