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\begin{document}

\title{Colitis cystica profunda: a two-patient case series}



\author[1]{qing ling jiang}%
\author[1]{Si Qin}%
\author[1]{Han Zhang}%
\author[1]{Guangjian Liu}%
\affil[1]{Sun Yat-sen University Sixth Affiliated Hospital}%


\vspace{-1em}



  
  \date{May 25, 2024}


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\selectlanguage{english}
\begin{abstract}
Colitis cystica profunda (CCP) is a rare benign disease characterized by
mucus-filled cysts in the submucosa, sometimes similar to malignant
tumors. Endoscopic, radiological and even histological examinations are
not highly specific, which can easily lead to missed diagnosis and
misdiagnosis, resulting in unnecessary radical surgical resection. In
this report, we present%
\end{abstract}%



\sloppy


Colitis cystica profunda: a two-patient case series

Qingling Jiang\textsuperscript{1,2} Si Qin\textsuperscript{1} Han
Zhang\textsuperscript{3} Guangjian Liu\textsuperscript{1*}

1.Department of Medical Ultrasound, The Sixth Affiliated Hospital, Sun
Yat-sen University, Guangzhou, Guangdong, China

2.Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun
Yat-sen University, Guangzhou, Guangdong, China

3.Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-sen
University, Guangzhou, Guangdong, China

Correspondence to

Dr.Guangjian Liu, Email: \emph{liugj@mail.sysu.edu.cn}

CONSENT

Written informed consent was obtained from the patient to publish this
report in accordance with the journal's patient consent policy

CONFLICT OF INTEREST

The authors have no pertinent conflict of interest to report for this
manuscript.

\textbf{Abstract}

Colitis cystica profunda (CCP) is a rare benign disease characterized by
mucus-filled cysts in the submucosa, sometimes similar to malignant
tumors. Endoscopic, radiological and even histological examinations are
not highly specific, which can easily lead to missed diagnosis and
misdiagnosis, resulting in unnecessary radical surgical resection. In
this report, we present two cases of CCP with their clinical and imaging
features.

\textbf{Keywords}

Rectum;Colitis cystica profunda;Endorectal ultrasound

\textbf{INTRODUCTION}

Submucosal cysts in the colon was first reported by Stark in 1766 during
the autopsy of two specimens of patients with chronic dysentery. In
1863, Virchow named it colitis cystica polyposa for multiple polypoid
cystic submucosal lesions. In 1957, Goodall and Sinclair renamed colitis
cystica polyposa to colitis cystica profunda (CCP), giving the name and
detailed description of the disease firstly \textsuperscript{{[}1,
2{]}}. CCP is a rare benign disease occurring in the rectum or colon,
most commonly in the anterior wall of the rectum. The main pathological
characteristics of CCP are mucus-containing cysts reaching deep into the
submucosa, muscular layer or even the serous layer. The cysts are filled
with large amounts of mucus, and floating exfoliated epithelial cells
visible in the mucus, without the characteristics of malignant
tumors\textsuperscript{{[}3{]}}. There are few case reports concerning
endorectal ultrasonography of CCP in previous literatures. We report two
cases of CCP with the purpose of better awareness of its clinical and
imaging features.

\textbf{CASE REPORT}

CASE 1

A 34-year-old male with defecation characteristics changed for more than
6 years, mainly manifested as mucous defecation, no increase in
defecation frequency, no urgency, no abdominal pain and other
discomfort. No special treatment was given, and now he came to the
hospital for diagnosis and treatment.

Digital rectal examination (DRE): 5cm into the finger can reach the
tough mass, smooth surface, movable, no blood staining in the receding
finger sleeve. Laboratory examinations: Blood routine, liver and kidney
function, tumor markers are all in normal range.

