Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2018; 6(14): 820-824
Published online Nov 26, 2018. doi: 10.12998/wjcc.v6.i14.820
Solitary rectal ulcer syndrome complicating sessile serrated adenoma/polyps: A case report and review of literature
Hui Sun, Wei-Qi Sheng, Dan Huang
Hui Sun, Wei-Qi Sheng, Dan Huang, Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Hui Sun, Wei-Qi Sheng, Dan Huang, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Author contributions: Sun H was involved in acquisition of patient data and was a major contributor in drafting the manuscript; Huang D was involved in reviewing the manuscript and giving the final approval for publication; all authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81101806; and Natural Science Foundation of Shanghai, No. 17ZR1406500.
Informed consent statement: Consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dan Huang, MD, PhD, Doctor, Professor, Teacher, Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai 200032, China. dianehuangfdcc@gmail.com
Telephone: +86-21-64175590 Fax: +86-21-64174774
Received: July 27, 2018
Peer-review started: July 30, 2018
First decision: September 13, 2018
Revised: October 17, 2018
Accepted: October 23, 2018
Article in press: October 22, 2018
Published online: November 26, 2018
Processing time: 125 Days and 3.7 Hours
Abstract

Solitary rectal ulcer syndrome (SRUS) is a rare benign condition, which can mimic many other diseases because of their similarities in clinical, endoscopic and histological features. Sessile serrated adenoma/polyp (SSA/p) is a premalignant lesion in the colon and rectum. The misdiagnosis of SSA/p in SRUS patients has been noted, but the case of SRUS arising secondarily to SSA/p has been rarely reported. We herein report the case of a 59-year-old man who presented with an ulcerative nodular lesion in the rectum, accompanied by the symptoms of blood and mucus in the feces, diarrhea and constipation. Magnetic resonance imagining revealed thickening of the rectal mucosa-submucosa. Histologically, the lesion was characterized by the hyperplastic lamina propria and diffusely serrated crypts. Further immunohistochemical staining showed the loss of HES1 and MLH1 expression in the epithelial cells in the serrated area. The patient with SRUS had histological changes of SSA/p, suggesting a potential of tumor transformation in certain cases. SRUS uncommonly accompanied by serrated lesions should at least be considered by pathologists and clinicians.

Keywords: Solitary rectal ulcer syndrome; Magnetic resonance imagining; Sessile serrated adenoma/polyp; Mucosal prolapse; HES1; Case report

Core tip: We report a 59-year-old man presenting with blood and mucus in the feces, diarrhea and constipation. A subsequent endoscopy of the rectum revealed a 5-cm ulcerative nodule in the anterior wall of the rectum, 5 cm from the anal verge. Abdominal magnetic resonance imagining revealed thickening of the mucosa-submucosa, raising suspicion of rectal carcinoma. The surgical resection of the rectum was performed. However, the final pathology suggested an unusual case of solitary rectal ulcer syndrome complicating sessile serrated adenoma/polyp.