Endoscopy 2014; 46(S 01): E377
DOI: 10.1055/s-0034-1377374
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

Extensive squamous metaplasia in the rectum stained with a Lugol’s solution in patient with ulcerative colitis and primary sclerosing cholangitis

Edyta Zagórowicz
1   Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
2   Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
,
Andrzej Pawełas
1   Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
2   Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
,
Anna Rawa-Gołębiewska
2   Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
,
Janina Orłowska
3   Department of Pathology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
› Author Affiliations
Further Information

Corresponding author

Edyta Zagorowicz, MD
Department of Gastroenterology
The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology
5 Roentgen Street
02-781 Warsaw
Poland   
Fax: +48-22-5463035   

Publication History

Publication Date:
25 September 2014 (online)

 

A case of extensive squamous metaplasia in a patient with longstanding ulcerative colitis and primary sclerosing cholangitis is presented. The patient was a 52-year-old man with a 20-year history of pancolitis who was referred for surveillance colonoscopy. No suspicious lesions had been found on previous examinations. Inspection of the rectum revealed a whitish epithelium lining the distal portion of the bowel, which was almost complete in circumferential extent and approximately 2 cm long at its maximum extent ([Fig. 1]). Lugol’s solution, known for its interaction with glycogen in a squamous epithelium, was used as a stain. An irregular border between the rectal mucosa and the metaplastic epithelium was clearly demarcated, and details of the surface of the latter could be easily observed ([Fig. 2]). As expected, histopathology confirmed the presence of squamous epithelium in the rectum.

Zoom Image
Fig. 1 A whitish epithelium in the distal rectum adjacent to the inflamed rectal mucosa.
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Fig. 2 The rectal mucosa and the squamous metaplasia stained with Lugol’s solution.

Although extremely rare, squamous metaplasia and squamous carcinoma of the rectum have been observed in longstanding ulcerative colitis [1] [2] [3]. In addition to chronic inflammation, human papilloma virus infection may play a role in the metaplasia – dysplasia – carcinoma sequence [1]. To the best of our knowledge, the combination of ulcerative colitis, squamous metaplasia, and primary sclerosing cholangitis has not been previously described.

Endoscopy_UCTN_Code_CCL_1AD_2AD


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Competing interests: None

  • References

  • 1 Cheng H, Sitrin MD, Satchidanand SK et al. Colonic squamous cell carcinoma in ulcerative colitis: report of a case and review of the literature. Can J Gastroenterol 2007; 21: 47-50
  • 2 Fu K, Tsujinaka Y, Hamahata Y et al. Squamous metaplasia of the rectum associated with ulcerative colitis diagnosed using narrow-band imaging. Endoscopy 2008; 40 (Suppl. 02) E45-46
  • 3 Lord JD, Upton MP, Hwang JH. Confocal endomicroscopic evaluation of colorectal squamous metaplasia and dysplasia in ulcerative colitis. Gastrointest Endosc 2011; 73: 1064-1066

Corresponding author

Edyta Zagorowicz, MD
Department of Gastroenterology
The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology
5 Roentgen Street
02-781 Warsaw
Poland   
Fax: +48-22-5463035   

  • References

  • 1 Cheng H, Sitrin MD, Satchidanand SK et al. Colonic squamous cell carcinoma in ulcerative colitis: report of a case and review of the literature. Can J Gastroenterol 2007; 21: 47-50
  • 2 Fu K, Tsujinaka Y, Hamahata Y et al. Squamous metaplasia of the rectum associated with ulcerative colitis diagnosed using narrow-band imaging. Endoscopy 2008; 40 (Suppl. 02) E45-46
  • 3 Lord JD, Upton MP, Hwang JH. Confocal endomicroscopic evaluation of colorectal squamous metaplasia and dysplasia in ulcerative colitis. Gastrointest Endosc 2011; 73: 1064-1066

Zoom Image
Fig. 1 A whitish epithelium in the distal rectum adjacent to the inflamed rectal mucosa.
Zoom Image
Fig. 2 The rectal mucosa and the squamous metaplasia stained with Lugol’s solution.