Endorectal ultrasound (ERUS): a cystic mass was observed at 70 mm from
the anal verge, at the 12-2 o'clock direction in the lithotomy position,
in the submucosal layer and intrinsic muscular layer of the rectum, with
a size of 26 mm in diameter, clear boundary, regular morphology,
protruding into the lumen, with poor internal transmission and
heterogeneous echogenicity, and continuous echogenicity in the mucosal
and serous layers of the rectum. Color Doppler flow imaging (CDFI): A
few blood flow signals were observed in the periphery, but no obvious
blood flow signals were observed in the interior of lesion (Figure 1).\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

Fig. 1 Endorectal ultrasound a, Gray scale ultrasound showed a cystic
mass in the submucosa, with clear boundary, poor internal transmission,
and continuous echogenicity in the mucosal layer (yellow arrow). b,
Color Doppler ultrasound showed a small amount of blood flow signal
around the cystic mass, no obvious blood flow signal inside, and
continuous echogenicity in the serous layer of the intestinal wall
(yellow arrow).

Contrast-enhanced computed tomography (CECT): A round-like low-density
lesion with a size of 3.1x2.4x2.2cm was observed in the submucosa of the
anterior wall of the middle rectum, with calcification on the edge and
no obvious enhancement. The rectal mucosa was smooth, the rectal wall
was intact, the surrounding fatty space was clear, and no enlarged lymph
nodes were seen (Figure 2).\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image2/image2}

\end{center}
\end{figure}

Fig. 2 Contrast enhanced CT. a, A quasi-circular low-density foci on
plain scan, with smooth rectal mucosa and intact intestinal wall. b-c,
No enhancement was seen in the arterial and venous phases of the lesion.

Contrast-enhanced magnetic resonance imaging (CEMRI): a round-like
signal foci with a size of about 2.3x1.8x1.7cm was seen in the submucosa
of the anterior wall of the middle rectum, T1 showed low signal, T2
showed high signal, DWI showed high signal, ADC showed no reduction, no
obvious enhancement of the foci in contrast enhanced scanning. The
rectal mucosa was smooth, the rectal wall was intact, the surrounding
fatty space was clear, and no obvious enlarged lymph nodes were seen in
the pelvic cavity (Figure 3).\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image3/image3}

\end{center}
\end{figure}

Fig. 3 Contrast-enhanced MRI. a, T2WI showed high signal. b, enhancement
showed slight enhancement in the periphery of the lesion and no
significant enhancement in the interior. c, DWI showed high signal. d,
ADC showed high signal.

Finally, the patient underwent transanal endoscopic resection of rectal
mass, and the postoperative pathology was as follows: multiple mucous
lakes could be seen in the rectal intestinal wall, locally covered by
intestinal epithelium, no atypia, and the laminar propria interstitials
could be seen, which was consistent with CCP (Figure 4).\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image4/image4}

\end{center}
\end{figure}

Fig. 4 Pathology. Multifocal mucus paste (red arrows) visible in the
intestinal wall, locally covered with intestinal epithelium without
heterogeneous hyperplasia (blue arrows).

CASE 2

A 27 years old female patient had a change in stool habits and traits
for more than 2 years, which showed that the frequency of defecation
increased to 5-6 times a day, and the stool became slightly thinner,
accompanied by a feeling of urgency and incompleteness of the stool, and
mucus on the surface of the stool. Colonoscopy was performed at a local
hospital, which showed that a mucosal eminence of about 2 \selectlanguage{ngerman}× 2.5cm in the
rectum 2-4cm from the anus. Biopsy under colonoscopy showed chronic
inflammation of the mucosa with erosion. No further treatment was
performed and no follow-up examination was conducted. Recently, the
stool surface was mixed with blood, so he came to the hospital for
diagnosis and treatment.

DRE: A tough mass about 2-3cm in diameter could be detected on the
anterior wall of the rectum about 6cm from the anus, with moderate
mobility, slight tenderness, and no blood staining after exiting the
finger sleeve. Laboratory examination: Blood routine, liver and kidney
function, tumor markers were all in normal range.

