Immunohistochemical Findings in Rectal Duplication Mimicking Rectal Prolapse

Abstract

Alimentary tract duplications represent rare anomalies, with only 5 % occurring in the rectum. The variety in clinical presentation may lead to a delay in diagnosis or to incorrect and multiple surgical procedures. We report the clinical, histological and immunohistochemical characteristics of a rectal duplication occurring in a 3-month-old male with an unusual clinical presentation. Using routine histology and immunohistochemistry, the rectal duplication showed the diffuse presence of gastric mucosa with a characteristic immunophenotype (i.e., diffuse cytokeratin 7 positivity and scattered chromogranin immunoreactivity). As far as we know, this is the first report showing an immunohistochemical differentiation pattern of gastric lining in a rectal duplication. Our results, showing the presence of gastric mucosa, are suggestive of a possible origin from the embryonic foregut.

Key words

rectal duplication - immunohistochemistry - gastrointestinal malformation - neonatal surgery

References

• 1 Amjadi K, Poenaru D, Sovoleski D, Hurlbut D, Kamal I. Anterior rectal duplication: a diagnostic challenge.  J Pediatr Surg. 2000;  35 613-614
• 2 Ballantyne E W. Sacrococcygeal tumors: adenocarcinoma of a cystic congenital embryonal remnant.  Arch Pathol. 1932;  14 1-9
• 3 Bremer J L. Diverticula and duplications of the intestinal tract.  Arch Pathol. 1944;  38 132-140
• 4 Gray S W, Skandalakis J E. Embryology for Surgeons. 2nd edn. Philadelphia; Saunders 1994: 248-252
• 5 Kraft R O. Duplication anomalies of the rectal.  Ann Surg. 1961;  155 230-232
• 6 La Quaglia M P, Feins N, Eraklis A, Hendren W H. Rectal duplications.  J Pediatr Surg. 1990;  25 980-984
• 7 Mathur M, Gupta S D, Bajpai M, Rohatagi M. Histochemical pattern in alimentary tract duplications of children.  Am J Gastroenterol. 1991;  86 1419-1423
• 8 Middeldorf K. Zur Kenntniss der angeborenen Sacralgesch.  Arch (A). 1885;  101 37-44
• 9 Park W H, Choi S O, Park K K. Cystic rectal duplication: a rare cause of neonatal bladder-outlet obstruction and hydronephrosis.  Pediatr Surg Int. 2001;  17 221-223
• 10 Praasad A R, Amin M B, Randolph T L, Lee C S, Ma C K. Retrorectal cystic hamartoma: report of 5 cases with malignancy arising in 2.  Arch Pathol Lab Med. 2000;  124 725-729
• 11 Rajah S, Ramanujam T M, Anas S R, Jayaram G, Baskaram P, Ganesan J, Tin M. Duplication of the rectum: report of four cases a review of the literature.  Pediatr Surg Int. 1998;  13 373-376