Endoscopy 2009; 41: E317-E318
DOI: 10.1055/s-0029-1215316
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Non-neoplastic enterogenous submucosal cystic lesion of the colon

Y.  S.  Yeh1 , 2 , W.  T.  Huang3 , C.  H.  Kuo4 , 5 , J.  Y.  Wang1 , 6 , 7 , 8
  • 1Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 2Department of Emergency Medicine, Department of Trauma, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 3Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 4Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 5Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 6Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 7Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 8Graduate Institute of Medical Genetics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Further Information

Publication History

Publication Date:
17 November 2009 (online)

Non-neoplastic enterogenous submucosal cystic lesions arise from the colonic or rectal wall, and more common ones include duplication cysts, lymphangiomas, and colitis cystic profunda [1]. An enterogenous cyst may detach itself from the intestinal wall and lie close to its point of origin, which may be in the intermuscular, submucosal, or subserosal layers of the intestinal wall. Accurate diagnosis of non-neoplastic enterogenous submucosal cystic lesions is difficult, and thus the preoperative diagnosis mainly depends on initial colonoscopy findings, which may provide information that supports the abnormal clinical findings [2].

We report a case of non-neoplastic colonic submucosal cystic lesion, discovered incidentally in a 62-year-old man. The patient had undergone sigmoidoscopy, which revealed abnormal findings related to a submucosal lesion in the descending colon. The surface was smooth and resembled that of a cyst ([Fig. 1]); a non-neoplastic colonic enterogenous submucosal cystic lesion was suspected. At exploratory laparotomy, the lesion was removed along with segmental resection of the descending colon. Gross examination of the resected specimen showed a grayish, elastic, monolocular cystic lesion measuring 4 × 3.5 × 0.8 cm, with a well-defined and smooth wall ([Fig. 2]). Histological examination revealed a multiloculated, submucosal cystic lesion lined by atrophic epithelium and lymphocytic inflammatory infiltrate in the edematous stroma ([Fig. 3]). The histopathologic diagnosis was colonic cyst.

Fig. 1 A polypoid lesion located 60 cm from the anal verge in the descending colon, near the splenic flexure.

Fig. 2 The grayish, elastic, monolocular cystic lesion measured 4 × 3.5 × 0.8 cm. The walls were smooth and well defined.

Fig. 3 Multiloculated submucosal cystic lesions contain serous fluid (hematoxylin and eosin, magnification × 20).

Non-neoplastic enterogenous submucosal cystic lesions are uncommon and present in a variety of ways. If a lesion is suspected to be a non-neoplastic enterogenous submucosal cyst, it should be completely excised for local control of symptoms and to prevent the risk of obstruction, septic sequelae, and malignant change [3] [4]. However, with regard to nonspecific symptoms and the clinical presentation of such lesions, there is a need for further prospective and retrospective studies to elucidate the prognosis and ideal treatment of these lesions.

Endoscopy_UCTN_Code_CCL_1AD_2AJ

References

  • 1 Pickhardt P J, Kim D H, Heise C P. et al . Evaluation of submucosal mucosal lesions of the large intestine. Part 2. Nonneoplastic causes.  Radiographics. 2007;  27 1693-1703
  • 2 Rajah S, Ramanujam T M, Tin M. et al . Duplication of the rectum: report of four cases and review of the literature.  Pediatr Surg Int. 1998;  13 373-376
  • 3 Pickhardt P J, Kim D H, Heise C P. et al . Evaluation of submucosal mucosal lesions of the large intestine. Part 1. Neoplasm.  Radiographics. 2007;  27 1681-1692
  • 4 Sato K, Maekawa T, Sugiyama N. et al . Cystic lymphangiomas of the colon.  J Gastroenterol. 1999;  34 520-524

J. Y. WangMD, PhD 

Department of Surgery
Faculty of Medicine
College of Medicine and Division of Gastroenterology and General Surgery
Department of Surgery
Kaohsiung Medical University Hospital
Kaohsiung Medical University

100 Tzyou 1st Road
San-Ming District
Kaohsiung 807
Taiwan

Fax: +886-7-3114679

Email: cy614112@ms14.hinet.net; cy614112@gmail.com

    >