ERUS: a cystic mass was seen in the submucosal layer of the rectum at
10-12 o'clock in the lithotomy position about 56 mm from the anal verge,
with size of 26 mm in diameter, clear borders, regular morphology,
intact mucosal layer, intact and continuous intrinsic muscular layer and
serous layer. CDFI: a small amount of blood flow signal was seen in the
periphery, and no significant blood flow signal was seen inside (Figure
5).\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image5/image5}

\end{center}
\end{figure}

Fig. 5 Endorectal ultrasound. a, Gray scale ultrasound showed a cystic
mass in the submucosal layer with clear borders and poor internal
transmission, and continuous echogenicity in the mucosal layer (yellow
arrow) and serous layer (white arrow). b, CDFI showed a small amount of
blood flow signal around the cystic mass, but no obvious blood flow
signal inside.

CECT: The anterior wall of the lower part of the rectum at about 50mm
from the anal margin, presented a local protuberant change, with a local
thickness of about 11mm, and the mucosal surface was smooth. The
enhancement of the local submucosal area was not obvious, and a patchy
dense shadow was still visible. The perienteric fatty space was clear
(Figure 6).\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image6/image6}

\end{center}
\end{figure}

Fig. 6 Contrast-enhanced CT. a, Localized thickening and eminence of the
anterior wall of the lower rectum in plain scan, with visible
calcification. b-c,No significant enhancement was seen in the arterial
and venous phase.

CEMRI: An oval abnormal signal foci was seen in the submucosa of the
anterior wall of the lower segment of the rectum about 46 mm away from
the anal verge, with a size of 17 mm\selectlanguage{ngerman}×18 mm×20 mm; T2WI showed high
signal and multiple low signal separations within it; No obvious limited
diffusion was observed on DWI and ADC images; separation enhancement was
observed on enhanced scan, and no clear enhancement was observed in the
remaining lesions; the boundary of the lesion was clear, and the outer
wall of the lesion was smooth (Figure 7).\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image7/image7}

\end{center}
\end{figure}

Fig. 7 Contrast-enhanced MRI. a, T2WI showed high signal intensity and
multiple low signal separations. b, separate enhancement was presented
in the lesion. C,DWI showed high signal (low signal area was
calcification). d,ADC showed high signal without any decrease.

Colonoscopy: A size of 20 mm \selectlanguage{ngerman}× 18mm protuberant mass was seen on the
anterior wall about 4cm from the anal verge, with superficial ulcer on
the surface. Endoscopic resection of rectal submucosal mass was
performed, and the submucosal incision showed gelatinous appearance
(Figure 8). Postoperative pathology: colitis cystica profunda of the
rectum with calcification (Figure 9).\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image8/image8}

\end{center}
\end{figure}

Fig. 8 Colonoscopy. a, A protuberant mass showing the formation of
superficial ulcers. b, gelatinous mucus can be seen by incision of
submucosa.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image9/image9}

\end{center}
\end{figure}

Fig. 9 Pathology. local erosion of intestinal mucosa, partly with
ulcerative repair changes (red arrow), and a focal cystic cavity
containing a large amount of mucus in the submucosa (blue arrow).

\textbf{DISCUSSION}

Cystica profunda is a rare benign non-neoplastic disease that can occur
throughout the gastrointestinal tract, mostly in the rectum, followed by
the colon, and more rarely in the stomach and small intestine. It is
also known as gastritis cystica profunda (GCP), enteritis cystica
profunda (ECP), and colitis cystica profunda
(CCP)\textsuperscript{{[}4{]}}. CCP is a rare benign disease occurring
in the rectum or colon, most commonly in the anterior wall of the
rectum. The pathogenesis of CCP is unknown and is thought to be due to
congenital or acquired mucosal muscle weakness caused by inflammation,
infection, trauma or ischemia resulting in embedding of the mucosal
epithelium in the submucosa \textsuperscript{{[}5{]}}. The main
histological features are the presence of multiple cysts of varying size
and morphology in the submucosa lined with a single layer of flattened
or columnar epithelial cells, which are filled with mucus, and the
disappearance of some of the covered epithelium of the cyst wall,
forming a mucus lake\textsuperscript{{[}6{]}}.

