Ewha Med J.  2016 Jan;39(1):28-31. 10.12771/emj.2016.39.1.28.

Solitary Rectal Ulcer Syndrome Mimicking Rectal Cancer

• Choi YM
• Song HJ
• Kim MJ
• Chang WY
• Kim BS
• Hyun CL

• KMID: 2152755
• DOI: http://doi.org/10.12771/emj.2016.39.1.28

Abstract

Solitary rectal ulcer syndrome (SRUS) is a rare benign and chronic rectal disease that has a wide spectrum of clinical presentations and variable endoscopic findings. It is usually diagnosed by histopathological examination through biopsy. A 68-year-old man was referred to our hospital with anal pain and difficulty on bowel movement. Colonoscopy showed a hemorrhagic ulcerated mass in the rectum. All radiologic findings such as abdominopelvic computed tomography (CT), positron emission tomography-CT and magnetic resonance imaging were suspicious of rectal cancer. Although the patient underwent repeat endoscopic biopsy and one surgical biopsy, the results were not indicative of malignancy. Two months after conservative management, clinical symptoms and colonoscopic findings were markedly improved. Thus, we report this rare case of a 68-year-old man who had a central ulcerated mass that mimicked rectal cancer on gross colonoscopic and radiologic findings, representing an SRUS variant.

Keyword

Solitary; Ulcer; Syndrome; Rectal neoplasms

MeSH Terms

Aged
Biopsy
Colonoscopy
Electrons
Humans
Magnetic Resonance Imaging
Rectal Diseases
Rectal Neoplasms*
Rectum
Ulcer*

Figure

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  Fig. 1 Endoscopic findings. (A) Colonoscopy shows a broad-based rectal lesion with irregular surface and hemorrhagic ulceration (arrow) (B) Rectal lesion is markedly improved with remnant ulcerative scarring two months later.

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  Fig. 2 Abdominopelvic computed tomography (CT) findings. (A) Enhanced CT image shows rectal wall thickening (arrow) and perirectal fatty infiltration. (B) Enlargement of multiple small mesocolic lymph nodes are observed (arrows).

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  Fig. 3 Radiologic findings. (A) Positron emission tomography-computed tomography shows intense fludeoxyglucose uptake (arrow) in rectum (maximum standardized uptake value, SUVmax 15.4), and (B) multiple enlarged mesocolic lymph nodes (arrows) with intense FDG uptake (SUV-max 8.1). (C) Magnetic resonance imaging reveals sagittal T2-weighted image of the pelvis showing irregular wall thickening of mid rectum (arrow).

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  Fig. 4 Pathologic findings. (A) There is surface erosion and ulceration, characterized by discontinuity of the epithelium with acute inflammation and exudates. The ulcerated rectal mucosa and submucosa reveals formation of granulation tissue characterized by an admixture of small vessels, numerous inflammatory cells, fibrin and edema (H&E, ×100). (B) Distorted crypts are strongly positive for cytokeratin staining (×100).

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