CCP can occur at any age, most common in young and middle-aged people
aged 30-40 years, and is more common in men. The clinical manifestations
of CCP are diverse and nonspecific, mainly including abdominal pain,
diarrhea, constipation, blood in stool, mucus stool, urgency, rectal
pain, change in stool habit, internal rotation, abdominal mass and
intestinal obstruction \textsuperscript{{[}7-9{]}}. According to the
extent of invasion, there are diffuse and local
types\textsuperscript{{[}10{]}}. The diffuse type involves the entire
colon with villous or tipped polypoid lesions or even ulcers, mostly due
to intestinal inflammation and ulceration. It is associated with Crohn's
disease, ulcerative colitis, infectious colitis and radiation
enteritis\textsuperscript{{[}11,12{]}}. The local type is mostly seen in
the anterior wall of the rectal 5-12 cm from the anal verge, presenting
as nodules or polyps, which is associated with rectal prolapse and
isolated rectal ulcer syndrome. The local type is the most common, while
the diffuse type accounts for less than 15\% of cases reported in the
literature \textsuperscript{{[}1,3,13,14{]}}. Both of the two cases in
this paper were young and middle-aged patients with clinical
characteristics of mucous excretion. The locations of all cases were
located in the anterior rectal wall of 5-12cm from the anal verge, which
was consistent with the location reported in the literature. Both cases
showed nodularity and belonged to the local type.

The imaging findings of CCP are characteristic. X-rays are normal or
nonspecific in the early stage, or show luminal narrowing and
irregularity due to multiple submucosal cystic structures. Barium enema
shows single or multiple filling defects or shows thickened folds. CT
images show a non-infiltrating submucosal mass with well-defined borders
and an unenhanced cystic lumen of variable sizes. The perirectal adipose
tissue was absent and the levator anus muscle was
thickened\textsuperscript{{[}2,15{]}}. MRI showed a homogeneous low
signal on T1WI and a submucosal high signal nodule on T2WI, with no
significant enhancement on contrast-enhanced images, high signal on DWI,
no diffusion restriction on ADC, and significant high signal on T2WI
suggesting that the presence of mucin in the
lesion\textsuperscript{{[}4,16{]}}. In both cases in this paper, CT
showed non-enhancing hypodense lesions with clear borders,
calcifications at the margins, smooth mucosa, intact rectal wall, clear
surrounding fatty spaces, and no enlarged lymph nodes. MRI presentations
were also consistent with the above imaging manifestations. However, the
thickening of the levator anus muscle described in the literature was
not present. In addition, the presence of calcification of the cyst wall
was described in our case, which suggests a chronic benign disease and
not associated with rectal cancer where calcification usually inside the
tumor \textsuperscript{{[}17{]}}.

Colonoscopy in CCP shows tipped or villous polypoid lesions covered by
normal, edematous or ulcerated mucosa, or shows polypoid or nodular
mucosal thickening with or without ulceration, which can be easily
confused with colorectal cancer \textsuperscript{{[}8{]}}. In contrast,
colonoscopy allows biopsy and therefore has the dual advantage of
obtaining both imaging and pathology at the same time. However, due to
insufficient depth of biopsy and limited sampling, it is easy to missed
diagnosis and misdiagnosis. In case 2, the results of the first external
colonoscopy biopsy only showed chronic inflammation of the mucosa with
erosion, which may be related to the shallow and limited sampling.

ERUS showed multiple hypoechoic or anechoic cysts in the submucosal
layer of the rectum with a small amount of internal echogenicity, no
involvement of the mucosal layer, no lymphadenopathy, and no penetration
or invasion of the muscular layer beyond the submucosal
layer\textsuperscript{{[}4,9{]}}. In this paper, ERUS showed cystic
lesions in the submucosal layer in both cases, with the mucosal and
serous layers intact. The difference between the two cases is that the
lesion was located in the submucosal layer and the intrinsic muscular
layer, with invasion of the muscular layer in case 1. While in case 2,
the lesion was located only in the submucosa, and the intrinsic muscle
layer was not invaded outside the submucosa. ERUS can clearly localize
the different layers of the intestinal wall and can assess whether the
mucosal layer, intrinsic muscular layer, and serous layer of the
intestinal wall are intact. Although ERUS cannot confirm the diagnosis,
it is of great importance to exclude malignant tumors in the deeper
layers of the intestinal wall. Moreover, ERUS is safe, noninvasive,
nonradioactive, easy to perform, well tolerated, and can be repeated as
a follow-up examination.

CCP is similar to benign and malignant colorectal tumors and
inflammatory bowel disease, and the diagnosis of CCP also requires the
identification of any colon or rectal polypoid or intramural benign or
malignant masses (adenomatous polyps, polypoid inflammatory granulomas,
leiomyomas, lipomas, adenocarcinomas, mucinous carcinomas, sarcomas),
inflammatory lesions (ulcerative colitis, Crohn's disease, and ischemic
colitis or proctitis), and endometriosis \textsuperscript{{[}10{]}}.

The goal of treatment for CCP is to prevent or reduce symptoms.
Depending on the severity of symptoms, treatment can be either
conservative medical or surgical. Patient education and behavior
modification are the primary treatments for patients with CCP.
Conservative treatment includes bowel habits, postural correction,
avoidance of stress and strain, and increased dietary fiber can
alleviate symptoms in the majority of patients. Conservative treatment
is ineffective and surgical resection is required when symptoms are
persistent or severe, such as bowel obstruction, bleeding, or rectal
prolapse\textsuperscript{{[}18,19{]}}. In recent years, endoscopic
submucosal dissection (ESD), with the advantages of rapid recovery,
minimal trauma, and preservation of colonic integrity, has been widely
used in the treatment of CCP \textsuperscript{{[}20{]}}.

In conclusion, CCP is a rare disease that is difficult to diagnose and
easily misdiagnosed as other occupying lesions of the intestine because
of its low incidence, lack of specificity in clinical and endoscopic
manifestations, and lack of awareness among physicians in various
disciplines. Once misdiagnosed, it not only brings unnecessary painful
surgical resection to patients, but also poses risks to physicians. In
contrast, imaging study plays a crucial role in both disease detection
and differentiation from malignant diseases, helping to initially
determine the benignity and malignancy of the lesion and avoiding
erroneous radical resection surgery.

\textbf{ACKNOWLEDGMENT}

Supported by the program of Guangdong Provincial Clinical Research
Center for Digestive Diseases (2020B1111170004).

\textbf{CONFLICT OF INTEREST}

The authors have no pertinent conflict of interest to report for this
manuscript.

\textbf{References}

{[}1{]}.Dan Z,Lingkang M,Yong Z.Colitis cystica profunda with partial
low-grade intraepithelial neoplasia of the glandular epithelium:report
of a case.Chin J Colorec Dis ( Electronic Edition ),2021,10(06):663-666.

{[}2{]}.Papalampros A, Vailas MG, Sotiropoulou M, et al. Report of a
case combining solitary Peutz-Jeghers polyp, colitis cystica profunda,
and high-grade dysplasia of the epithelium of the colon. World J Surg
Oncol,2017,15(1):188.

{[}3{]}.Kornprat P, Langner C, Pfeifer J,et al. Colitis cystica profunda
associated with rectal prolapse: report of a case. Int J Colorectal Dis,
2007,22(12):1555-1556.

{[}4{]}.Inan N, Arslan AS, Akansel G,et al. Colitis cystica profunda:
MRI appearance. Abdom Imaging,2007,32(2):239-42.

{[}5{]}.Hernandez-Prera JC, Polydorides AD. Colitis cystica profunda
indefinite for dysplasia in Crohn disease: a potential diagnostic
pitfall. Pathol Res Pract,2014,210(12):1075-8.

{[}6{]}.Rumi N, Cilla S, De Ninno M,et al. Colitis cystica profunda of
the rectum with adenomatous dysplastic features: Radiologic-pathologic
correlation. Radiol Case Rep, 2019,14(6):740-745.

{[}7{]}.Wenjie Z, Xuantong W, Yanjie L,et al.Endoscopic submucosal
dissection in the treatment of colitis cystic profunda : a case
report.Chin J Gastrointestinal Endoscopy ( Electronic
Edition),2021,8(03):136-139.

{[}8{]}.Chen G, Jiang W, Yue M. Colitis cystica profunda of the rectum
diagnosed by endoscopic submucosal dissection. Rev Esp Enferm Dig.
2023,115(2):91-92.

{[}9{]}.Sarzo G, Finco C, Parise P,et al. Colitis cystica profunda of
the rectum: report of a case and review of the literature. Chir Ital,
2005,57(6):789-98.

{[}10{]}.Zaki TA, Mbah M, Mir M,et al. Colitis Cystica Profunda: A Rare
Mimicker of Colorectal Neoplasia. Dig Dis Sci,2022,67(7):2693-2695.

{[}11{]}.Jeruc J, Drobne D, Zidar N. Diffuse Colitis Cystica Profunda in
Crohn's Disease: A Potential Diagnostic Pitfall. J Crohns
Colitis,2019,13(10):1362.

{[}12{]}.Toll AD, Palazzo JP. Diffuse colitis cystica profunda in a
patient with ulcerative colitis. Inflamm Bowel
Dis,2009,15(10):1454-1555.

{[}13{]}.Spicakova K, Pueyo BA, de la Piscina PR,et al. Colitis cystica
profunda: A report of 2 cases with a 15-year follow-up. Gastroenterol
Hepatol,2017,40(6):406-408.

{[}14{]}.Lord A, Hompes R, Arnold S,et al. Ultra-low anterior resection
with coloanal anastomosis for recurrent rectal prolapse in a young woman
with colitis cystica profunda. Ann R Coll Surg Engl,2015,97(2):e32-33.

{[}15{]}.Wang LB, He C, Tang TY,et al. Multi-Colitis Cystica Profunda: A
Case Report. Chin Med J (Engl),2015,128(23):3254-3255.

{[}16{]}.Masood L, Sayeed S, Asghar M. MRI Appearances of Colitis
Cystica Profunda: A Rare Benign Mimicker of Colorectal Malignancy. J
Coll Physicians Surg Pak,2018,28(9):S162-S163.

{[}17{]}.Ko EY, Ha HK, Kim AY, et al. CT differentiation of mucinous and
nonmucinous colorectal carcinoma. AJR Am J
Roentgenol,2007,188(3):785-791.

{[}18{]}.Suter KJL, Skinner SA. Rare presentation of colitis cystica
profunda in a single rectal ulcer. ANZ J Surg,2023,93(4):1058-1059.

{[}19{]}.Zhang Y, Tian F, Li H. Solitary Rectal Ulcer Syndrome
Coexisting with Colitis Cystica Profunda-Is Mucosal Resection Radical or
Not?. Inflamm Bowel Dis,2022,10(28):izac232.

{[}20{]}.Abe T, Hamamoto M, Nagai T, et al. Colitis cystica profunda
mimicking mucinous adenocarcinoma of the rectum diagnosed by endoscopic
submucosal dissection. Endoscopy,2021,53(4):E157-E159.

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